罗格列酮治疗非酒精性脂肪性肝病的研究  

The efficacy of rosiglitazone in treating non-alcoholic fatty liver disease

作　　者：金抒清[1] 黄智铭[1] 王剑虹[1] 洪万东[1] 殷薇薇[2] 吴建胜[1] 陈向荣[1] 

机构地区：[1]温州医学院附属第一医院消化内科,浙江温州325000 [2]温州医学院附属第一医院放射科,浙江温州325000

出　　处：《肝胆胰外科杂志》2008年第3期187-189,192,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：温州市科技局基金资助项目(2004A126)

摘　　要：目的探讨罗格列酮对非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者的治疗作用。方法选取NAFLD患者62例(其中21例为对照组、41例为治疗组),正常健康体检者20例(正常组),分别测定空腹血糖、胰岛素、甘油三脂、总胆固醇、血清丙氨酸氨基转移酶(alanine aminotransferase,ALT)和天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、血清Ⅲ型前胶原、四型胶原。行CT检查,分别记录其肝脏平均的CT值。治疗组予文迪雅4 mg/d口服,连续6个月,低脂饮食;对照组予低脂饮食。期间密切监测两组肝功能、血脂水平及血糖水平及可能药物副作用。6个月后再次测定空腹血糖、胰岛素、甘油三脂、总胆固醇、血清ALT、AST、血清Ⅲ型前胶原和四型胶原。并再次行CT检查,记录其肝脏平均的CT值。结果NAFLD患者胰岛素抵抗指数小于正常组(P<0.05),治疗组经罗格列酮治疗半年后胰岛素抵抗指数较治疗前明显增高(P<0.05),而对照组改变不明显(P>0.05);NAFLD患者肝纤维谱水平明显高于正常组(P<0.05),治疗组经治疗后,其血糖、血脂、肝纤维谱较治疗前明显下降(P<0.05),其肝脏CT值明显上升(P<0.05)。而对照组改变不明显(P>0.05)。结论罗格列酮具有改善NAFLD患者的胰岛素抵抗、调节血脂及改善肝脏纤维化的作用,并且无明显肝功能损害。Objective To elucidate the efficacy of rosiglitazone in treating non-alcoholic fatty liver disease. Methods A trial involving 62 patients with non-alcoholic fatty liver disease （21 patients entry into control group, the other 41 patients as treatment group） and 20 healthy people as control （defined as normal group） was conducted. Fasting plasma glucose, insulin, triglyceride, total cholesterol, ALT, AST, serum procollagen Type Ⅲ and Collagen Type IV were measured in all subjects, respectively. Every patient underwent CT scan in order to obtain average CT value of liver. Treatment group was treated with oral rosiglitazone （4 mg daily） for six months accompanied with low fat diet while only low fat diet carried out in control group. During the follow-up stage, liver function, serum lipid, glucose and potential drug adverse are monitored carefully. After six-month follow-up, fasting plasma glucose, insulin, triglyceride, total cholesterol, ALT, AST, procollagen type Ⅲ and collagen type IV were measured again and abdominal CT scan was performed again in order to record the average CT value of liver. Results Index of insulin resistance was significantly lower in patients with non-alcoholic fatty liver disease than that in normal group （P〈0.05）. Index of insulin increases significantly in treatment group after treatment with rosiglitazone for six month compared to baseline （P〈0.05） while there was no significant change in control group （P〉0.05）. The value of marks of hepatic fibrosis was much higher in patients with fatty liver than that in normal group （P〈0.05）. The fasting plasma glucose, lipid, marks of hepatic fibrosis decreased significantly in treatment group. At the same time CT value in liver increased obviously compared to baseline after treatment （P〈0.05）. On the contrary, few changes happened in control group （P〉0.05）. Conclusion Rosiglitazone not only improve insulin resistance but also regulate lipid levels and relieve fibrosis in liver without obvious li

关 键 词：非酒精性脂肪性肝病 罗格列酮 胰岛素抵抗 

分 类 号：R575.5[医药卫生—消化系统]