糖尿病临床研究

　　[摘要]

　　目的 观察艾塞那肽对T2DM合并非酒精性脂肪肝(NAFLD) 患者血糖、体重和肝酶学指标的治疗效果。方法 T2DM合并NAFLD患者117例,，随机分为艾塞那肽组和二甲双胍组，治疗12周，观察体重、血糖、血脂、胰岛素抵抗指数(HOMA-IR)、肝酶学指标和脂联素(APN)及高敏C反应蛋白(hs-CRP)的变化。结果 与二甲双胍组相比，艾塞那肽组体重 [(76.09±9.85) vs(77.22±10.15)]、腰臀比[(0.94±0.05) vs(0.96±0.04,)]、谷丙转氨酶 [(39.82±14.05) vs(51.48±18.89) ]、谷草转氨酶 [(25.61±7.87) vs(31.54±10.75)]、谷氨酰转肽酶[ (47.53±15.80) vs(53.44±15.00) ]和 hs-CRP[ (2.18±0.34) vs (2.69±0.53) ]明显降低(P<0.05或P<0.01);APN水平[(10.44±3.29) vs(8.48±2.67)]明显升高。结论 与二甲双胍相比，艾塞那肽用于T2DM合并NAFLD患者，在有效控制血糖及降低体重的同时可以更好地改善肝酶学指标。

　　[关键词] 糖尿病，2型;非酒精性脂肪性肝病;艾塞那肽;二甲双胍

　　【Abstract】 Objective To evaluate the curative effect of exenatide on the plasma glucose, body weight and liver enzymology in obese type 2 diabetic patients with non-alcoholic fatty liver disease (NAFLD). Methods 117 cases of obese type 2 diabetic patients with NAFLD were randomly divided into two groups. Subjects of the two groups were given exenatide or metformin treatment for 12 weeks. The changes of body weight, blood glucose, lipids, insulin resistance index (HOMA-IR), liver enzymes, adiponectin (APN) and high-sensitive C-reactive protein (hs-CRP) were evaluated. Results: After treatment of exenatide or metformin for 12 weeks, weight[(76.09±9.85) vs(77.22±10.15)]，waist-hip ratio[(0.94±0.05) vs(0.96±0.04,)]，alanine　transaminase [(39.82±14.05) vs(51.48±18.89) ]，aspartate aminotransferase　 [(25.61±7.87) vs(31.54±10.75)]，glutamyl transpeptidase [ (47.53±15.80) vs(53.44±15.00) ]and hs-CRP [ (2.18±0.34) vs(2.69±0.53) ] were significantly lower in exenatide group than in metformin group，and plasma adiponectin level (10.44±3.29vs 8.48±2.67, p=0.00) was obviously higher in exenatide group than in metformin group(P<0.05 or P<0.01). There were no significant difference in HbA1c, HOMA-IR, and lipid metabolism marker between two groups. Conclusion Compared with metformin, exenatide can control plasma glucose and lower body weight effectively, and improve liver enzymolog of type 2 diabetic patients with NAFLD significantly.

　　【Keywords】 Diabetes mullitus，type 2;Nonalcoholic fatty liver disease;Exenatide; Metformin