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目的在使用二甲双胍的前提下,探讨厄贝沙坦联合α-硫辛酸对2型糖尿病合并非酒精性脂肪肝(NAFLD)患者胰岛素抵抗相关指标的影响。方法将112例2型糖尿病合并NAFLD患者随机分为对照组和观察组,均进行健康教育,对照组给予二甲双胍500 mg起始剂量进行药物干预,观察组在对照组治疗基础上给予厄贝沙坦+α-硫辛酸干预。其中厄贝沙坦150 mg口服,每日一次;α-硫辛酸600 mg,每日一次,静滴2~3周,出院后改为口服制剂序贯治疗,600 mg,每日一次。均治疗8周。治疗前后观察患者空腹血糖、餐后2 h血糖、糖化血红蛋白(HBA1c)、C肽、瘦素、内脏脂肪素、胰岛素、胰岛素抵抗指数(IRI)、血压和血脂等的变化。结果较治疗前相比,治疗后所有患者空腹血糖和餐后2 h血糖较治疗前明显下降(P<0.05),观察组较对照组下降明显(P<0.05);治疗后两组患者HBA1c有下降趋势,但却未见显著差异(P>0.05);两组C肽逐渐下降,与治疗前相比差异显著(P<0.05),且组间具有显著差异(P<0.05);治疗后受试患者胰岛素、IRI以及瘦素、内脏脂肪素水平均明显降低(P<0.05),且观察组较上述指标下降更为明显;治疗后两组三酰甘油和总胆固醇均下降(P<0.05),但组间无明显差异(P>0.05),血压下降均在正常范围内。结论在二甲双胍降糖治疗基础上,厄贝沙坦联合α-硫辛酸较单用二甲双胍方案能改善胰岛素抵抗效应,明显地抑制机体瘦素和内脏脂肪素的分泌,且安全及耐受性较佳。
Objective To investigate the effect of irbesartan and α-lipoic acid on insulin resistance in type 2 diabetic patients with non-alcoholic fatty liver disease (NAFLD) on the premise of using metformin. Methods One hundred and twelve patients with type 2 diabetes mellitus and NAFLD were randomly divided into control group and observation group. All patients were given health education. The control group was given 500 mg initial dose of metformin for drug intervention. The observation group was given irbesartan + α-lipoic acid intervention. Irbesartan 150 mg orally, once daily; α-lipoic acid 600 mg once daily for 2 to 3 weeks, after discharge to oral preparation sequential treatment, 600 mg once daily. All patients were treated for 8 weeks. Fasting blood glucose, postprandial blood glucose, HbA1c, C-peptide, leptin, visfatin, insulin, insulin resistance index (IRI), blood pressure and blood lipid were observed before and after treatment. Results Compared with those before treatment, the fasting blood glucose and postprandial 2h blood glucose of all the patients were significantly lower than those before treatment (P <0.05), the observation group was significantly lower than the control group (P <0.05); after treatment, HBA1c (P <0.05). The C-peptide levels in both groups decreased gradually compared with before treatment (P <0.05), and there was significant difference between the two groups (P <0.05). After treatment The levels of insulin, IRI, leptin and visceral adiponectin in the test patients were significantly lower (P <0.05), and the observation group was more obvious than the above indexes. The triglyceride and total cholesterol in both groups decreased after treatment (P <0.05) , But there was no significant difference between the two groups (P> 0.05). The drop of blood pressure was within the normal range. Conclusion On the basis of metformin hypoglycemic therapy, irbesartan combined with α-lipoic acid can improve the insulin resistance effect and relieve the secretion of leptin and visceral adipose obviously, with better safety and tolerability .