厄贝沙坦和α-硫辛酸联合二甲双胍治疗2型糖尿病合并非酒精性脂肪肝的疗效及对患者胰岛素抵抗的影响

摘要

目的 探究厄贝沙坦、α-硫辛酸联合二甲双胍治疗2型糖尿病 (Type 2 diabetes melli-tus, T2DM) 合并非酒精性脂肪肝 (Nonalcoholic fatty liver disease, NAFLD) 的临床疗效及对患者胰岛素抵抗 (Insulin resistance, IR) 的影响.方法 选取2014年12月 ~2015年6月于我院门诊及住院部诊治的T2DM合并NAFLD患者156例,依据治疗方式的不同将患者分为对照组 (n=90) 及观察组 (n =66),对照组给予常规治疗,观察组在对照组的基础上联合厄贝沙坦及 α -硫辛酸治疗,两组均连续治疗3个月.检测并比较治疗前后两组血清糖脂代谢指标和肝功能指标水平,以及比较两组治疗前后血清胰岛素水平,计算胰岛素抵抗指数 (HOMA insulin resistance index, HOMA-IR),分析治疗前后患者IR改善情况.结果 治疗后两组血清空腹血糖 (Fasting plasma glucose, FPG)、餐后2h 血糖 (2h plasma glucose, 2hPG)、糖化血红蛋白 (Hemoglobin Alc, HbA1c) 含量,血清总胆固醇 (Total cholesterol, TC)、甘油三酯 (Triglyceride, TG)、低密度脂蛋白胆固醇 (low density lipoprotein cholesterin, LDL-C) 水平、血清空腹胰岛素 (Fasting insulin, FINS) 水平和HOMA-IR均较治疗前显著降低 (P <0.05或 P <0.01),且观察组显著低于对照组 (P<0.05或P<0.01).治疗后观察组血清游离脂肪酸 (Free fatty acid, FFA) 水平较治疗前显著降低 (P<0.05),且显著低于对照组 (P <0.05).治疗后脂肪肝病变改善方面观察组总有效率为71.21%,显著高于对照组的35.56% (P<0.01).与治疗前比较,治疗后两组血清丙氨酸氨基转移酶 (Alanine aminotransfease, ALT)、天门冬氨酸氨基转移酶 (Aspartate aminotransferase, AST) 和谷氨酰转肽酶 (Gamma glutamyl transpeptidase, GGT) 水平均显著降低,且观察组显著低于对照组 (P <0.01).结论 厄贝沙坦、α-硫辛酸联合二甲双胍可有效调节 T2DM 合并 NAFLD 患者的糖脂代谢紊乱,改善机体IR效应,抑制脂肪肝恶化,有效保护患者肝功能,临床疗效显著.%Objective To investigate the clinical efficacy of irbesartan, α-lipoic acid combined with metformin on insulin resistance (IR) in the treatment of type 2 diabetes mellitus (T2DM) with nonalcoholic fatty liver (NAFLD). Methods 156 T2DM patients with NAFLD in our hospital from December in 2014 to June in 2015 were selected and were divided into the control group (n=90) and the observation group (n=66) according to different treatment methods. The control group receicved routine treatment and observation group received irbesartan and α-lipoic acid on the basis of the control group. The courses of the treatment in the two groups were 3 months. The levels of serum glucose, lipid metabolism and liver function were measured before and after treatment.The serum insulin levels were measured, the insulin resistance index (HOMA-IR) was calculated and the improvement of IR was analyzed before and after treatment. Results After the treatment, the levels of serum fasting plasma glucose (FPG), 2h plasma glucose (2h PG), hemoglobin Alc (HbA1c), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterin (LDL-C), fasting insulin (FINS) and HOMA-IR in the two groups were significantly lower than those before the treatment (P<0.05 or P<0.01), and the ones in the observation group were significantly lower than those in the control group (P<0.05 or P<0.01). The level of serum free fatty acid (FFA) in the observation group was lower before the treatment than the control group (P<0.05). After the treatment, the total effective rate of liver steatosis was 71.21% in the observation group, which was significantly higher than that in the control group (35.56%) (P <0.01). After the treatment, the levels of serum alanine aminotransfease (ALT), aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (GGT) in the two groups were significantly lower than those before the treatment (P<0.05 or P<0.01), and the ones in the observation group were significantly lower than those in the control group (P<0.05 or P<0.01). Conclusion Irbesartan, α-lipoic acid combined with metformin can effectively regulate the glucose and lipid metabolism disorders of T2DM patients with NAFLD, improve the IR effect of the body, inhibit the deterioration of fatty liver and protect the liver function of patients.