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目的探究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(NAFLD)的临床效果及安全性。方法选择2012年6月—2015年6月渭南市中心医院收治的65例2型糖尿病合并NAFLD患者,随机分为观察组32例和对照组33例。对照组患者予以单纯二甲双胍治疗,观察组患者在对照组基础上加用西格列汀治疗,均持续治疗16周。观察两组患者治疗前及治疗后的糖代谢相关指标,包括体质指数(BMI)、空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(Hb A1c)以及胰岛素抵抗指标(HOMA-IR)和肝功能相关指标,包括天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)、总胆固醇(TC)、三酰甘油(TG)以及肝脏彩超的变化,比较分析两组的治疗有效率及安全性。结果治疗后,两组患者的HOMA-IR、FPG、2h PG以及Hb A1c均有明显改善,同组治疗前后比较差异有统计学意义(P<0.05);同时,观察组患者的HOMA-IR与Hb A1c显著优于对照组,组间比较差异有统计学意义(P<0.05)。治疗后两组患者的肝功能相关指标均有显著性改善,同组治疗前后比较差异有统计学意义(P<0.05);且观察组的AST、ALT、GGT及TG均明显优于对照组,组间比较差异具有统计学意义(P<0.05)。此外,观察组的脂肪肝治疗总有效率为90.9%,显著高于对照组的42.4%,差异有统计学意义(P<0.05)。用药期间,观察组的总不良反应发生率为15.6%,对照组为9.1%,两组比较差异无统计学意义。结论西格列汀联合二甲双胍对2型糖尿病合并NAFLD患者的代谢综合征及肝功能改善作用明显,治疗有效率高且安全性好。
Objective To investigate the clinical efficacy and safety of sitagliptin and metformin in the treatment of type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease (NAFLD). Methods Sixty-five patients with type 2 diabetes mellitus and NAFLD admitted from Weinan Central Hospital from June 2012 to June 2015 were randomly divided into observation group (32 cases) and control group (33 cases). Patients in the control group were treated with metformin alone. Patients in the observation group were treated with sitagliptin on the basis of the control group, and were treated for 16 weeks. The indexes of glucose metabolism, including BMI, fasting blood glucose (FPG), postprandial 2h PG, Hb A1c and insulin resistance (HOMA) were observed before and after treatment. -IR) and liver function related indicators, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), total cholesterol Acylglycerols (TG) and liver changes in color Doppler ultrasound, comparative analysis of the two groups of treatment efficiency and safety. Results After treatment, the levels of HOMA-IR, FPG, 2h PG and Hb A1c in both groups were significantly improved (P <0.05). The HOMA-IR and Hb A1c was significantly better than the control group, the difference was statistically significant (P <0.05). After treatment, the indexes of liver function in both groups were significantly improved (P <0.05), and the levels of AST, ALT, GGT and TG in the observation group were significantly better than those in the control group The difference between the groups was statistically significant (P <0.05). In addition, the total effective rate of treatment of fatty liver in the observation group was 90.9%, which was significantly higher than that of the control group (42.4%), the difference was statistically significant (P <0.05). During the treatment, the incidence of adverse reactions in the observation group was 15.6%, while that in the control group was 9.1%. There was no significant difference between the two groups. Conclusion Sitagliptin combined with metformin significantly improves the metabolic syndrome and liver function in patients with type 2 diabetes mellitus and NAFLD. The treatment is effective and safe.