初诊T2DM伴NAFLD患者应用水飞蓟宾对肝纤维化进程、糖脂代谢紊乱的调节效果  

Effect of silybin on the regulation of hepatic fibrosis process and glucose lipid metabolism disorder in newly diagnosed T2DM patients with NAFLD

作　　者：汪美玲 李毅芳[1] 房艳珍[2] 王朝华[3] 肖倬君[4] WANG Meiling;LI Yifang;FANG Yanzhen;WANG Zhaohua;XIAO Zhuojun(Department of General Medicine,Hunan Second People's Hospital,Hunan Provincial Brain Hospital,Changsha 410021,China;Physical Examination Center,Hunan Second People's Hospital,Hunan Provincial Brain Hospital,Changsha 410021,China;Department of Cardiovascular,Hunan Second People's Hospital,Hunan Provincial Brain Hospital,Changsha 410021,China;Department of Neonatology,Hunan Children's Hospital,Changsha,410021,China)

机构地区：[1]湖南省第二人民医院·湖南省脑科医院全科医学科,湖南长沙410021 [2]湖南省第二人民医院·湖南省脑科医院体检中心,湖南长沙410021 [3]湖南省第二人民医院·湖南省脑科医院心血管内科,湖南长沙410021 [4]湖南省儿童医院新生儿科,湖南长沙410021

出　　处：《西部医学》2024年第11期1671-1675,共5页Medical Journal of West China

基　　金：湖南省科技创新计划项目(2018JJ6101)。

摘　　要：目的探讨水飞蓟宾治疗初诊2型糖尿病(T2DM)伴非酒精性脂肪肝(NAFLD)对患者肝纤维化进程、糖脂代谢紊乱的调节效果。方法选取2016年1月—2019年1月湖南省脑科医院收治的93例初诊T2DM伴NAFLD患者作为研究对象,采用随机数字表分为观察组47例和对照组46例。两组患者均采取运动、饮食干预+二甲双胍治疗,观察组同时服用水飞蓟宾治疗;对比两组治疗前后的空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、三酰甘油(TG)、脂联素、瘦素、白细胞介素-6(IL-6)、超氧化物歧化酶(SOD)、Ⅲ型前胶原肽(Ⅲ-PC)、层黏蛋白(LN)、透明质酸(HA)、肝脏彩超评分及不良反应。结果治疗前,两组FPG、2 h PG、HbA1c、HOMA-IR、TC、TG、脂联素、瘦素、IL-6、SOD、彩超评分、Ⅲ-PC、LN、HA测定值比较,差异无统计学意义(P>0.05);治疗后,两组FPG、2 h PG、HbA1c、HOMA-IR、TC、TG、瘦素、IL-6、彩超评分、Ⅲ-PC、LN、HA较治疗前均降低,脂联素、SOD水平较治疗前均升高(均P<0.05),且观察组的TC、TG、瘦素、IL-6、彩超评分、Ⅲ-PC、LN、HA低于对照组,脂联素、SOD水平高于对照组(均P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论T2DM伴NAFLD患者采用水飞蓟宾联合运动、饮食干预+二甲双胍治疗在良好的控制血糖基础上,还能抑制肝纤维化进程,调节糖脂代谢紊乱,临床效果值得肯定。Objective To investigate the regulation effect of silybin in the treatment of newly diagnosed type 2 diabetes mellitus(T2DM)with non-alcoholic fatty liver disease(NAFLD)on the progression of liver fibrosis and the disorder of glucose and lipid metabolism.Methods 93 newly diagnosed T2DM patients with NAFLD admitted to our hospital were selected as the study subjects.They were randomly divided into an observation group of 47 cases and a control group of 46 cases using a random number table.Both groups of patients received exercise,dietary intervention,and metformin treatment,while the observation group received silybin treatment simultaneously.Compare the fasting blood glucose(FPG),2-hour postprandial blood glucose(2 h PG),glycated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),total cholesterol(TC),triglycerides(TG),adiponectin,leptin,interleukin-6(IL-6),superoxide dismutase(SOD),type Ⅲ procollagen peptide(Ⅲ-PC),lamin(LN),hyaluronic acid(HA),liver ultrasound scores,and adverse reactions between two groups before and after treatment.Results After treatment,the FPG,2 h PG,HbA1c,and HOMA-IR measurements of both groups of patients decreased compared to before treatment(P<0.05).Before treatment,there was no statistically significant difference in TC,TG,adiponectin,leptin,IL-6,SOD,ultrasound scores,Ⅲ-PC,LN,and HA measurements between the observation group and the control group(P>0.05).After treatment,the TC,TG,leptin,IL-6,ultrasound score,Ⅲ-PC,LN,HA of the observation group were lower than those of the control group(P<0.05),while the levels of adiponectin and SOD were higher than those of the control group(P<0.05).ConclusionIn T2DM patients with NAFLD,the treatment of silybin combined with exercise,dietary intervention and metformin can also inhibit the progression of liver fibrosis and regulate the disorder of glucose and lipid metabolism on the basis of good control of blood sugar,the clinical effect is worthy of recognition.

关 键 词：水飞蓟宾 初诊2型糖尿病 非酒精性脂肪肝 二甲双胍 肝纤维化 糖脂代谢 

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