安达释联合盐酸吡格列酮治疗 2 型糖尿病合并代谢相关脂肪性肝病的疗效

Clinical efficacy of dapagliflozin/metformin and pioglitazone in type 2 diabetes mellitus with metabolic-associated fatty liver disease

关键词:  2 型糖尿病  代谢相关脂肪性肝病  安达释  吡格列酮

Key words:  type 2 diabetes mellitus: metabolic-associated fatty liver disease: dapagliflozin/metformin  pioglitazone

摘要:

目的　观察安达释联合盐酸吡格列酮片治疗 2 型糖尿病（T2DM）合并代谢相关脂肪性肝病（MAFLD）的疗 效。方法　2023 年 12 月至 2024 年 4 月东莞康华医院 110 例T2DM合并MAFLD患者分别使用安达释（对照组）或安达 释联合盐酸吡格列酮（观察组）治疗，比较两组胰岛功能、血糖、血脂、炎症因子、肝脏指标和不良反应。结果　与对照组相 比，观察组胰岛素β细胞抵抗指数、总胆固醇、甘油三酯、肿瘤坏死因子-α、白介素-1β、超敏C反应蛋白、丙氨酸氨基转移 酶、天门冬氨酸基转移酶、血糖、糖化血红蛋白水平及肝脏硬度、肝脏脂肪含量明显降低，而胰岛素β细胞分泌功能指数则 明显升高（P<0.01 或 0.05）。两组不良反应总发生率差异无统计学意义（P>0.05）。结论　安达释联合盐酸吡格列酮片既 可改善T2DM合并MAFLD患者的胰岛功能、血脂、肝功能和血糖水平，又可降低炎症因子、肝脏硬度和肝脏脂肪含量。

Abstract:

Objective　To observe the therapeutic effect of dapagliflozin/metformin and pioglitazone in type 2 diabetes mellitus (T2DM) with metabolic-associated fatty liver disease (MAFLD). Methods　A total of 110 patients with T2DM and MAFLD in Dongguan KangHua Hospital from December 2023 to April 2024 were treated with dapagliflozin/metformin (control group) or dapagliflozin/metformin plus pioglitazone (observation group). The islet function, blood glucose, blood lipid, inflammatory factors, liver indexes and adverse reactions were compared between two groups. Results　Compared with control group, islet β resistance index, total cholesterol, triglyceride, tumor necrosis factor-α, interleukin-1β, hypersensitive C-reactive protein, alanine/aspartate aminotransferases, blood glucose, glycosylated hemoglobin, liver stiffness and liver fat content were significantly decreased, while islet β secretion function index increased in observation group (P<0.01 or 0.05). There was no significant difference in the overall incidence of adverse reactions between two groups (P>0.05). Conclusion　 The combined use of dapagliflozin/metformin and pioglitazone can not only improve the islet function, blood lipid, liver function and blood glucose, but also reduce inflammatory factors, liver stiffness and liver fat content in T2DM patients with MAFLD.