摘要
目的 观察利拉鲁肽对非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者心血管代谢和左心室结构及功能的影响。方法 回顾性选取2019年1月-2022年12月至我院内分泌科初次就诊的NAFLD合并T2DM患者351例,根据不同治疗方案分为对照组(196例)和观察组(155例)。对照组患者接受常规标准治疗方案,观察组在对照组基础上加用利拉鲁肽注射液0.6 mg/d,皮下注射,每天1次,7 d后调整至1.2 mg/d。两组患者均规律治疗超过12个月。采用倾向性匹配法对两组患者进行1∶1匹配后,比较其心血管代谢指标、心脏超声参数等,并分析左心室结构、功能参数与心血管代谢指标的相关性。结果 倾向性匹配后,两组患者(各155例)治疗前的基线临床资料比较,差异均无统计学意义(P>0.05)。治疗12个月后,两组患者的腰围、体重、体重指数(BMI)、收缩压(SBP)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)和观察组患者的舒张压(DBP)、总胆固醇(TC)、尿酸(UA)、左室心肌质量(LVM)均较同组治疗前显著降低(P<0.05);两组患者的高密度脂蛋白胆固醇(HDL-C)、估算肾小球滤过率(eGFR)、二尖瓣舒张早期血流峰值速度与二尖瓣舒张晚期血流峰值速度的比值(E/A比值),对照组患者的天冬氨酸转氨酶(AST),以及观察组患者的左室射血分数(LVEF)均较同组治疗前显著升高(P<0.05),且观察组患者上述指标(TG、SBP除外)的改善普遍较对照组显著(P<0.05)。两组患者治疗前后的左心室结构、功能参数(LVM、LVEF、E/A比值)与其腰围、体重、BMI、SBP、FBG、HbA1c有不同程度的关联,且BMI(观察组:β=0.229,P=0.004)和SBP(对照组:β=0.240,P=0.004;观察组:β=0.226,P=0.007)是患者LVM独立影响因素。结论 在常规标准治疗方案基础上加用利拉鲁肽可有效控制NAFLD合并T2DM患者的血糖,降低其腰围、体重和血压,并改善其血脂紊乱,且对患者心脏结构和功能具有保护作用。
OBJECTIVE To observe the effects of liraglutide on cardiovascular metabolism,left ventricular structure and function of non-alcoholic fatty liver disease(NAFLD) patients with type 2 diabetes mellitus(T2DM).METHODS Totally 351NAFLD patients with T2DM were enrolled retrospectively,who visited the Department of Endocrinology in our hospital from January 2019 to December 2022.They were divided into control group(196 cases) and observation group(155 cases) according to different treatment regimens.The control group received conventional standard treatment,and the observation group was additionally given Liraglutide injection 0.6 mg/d subcutaneously once a day based on the control group,adjusted to 1.2 mg/d after 7days.Both groups received regular treatment for more than 12 months.The propensity matching method was used to match the two groups of patients at a ratio of 1∶1.The cardiovascular metabolism indexes and cardiac ultrasound parameters were compared,and the correlation between left ventricular structure,function parameters and cardiovascular metabolism indexes was analyzed.RESULTS After propensity score matching,there was no significant difference in baseline clinical data between the two groups(each 155 cases) before treatment(P>0.05).After 12 months of treatment,the waist circumference,weight,body mass index(BMI),systolic blood pressure(SBP),fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c) and triglyceride(TG) of both groups,as well as the diastolic blood pressure(DBP),total cholesterol(TC),uric acid(UA) and left ventricular mass(LVM) of the observation group,exhibited a significant decrease compared to pre-treatment levels(P<0.05).The high-density lipoprotein cholesterol(HDL-C),estimated glomerular filtration rate(e GFR),and E/A ratio in both groups,as well as the aspartate aminotransferase(AST) in the control group and the left ventricular ejection fraction(LVEF) in the observation group,were all significantly increased compared with before treatment in the same group(P<0.05).Moreover,the improvement of the above indicators(except for TG and SBP) in the observation group was generally more significant than those in the control group(P<0.05).The left ventricular structure and functional parameters(LVM,LVEF,E/A ratio) of the two groups before and after treatment had varying degrees of correlation with the patients' waist circumference,body weight,BMI,SBP,FBG and HbA1c.Moreover,BMI(observation group:β =0.229,P=0.004) and SBP(control group:β=0.240,P=0.004;observation group:β =0.226,P=0.007) were independent influential factors for LVM of the patients.CONCLUSIONS Liraglutide combined with conventional standard treatment can effectively control blood glucose in NAFLD patients with T2DM,reduce waist circumference,body weight and blood pressure,improve blood lipid disorders,and protect their cardiac structure and function.
作者
宋白利
付留俊
常毅娜
袁园
姜宏卫
彭慧芳
SONG Baili;FU Liujun;CHANG Yina;YUAN Yuan;JIANG Hongwei;PENG Huifang(Dept.of Endocrinology,the First Affiliated Hospital of Henan University of Science and Technology/Clinical Medical College of Henan University of Science and Technology,Henan Luoyang 471003,China)
出处
《中国药房》
CAS
北大核心
2024年第14期1737-1742,共6页
China Pharmacy
基金
河南省科技发展计划项目(No.222102310008)。
