达格列净联合水飞蓟宾治疗2型糖尿病合并非酒精性脂肪肝患者疗效分析  

Efficacy analysis of dagliflozin combined with silymarin in the treatment of type 2 diabetes mellitus combined with nonalcoholic fatty liver disease

作　　者：张丽[1] 王晨菲[1] 陆春晖[1] 宇文彬雅 Zhang Li;Wang Chenfei;Lu Chunhui;Yuwen Binya(Department of Endocrinology,The Fifth Affiliated Hospital of Xinjiang Medical University,Xinjiang Province,Urumqi 830000,China)

机构地区：[1]新疆医科大学第五附属医院内分泌科,乌鲁木齐830000

出　　处：《疑难病杂志》2024年第3期328-333,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：新疆维吾尔自治区自然科学基金资助项目(2020D01C402)。

摘　　要：目的探讨达格列净联合水飞蓟宾对2型糖尿病合并非酒精性脂肪肝(NAFLD)患者的治疗效果。方法收集2021年1月—2022年12月新疆医科大学第五附属医院内分泌科诊治2型糖尿病合并NAFLD患者104例作为研究对象,按随机数字表法分为对照组52例和研究组52例,2组患者均给予常规治疗及二甲双胍降血糖治疗,研究组在此基础上给予达格列净联合水飞蓟宾治疗,治疗6个月后,比较2组患者治疗前后糖脂代谢指标、肝功能、肝脏硬度、肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)以及脂联素(APN)水平变化。结果治疗后2组患者糖化血红蛋白、空腹血糖、餐后2 h血糖以及胰岛素抵抗指数(HOMA-IR)较治疗前下降,且研究组低于对照组(t/P=3.411/<0.001,2.926/0.005,3.578/<0.001,2.672/0.015),研究组患者治疗后体质量指数(BMI)、腰臀比、内脏脂肪面积、总胆固醇(TC)、三酰甘油(TG)以及低密度脂蛋白胆固醇(LDL-C)明显低于治疗前,且低于对照组(t/P=2.873/0.008,2.435/0.013,4.878/<0.001,3.997/<0.001,2.265/0.025,1.997/0.038);研究组患者治疗后天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)以及总胆红素较治疗前明显下降,且研究组患者低于对照组(t/P=5.737/<0.001,4.971/<0.001,3.258/<0.001);治疗后研究组患者TNF-α降低,SOD及APN升高,且研究组降低/升高幅度大于对照组(t/P=2.453/0.021,3.842/<0.001,3.927/<0.001);治疗期间2组患者恶心呕吐、腹泻、腹胀、便秘、体质量增加、贫血以及低血糖等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论在二甲双胍降糖治疗基础上给予达格列净联合水飞蓟宾可明显改善2型糖尿病合并NAFLD患者胰岛素抵抗水平以及肝功能,降低炎性因子水平和氧化应激损伤,提高APN水平。Objective To investigate the therapeutic effect of dagliflozin combined with silymarin in patients with type 2 diabetes mellitus combined with non-alcoholic fatty liver disease(NAFLD).Methods One hundred and four patients with type 2 diabetes mellitus combined with NAFLD were collected and treated in the Department of Endocrinology of the Fifth Affiliated Hospital of Xinjiang Medical University from January 2021 to December 2022,and were divided into 52 patients in the control group and 52 patients in the study group according to the method of randomized numerical table,and the patients in the two groups were given conventional treatment and metformin hypoglycemic treatment,and the study group was given dagliflozin on top of this treatment.The study group was given dagliflozin combined with silymarin treatment on this basis.After 6 months of treatment,changes in glycemic and lipid metabolism indexes,liver function,liver hardness,tumor necrosis factor-alpha(TNF-alpha),superoxide dismutase(SOD),and adiponectin(APN)levels of the patients in the two groups were compared before and after treatment.Results glycated hemoglobin,fasting glucose,2 h postprandial glucose,and insulin resistance index(HOMA-IR)decreased in the two groups after treatment compared with the pre-treatment level,and the study group was lower than the control group(t/P=3.411/<0.001,2.926/0.005,3.578/<0.001,2.672/0.015),and body mass index(BMI),waist-to-hip ratio,visceral fat area,total cholesterol(TC),triacylglycerol(TG),and low-density lipoprotein cholesterol(LDL-C)were significantly lower than that before treatment in the study group and were lower than that in the control group after treatment(t/P=2.873/0.008,2.435/0.013,4.878/<0.001,3.997/<0.001,2.265/0.025,1.997/0.038);aspartate aminotransferase(AST),alanine aminotransferase(ALT),and total bilirubin decreased significantly after treatment compared with pretreatment in patients in the study group,and patients in the study group were lower than those in the control group(t/P=5.737/<0.001,4.971/<0

关 键 词：2型糖尿病 非酒精性脂肪肝 达格列净 水飞蓟宾 糖脂代谢 肝功能 

分 类 号：R587.1[医药卫生—内分泌] R575.5[医药卫生—内科学]