非酒精性脂肪性肝病合并2型糖尿病的药物治疗的病例对照研究  

Case-control study on drug therapy for nonalcoholic fatty liver disease complicating type 2 diabetes mellitus

作　　者：刘彦[1] 朱韦[2] 郑丹 冯盼盼[2] 王运兵[2] 李泽民 LIU Yan;ZHU Wei;ZHENG Dan;FENG Panpan;WANG Yunbing;LI Zemin(Department of Gastroenterology,Chengdu Municipal Fifth People′s Hospital,Chengdu,Sichuan 611130,China;Department of Hepatobiliary Surgery,Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Child Health Care,Affiliated Children′s Hospital of Chongqing Medical University,Chongqing 400014,China;Pengshui County People′s Hospital,Chongqing 409600,China)

机构地区：[1]四川省成都市第五人民医院消化内科,611130 [2]重庆医科大学附属第二医院肝胆外科,400010 [3]重庆医科大学附属儿童医院儿童保健科,400014 [4]重庆市彭水县人民医院,409600

出　　处：《重庆医学》2018年第35期4474-4478,共5页Chongqing medicine

基　　金：重庆市卫生和计划生育委员会科研面上项目(2016MSXM206);四川省医学会项目(S16007);四川省卫生和计划生育委员会重点项目(17ZD008)

摘　　要：目的探讨对非酒精性脂肪性肝病(NAFLD)合并2型糖尿病的患者预后影响因素及有治疗作用的药物,为临床治疗提供依据。方法对2014年1月1日至2016年7月1日在重庆医科大学附属第二医院内分泌科住院治疗的NAFLD合并2型糖尿病的150例患者的临床资料进行回顾性分析,从血糖、糖化血红蛋白(HbA1c)、血脂、血压、清蛋白、低密度脂蛋白(LDL)等指标及患者不同时间段的两次超声结果确定脂肪肝严重程度的变化来比较降糖药、降脂药他汀类,降压药ACEI、钙离子拮抗剂等对NAFLD治疗效果的差别。本组研究按照治疗后与治疗前脂肪肝严重程度比较分为两组:好转者为病例组,无好转者为对照组,共纳入150例患者,病例组52例,对照组98例,主要从降糖药胰岛素及胰岛素类似物、双胍类、格列酮类、格列奈类、磺脲类、葡萄糖苷酶抑制剂、DDP4、GLP-1,降压药ACEI、ARB、B-受体阻滞剂、钙离子拮抗剂,降脂药他汀类、贝特类的使用情况来比较病例组和对照组的疗效情况。结果 (1)病例组与对照组治疗前各指标比较:病例组HbA1c、丙氨酸氨基转移酶(ALT)较低;治疗后比较:血糖较高,LDL较低;(2)病例组治疗前后比较:治疗后HbA1c、血糖升高;对照组治疗前后比较:治疗后HbA1c降低;(3)不同药物使用情况疗效比较:使用降压药物组患者的有效率(42.86%)较未使用组(24.24%)更高,降脂药物组患者的有效率(33.33%)较未使用组(37.5%)更低。降糖合并降压药与降糖合并降脂药治疗脂肪肝好转率比较(χ2=6.063,P=0.014);降糖合并降脂药与降糖合并降脂降压药治疗脂肪肝好转率比较(χ2=7.391,P=0.007);(4)具体药物疗效分析:他汀类、ACEI类和钙拮抗剂对脂肪肝好转有疗效(P≤0.05)。结论降糖药的使用可能对NAFLD合并2型糖尿病的患者治疗无效,ACEI、钙离子拮抗剂及他汀类对NAFLD合并2型糖尿病的患者治疗有效。Objective To investigate the prognostic factors and therapeutic drugs for the patients with nonalcoholic fatty liver disease(NAFLD)complicating type 2 diabetes mellitus(T2DM)to provide the evidence for clinical treatment.Methods The clinical data of 150 patients with NAFLD complicating T2DM admitted to the endocrinology department of the Second Affiliated Hospital of Chongqing Medical University from January 1,2014 to July 1,2016 were retrospectively analyzed.The differences in treating NAFLD were compared among hypoglycemic agents,lipid-lowering drugs statins,antihypertensive drugs ACEI and calcium antagonists from the indexes such as blood glucose,glaciated hemoglobin(HbA1c),blood lipids,blood pressure,albumin,LDL and the severity change of fatty liver determined by twice ultrasound results.This study was divided into the two groups according to the severity of fatty liver after treatment and before treatment:the patients with improvement as the case group and the patients without improvement as the control group.A total of 150 cases were included,52 cases in the case group and 98 cases in the control group.The effects were compared between the case group and control group mainly from the use situation of hypoglycemic agents insulin and insulin analogues,biguanides,glitazones,glinides,sulfonylureas,glucosidase inhibitors,DDP4,GLP-1,antihypertensive drugs ACEI,ARB,β-receptor blockers,calcium antagonists,lipid-lowering drugs statins and fibrates.Results(1)The comparison of the indicators before treatment between the case group and the control group:HbA1c and ALT were lower in the case group;after treatment:higher blood glucose and lower LDL;(2)comparison before and after treatment in the case group:HbA1c and blood glucose after treatment were increased;comparison before and after treatment in the control group:HbA1c after treatment was decreased;(3)the comparison of use situation of different drugs:the effective rate in the using antihypertensive drugs group was 42.86%,which was higher than 24.24%in the non-use

关 键 词：非酒精性脂肪性肝病 药物治疗 血管紧张素转换酶抑制药 钙通道阻滞药 他汀 

分 类 号：R575.5[医药卫生—消化系统]