司美格鲁肽治疗肥胖2型糖尿病伴非酒精性脂肪性肝病疗效观察  

Efficacy of Semaglutide in Treating Obese with Type 2 Diabetes and Non-Alcoholic Steatohepatitis

作　　者：万超 张美敏 WAN Chao;ZHANG Meimin(The Second Affiliated Hospital of Guizhou Medical University Endocrine Department,Kaili 556000,China;Qiandongnan Prefecture People's HospitalEndocrine Department,Kaili 556000,China)

机构地区：[1]贵州医科大学第二附属医院内分泌科,贵州凯里556000 [2]黔东南州人民医院内分泌科,贵州凯里556000

出　　处：《中华灾害救援医学》2025年第2期204-208,共5页Chinese Journal of Disaster Medicine

摘　　要：目的探讨司美格鲁肽联合二甲双胍治疗肥胖2型糖尿病伴非酒精性脂肪性肝病患者的临床疗效及其对体质量、血糖和血脂水平的影响。方法选取2022年4月至2024年4月贵州医科大学第二附属医院收治的80例肥胖2型糖尿病伴非酒精性脂肪性肝病患者。根据是否联用司美格鲁肽,分为观察组(二甲双胍+吡格列酮+司美格鲁肽,40例)和对照组(二甲双胍+吡格列酮,40例)。比较两组患者的肥胖程度、血糖水平、血脂水平、肝功能指标、不良反应发生情况。结果治疗前,两组患者的腰围、体质量、体质量指数、血糖指标[糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2h血糖(2hPG)、胰岛素抵抗指数(HOMA-IR)]水平、血脂指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)]水平均无明显差异(P>0.05)。治疗后,两组患者腰围、体质量、体质量指数、FPG、2hPG、HbA1c、HOMA-IR、TG、TC、LDL-C均较治疗前明显减少(P<0.05);且与对照组相比,治疗后观察组患者腰围、体重、体质量指数、FPG、2hPG、HbA1c、HOMA-IR、TG、TC、LDL-C明显更低(P<0.05)。两组患者治疗后肝功能指标均有显著下降,但与对照组相比,观察组患者的丙氨酸氨基转移酶(ALT),天门冬氨酸氨基转移酶(AST),γ-谷氨酰转移酶(GGT)下降更为明显,差异具有统计学意义(P<0.05)。两组患者的不良反应总发生率无明显差异(P>0.05)。结论联合应用二甲双胍和司美格鲁肽可显著改善肥胖2型糖尿病伴非酒精性脂肪性肝病患者体质量、血糖、血脂相关指标水平,改善肝功能指标,降低肝脏脂肪含量,缓解肝损害程度,且安全性较高。Objective To investigate the clinical efficacy of smeglutide combined with metformin in the treatment of obese type 2 diabetes patients with nonalcoholic fatty liver disease and its effects on body mass,blood glucose and blood lipid levels.Methods From April 2022 to April 2024,80 obese type 2 diabetes patients with nonalcoholic fatty liver disease were selected from the Second Affiliated Hospital of Guizhou Medical University.According to whether semaglutide is used in combination,it is divided into an observation group(metformin+pioglitazone+semaglutide,40 cases)and a control group(metformin+pioglitazone,40 cases).Compare the obesity level,blood glucose level,blood lipid level,liver function indicators,and incidence of adverse reactions between two groups of patients.Results Before treatment,there were no significant differences in waist circumference,body mass,body mass index,blood glucose levels[glycated hemoglobin(HbA1c),fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),insulin resistance index(HOMA-IR)],and blood lipid levels[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C)]between the two groups of patients(P>0.05).After treatment,the waist circumference,weight,body mass index,FPG,2hPG,HbA1c,HOMA-IR,TG,TC,and LDL-C of both groups of patients were significantly reduced compared to before treatment(P<0.05);Compared with the control group,the observation group had significantly lower waist circumference,weight,body mass index,FPG,2hPG,HbA1c,HOMA-IR,TG,TC,and LDL-C after treatment(P<0.05).After treatment,both groups of patients showed a significant decrease in liver function indicators.However,compared with the control group,the observation group had a more significant decrease in alanine aminotransferase(ALT),aspartate aminotransferase(AST),and gamma glutamyl transferase(GGT),and the difference was statistically significant(P<0.05).There was no significant difference in the overall incidence of adverse reactions between the two groups of patients(P>0.05).Concl

关 键 词：2型糖尿病 肥胖 司美格鲁肽 非酒精性脂肪性肝病 

分 类 号：R587.1[医药卫生—内分泌]