司美格鲁肽联合非诺贝特治疗2型糖尿病合并非酒精性脂肪性肝病疗效及安全性观察  

Efficacy and safety of semaglutide combined with fenofibrate in treatment of T2DM complicated with NAFLD

作　　者：李辉 安盟盟 张会 刘建凤 张于 袁敏 刘金良 LI Hui;AN Mengmeng;ZHANG Hui;LIU Jianfeng;ZHANG Yu;YUAN Min;LIU Jinliang(Department of Endocrinology and Metabolism,Cancer Campus,Cangzhou People’s Hospital,Cangzhou 061000,China;Department of Hematology,Cancer Campus,Cangzhou People’s Hospital,Cangzhou 061000,China;Department of Medical Imaging,Cancer Campus,Cangzhou People’s Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市人民医院肿瘤院区内分泌代谢科,河北沧州061000 [2]沧州市人民医院肿瘤院区血液内科,河北沧州061000 [3]沧州市人民医院肿瘤院区医学影像科,河北沧州061000

出　　处：《陕西医学杂志》2025年第3期378-383,共6页Shaanxi Medical Journal

基　　金：河北省医学科学研究课题(20200296)。

摘　　要：目的:探究司美格鲁肽联合非诺贝特治疗2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的疗效及安全性。方法:将97例T2DM合并NAFLD患者随机分为观察组(47例)和对照组(50例),对照组采用常规治疗联合非诺贝特胶囊治疗,观察组在对照组基础上给予司美格鲁肽治疗。比较两组疗效、体重指数(BMI)、体重、肝/脾CT值、胰岛素相关指标、糖脂代谢指标、肝功能指标、血管内皮功能指标、氧化应激指标、血清肝纤维化指标以及不良反应发生率。结果:观察组临床疗效高于对照组(P<0.05)。治疗后,与对照组比较,观察组BMI、体重、胰岛素抵抗指数(HOMA-IR)、肝脏脂肪含量(LFC)、胰岛素敏感指数(HOMA-ISI)、丙二醛(MDA)、8-异前列腺素F2α(8-iso-PGF2α)、透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CⅣ)、空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、谷氨酰胺转移酶(GGT)、血清内皮素(ET)、血栓素B2(TXB2)水平下降,前列环素(PGI2)、一氧化氮(NO)、肝/脾CT值、谷胱甘肽过氧化物酶(GSH-Px)水平升高(均P<0.05)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论:司美格鲁肽联合非诺贝特能改善T2DM合并NAFLD患者糖脂代谢、肝功能、内皮功能、肝纤维化及氧化应激水平,具有良好的安全性。Objective:To investigate the efficacy and safety of semaglutide combined with fenofibrate in the treatment of T2DM complicated with NAFLD.Methods:A total of 97 T2DM patients complicated with NAFLD were randomly divided into observation group(47 cases)and control group(50 cases).The control group was treated with conventional treatment combined with fenofibrate capsule,and the observation group was treated with semaglutide on basis of control group.The efficacy,BMI,body weight,liver/spleen CT value,insulin-related indicators,glucose and lipid metabolism indicators,liver function indicators,vascular endothelial function indicators,oxidative stress indicators,serum liver fibrosis indicators,and the incidence of adverse reactions were compared between two groups.Results:The efficacy of observation group was higher than that of control group(P<0.05).After treatment,compared with the control group,the BMI,body weight,HOMA-IR,LFC,HOMA-ISI,MDA,8-iso-PGF2α,HA,LN,PCⅢ,CⅣ,FPG,2hPG,HbA1c,TG,TC,LDL-C,ALT,AST,GGT,ET,TXB2,PGI2,NO,liver/spleen CT value and GSH-Px were increased(all P<0.05).There was no significant difference in the total incidence of adverse reactions between two groups(P>0.05).Conclusion:Semaglutide combined with fenofibrate can improve glucose and lipid metabolism,liver function,endothelial function,liver fibrosis and oxidative stress level in T2DM patients complicated with NAFLD,with good safety.

关 键 词：2型糖尿病 非酒精性脂肪性肝病 司美格鲁肽 非诺贝特 肝纤维化 肝功能 

分 类 号：R587.1[医药卫生—内分泌]