二甲双胍联合达格列净治疗T2DM合并NAFLD患者疗效及血清二肽基肽酶4和C肽变化  

Short-term observation of metformin and dapagliflozin combination therapy in the treatment of patients with T2DM and NAFLD and their impact on serum dipeptidyl peptidase 4 and C-peptide levels

作　　者：王诗淞 林辉雄 张泰胜 董俪雯 王英霞 林秋香 Wang Shisong;Lin Huixiong;Zhang Taisheng(Department of Pharmacy,People's Hospital Affiliated to Hainan Medical College,Qionghai 571400,Hainan Province,China)

机构地区：[1]海南医学院附属琼海市人民医院药学部,海南省琼海市571400 [2]海南医学院附属琼海市人民医院肿瘤科,海南省琼海市571400 [3]海南医学院附属琼海市人民医院内分泌风湿免疫科,海南省琼海市571400 [4]海南医学院附属琼海市人民医院神经内科,海南省琼海市571400

出　　处：《实用肝脏病杂志》2022年第3期379-382,共4页Journal of Practical Hepatology

基　　金：海南省医药卫生科研项目(编号:20A200068)。

摘　　要：目的探讨应用二甲双胍联合达格列净治疗2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者疗效及血清可溶性二肽基肽酶4(sDPP-4)和空腹C肽的变化。方法2018年9月~2021年9月我院收治的T2DM合并NAFLD患者98例,采用随机数字表法分为对照组49例和观察组49例,分别给予二甲双胍或二甲双胍联合达格列净治疗24 w。检测血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)。采用电化学发光法检测血清空腹胰岛素(FINS),并计算稳态模型胰岛素抵抗指数(HOMA-IR)。采用化学发光法检测血清空腹C肽,采用ELISA法检测血清sDPP-4。结果在治疗24 w末,观察组血清GGT水平为(61.0±6.4)U/L,显著低于对照组【(79.2±6.9)U/L,P<0.05】;肝/脾CT比值为(0.9±0.2),显著高于对照组【(0.7±0.2),P<0.05】,血清空腹C肽水平为(1.6±0.3)ng/ml,显著低于对照组【(2.2±0.5)ng/ml,P<0.05】,sDPP-4水平为(901.5±228.3)ng/ml,显著低于对照组【(1086.2±275.8)ng/ml,P<0.05】;FPG水平为(6.1±1.2)mmol/L,显著低于对照组【(6.9±1.5)mmol/L,P<0.05】,HbA1c水平为(7.1±1.3)%,显著低于对照组【(7.8±1.0)%,P<0.05】,HOMA-IR水平为(2.3±0.5),显著低于对照组【(2.8±0.4),P<0.05】;血清TC水平为(4.5±0.6)mmol/L,显著低于对照组【(5.1±0.6)mmol/L,P<0.05】,TG水平为(2.2±0.4)mmol/L,显著低于对照组【(2.6±0.5)mmol/L,P<0.05】,LDL-C水平为(3.1±0.4)mmol/L,显著低于对照组【(3.5±0.5)mmol/L,P<0.05】,而血清HDL-C水平为(1.8±0.4)mmol/L,显著高于对照组【(1.4±0.3)mmol/L,P<0.05】。结论应用二甲双胍联合达格列净治疗T2DM合并NAFLD患者能有效控制血糖并纠正脂代谢紊乱,降低血清sDPP-4和胰岛素抵抗水平,在改善肝脂肪变性方面显示出较好的治疗苗头,值得深入探讨。Objective The aim of this study was to observe the short-term efficacy of metformin and dapagliflozin combination therapy in the treatment of patients with diabetes mellitus type 2(T2DM)and non-alcoholic fatty liver diseases(NAFLD)and their impact on serum soluble dipeptidyl peptidase 4(sDPP-4)and C-peptide levels.Methods 98 patients with T2DM and NAFLD were enrolled in our hospital between September 2018 and September 2021,and were divided randomly into control(n=49)and observation(n=49)group,receiving metformin or metformin and dapagliflozin combination therapy,respectively,for 24 weeks.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(GGT),total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting blood glucose(FPG)and glycosylated hemoglobin(HbA1c)were routinely detected.Serum fasting insulin(FINS)was detected by electrochemiluminescence,and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.Serum fasting C-peptide level was detected by chemiluminescence.Serum sDPP-4 level was detected by ELISA.Results At the end of 24 week treatment,serum GGT level was(61.0±6.4)U/L,significantly lower than[(79.2±6.9)U/L,P<0.05]in the control;the ratio of liver/spleen CT value in the observation group was(0.9±0.2),significantly higher than[(0.7±0.2),P<0.05],serum fasting C-peptide level was(1.6±0.3)ng/ml,significantly lower than[(2.2±0.5)ng/ml,P<0.05],and serum sDPP-4 level was(901.5±228.3)ng/ml,also significantly lower than[(1086.2±275.8)ng/ml,P<0.05]in the control in the control;the FPG level was(6.1±1.2)mmol/L,significantly lower than[(6.9±1.5)mmol/L,P<0.05],the HbA1c level was(7.1±1.3)%,significantly lower than[(7.8±1.0)%,P<0.05],and the HOMA-IR was(2.3±0.5),significantly lower than[(2.8±0.4),P<0.05]in the control;serum TC level was(4.5±0.6)mmol/L,serum TG level was(2.2±0.4)mmol/L,and LDL-C level was(3.1±0.4)mmol/L,all significantly lower than[(5.1±0.6)mmol

关 键 词：非酒精性脂肪性肝病 2型糖尿病 达格列净 二甲双胍 可溶性二肽基肽酶4 胰岛素抵抗 治疗 

分 类 号：R587.2[医药卫生—内分泌] R575.5[医药卫生—内科学]