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目的观察艾塞那肽对2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者血糖、肝脏脂肪含量及血清chemerin水平的影响。方法 T2DM合并NAFLD患者60例,随机分为2组,每组30例,艾塞那肽组在原治疗方案基础上加用艾塞那肽10μg,早晚餐前1 h皮下注射,对照组加用甘精胰岛素,起始剂量0.2 U/kg或6~10 U。治疗12周,观察体质量(BW)、体质量指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、血脂(TG、TC、HDL、LDL)、胰岛素抵抗指数(HOM A-IR)、肝酶学指标(ALT、AST)及血清chemerin水平,B超定量肝脏脂肪含量(LFC)变化。结果治疗12周后,艾塞那肽组BW、BMI、腰臀比(WHR)、Hb A1c、FPG、TG,2h PG、ALT、AST水平均降低(P<0.05,P<0.01),FINS、HOMA-IR及chemerin水平亦降低(P<0.01),LFC减少(P<0.01)。对照组的Hb A1c、FPG较治疗前降低(P<0.01)。相关回归分析显示BMI、TG、HOMA-IR、chemerin与LFC相关;多元逐步回归分析结果显示HOMA-IR、TG的下降纳入回归方程,是LFC下降的独立影响因子(β值分别为1.614、1.360,P<0.05)。结论艾塞那肽能够改善糖脂代谢、肝功能,同时减轻体质量和肝脏脂肪含量,降低血清chemerin水平,有可能成为治疗T2DM合并NAFLD的有效药物。
Objective To observe the effect of exenatide on blood glucose, liver fat and serum chemerin in patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD). Methods Sixty patients with T2DM complicated with NAFLD were randomly divided into 2 groups (30 in each group). Exenatide group was treated with exenatide 10μg on the basis of the original treatment regimen, subcutaneous injection 1h before and after mealtime, and control group plus Insulin, initial dose 0.2 U / kg or 6 ~ 10 U. After 12 weeks of treatment, BW, BMI, Hb A1c, TG, TC, HDL, LDL, HOM A-IR ), Liver enzymes (ALT, AST) and serum chemerin levels, B ultrasound quantitative liver fat content (LFC) changes. Results The serum levels of BW, BMI, WHR, Hb A1c, FPG, TG, 2h PG, ALT and AST decreased in exenatide group after 12 weeks of treatment (P <0.05, HOMA-IR and chemerin levels also decreased (P <0.01), LFC decreased (P <0.01). Hb A1c and FPG in control group were lower than before treatment (P <0.01). Correlation analysis showed that BMI, TG, HOMA-IR and chemerin were correlated with LFC. Multiple stepwise regression analysis showed that the decrease of HOMA-IR and TG were included in the regression equation, which was the independent factor of LFC decline (β values were 1.614,1.360, P <0.05). Conclusion Exenatide can improve glucose and lipid metabolism, liver function, reduce body weight and liver fat content, and reduce serum chemerin levels, which may become an effective drug for the treatment of T2DM with NAFLD.