摘要
目的比较达格列净或吡格列酮联合二甲双胍治疗2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的疗效。方法210例T2DM合并NAFLD患者随机均分为吡格列酮组和达格列净组,分别口服吡格列酮(30 mg,qd)或达格列净(10 mg,qd)联合二甲双胍(500 mg,tid),并进行生活方式干预治疗。治疗24周后,观察记录患者体征、血糖和血脂水平、CT肝脾密度比值、脂联素(APN)和内脏脂肪含量等指标,比较2组临床疗效,并记录不良反应。结果共204例患者完成试验。除饮酒史外,2组基线值无显著差异(P>0.05)。治疗24周后,2组患者的内脏脂肪面积、糖化血红蛋白、胰岛素抵抗指数、丙氨酸转氨酶、谷氨酰转肽酶、总胆固醇、三酰甘油及低密度脂蛋白胆固醇均较治疗前降低,高密度脂蛋白胆固醇、APN及CT肝脾密度比值均较治疗前升高(P<0.05),且达格列净组变化比吡格列酮组更显著(P<0.05);吡格列酮组腰臀比和BMI与治疗前相比无显著改变(P>0.05),而达格列净组腰臀比和BMI较治疗前下降明显(P<0.05)。达格列净组总有效率显著高于吡格列酮组(76.5%vs.52.0%,P<0.01),2组不良反应发生率无显著差异(4.8%vs.2.0%,P>0.05)。结论达格列净或吡格列酮联合二甲双胍均可改善T2DM合并NAFLD患者的血糖和血脂水平、肝功能和脂肪肝程度,无严重不良反应,且达格列净联用的疗效优于吡格列酮。
AIM To compare the efficacy of daglitazine or pioglitazone combined with metformin in the treatment of type 2 diabetes mellitus(T2 DM)and non-alcoholic fatty liver disease(NAFLD).METHODS Two hundred and ten patients with T2DM and NAFLD were randomly divided into pioglitazone group and dapagliflozin group.On the basis of lifestyle intervention,the two groups were given pioglitazone(30 mg,qd,po)or daglitazine(10 mg,qd,po)and metformin(500 mg,tid,po).After 24 weeks of treatment,the patient’s physical signs,blood glucose and lipid levels,liver function,CT liver and spleen density ratio,adiponectin(APN)and visceral fat content were observed.The efficacy of fatty liver was evaluated and the adverse drug reactions were recorded.RESULTS A total of 204 patients completed the experiment.Except for the history of drinking,there was no significant difference in the baseline value between the two groups(P>0.05).After 24 weeks treatment,visceral fat area,glycosylated hemoglobin(HbA1c),insulin resistance index,glutamic pyruvic transaminase,glutamyl transpeptidase,total cholesterol,total triglyceride and low density lipoprotein cholesterol decreased,while high density lipoprotein cholesterol,APN and CT liver and spleen density ratio increased in both groups(P<0.05).The changes in the dapagliflozin group were more significant than those in the pioglitazone group(P<0.05).There was no significant change in waist-to-hip ratio and BMI in the pioglitazone group(P>0.05).While the waist-hip ratio and BMI in dapagliflozin group were significantly lower than those before treatment(P<0.05).The total effective rate of dapagliflozin group was significantly higher than that of pioglitazone group(76.5%vs.52.0%,P<0.01).There were no significant difference in adverse reaction rate between the two groups(4.8%vs.2.0%,P>0.05).CONCLUSION Doglitazine or pioglitazone combined with metformin can improve blood glucose,blood lipids,liver function and the degree of fatty liver in patients with T2DM and NAFLD,without serious adverse reactions,and the combined efficacy of dapagliflozin is better than pioglitazone.
作者
逄琪琪
王美荣
高倩
尚恒
陈云霞
PANG Qi-qi;WANG Mei-rong;GAO Qian;SHANG Heng;CHEN Yun-xia(Department of Endocrinology,Cangzhou People’s Hospital,Chengde Medical College,Cangzhou HEBEI 061000,China)
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2020年第11期675-679,共5页
Chinese Journal of New Drugs and Clinical Remedies
关键词
达格列净
吡格列酮
糖尿病
2型
非酒精性脂肪性肝病
疗效比较研究
daglitazine
pioglitazone
diabetes mellitus,type 2
non-alcoholic fatty liver disease
comparative effectiveness research
