西格列汀联合二甲双胍对2型糖尿病合并非酒精性脂肪肝患者的疗效观察

摘要

Objective:To compare the curative effects of sitagliptin and glipizide on patients of type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease,and to analyze their effects on blood glucose and liver function.Methods:A total of 112 patients of type 2 diabetes mellitus complicated with nonalcoholic fatty liver in the Third Rehabilitation Hospital in Shanghai from June 2015 to April 2017 were randomized into sitagliptin group (n=56) treated with metformin combined with sitagliptin and glipizide group (n=56) treated with metformin combined with glipizide.The efficacy on fatty liver was compared between two groups,the blood glucose,liver function,blood lipid and insulin resistance index (HOMA-IR) were compared between two groups before and after treatment.Results:The total effective rate was 94.6％ (53/56) in sitagliptin group,significantly higher than that in glipizide group (75.0％,42/56,P＜0.05).The blood glucose and blood lipid were significantly improved after treatment in both group,with no significantly difference between two groups.The liver function indexes (AST,ALT,GGT) and HOMA-IR were all significantly improved after treatment in both groups,being significantly better in sitagliptin group compared with those in glipizide group (P＜0.05).The overall adverse reaction rate was 19.6％ (11/56) in sitagliptin group and 17.9％ (10/56) in glipizide group,with no statistical difference.Conclusions:Sitagliptin combined with metformin can improve the therapeutic effect on fatty liver in patients of type 2 diabetes complicated with nonalcoholic fatty liver.Compared with glipizide,sitagliptin can more effectively improve the liver function and HOMA-IR,worthy to be popularized.%目的:探讨西格列汀与格列吡嗪治疗2型糖尿病合并非酒精性脂肪肝患者的疗效,分析2种药物对患者血糖及肝功能的影响.方法:选取2015年6月至2017年4月上海市第三康复医院收治的112例2型糖尿病合并非酒精性脂肪肝患者,采用数字表法随机分为西格列汀组和格列吡嗪组,各56例.西格列汀组患者给予二甲双胍联合西格列汀治疗,格列吡嗪组患者给予二甲双胍联合格列吡嗪治疗.对比两组患者的脂肪肝疗效,并比较两组患者治疗前后的血糖、肝功能、血脂及胰岛素抵抗指数(HOMA-IR)等指标.结果:西格列汀组患者的总有效率为94.6％(53/56),高于格列吡嗪组(75.0％,42/56;P＜0.05).两组患者的血糖、血脂指标较治疗前均显著改善,但两组间差异无统计学意义;两组患者的肝功能(AST、ALT、GGT)及HOMA-IR较治疗前显著改善,西格列汀组改善程度显著优于格列吡嗪组,差异有统计学意义(P＜0.05).西格列汀组总体不良反应发生率为19.6％(11/56),格列吡嗪组总体不良反应发生率为17.9％(10/56),两组差异无统计学意义.结论:西格列汀联合二甲双胍治疗2型糖尿病合并非酒精性脂肪肝能够提高脂肪肝的治疗效果,与格列吡嗪相比能够更有效地改善患者的肝功能及HOMA-IR,值得临床推广.