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目的 探究西格列汀联合二甲双胍治疗2型糖尿病合并非酒精性脂肪肝(NAFLD)的临床效果及安全性。方法 选择2012年6月-2015年6月渭南市中心医院收治的65例2型糖尿病合并NAFLD患者,随机分为观察组32例和对照组33例。对照组患者予以单纯二甲双胍治疗,观察组患者在对照组基础上加用西格列汀治疗,均持续治疗16周。观察两组患者治疗前及治疗后的糖代谢相关指标,包括体质指数(BMI)、空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)以及胰岛素抵抗指标(HOMA-IR)和肝功能相关指标,包括天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)、总胆固醇(TC)、三酰甘油(TG)以及肝脏彩超的变化,比较分析两组的治疗有效率及安全性。结果 治疗后,两组患者的HOMA-IR、FPG、2hPG以及HbA1c均有明显改善,同组治疗前后比较差异有统计学意义(P<0.05);同时,观察组患者的HOMA-IR与HbA1c显著优于对照组,组间比较差异有统计学意义(P<0.05)。治疗后两组患者的肝功能相关指标均有显著性改善,同组治疗前后比较差异有统计学意义(P<0.05);且观察组的AST、ALT、GGT及TG均明显优于对照组,组间比较差异具有统计学意义(P<0.05)。此外,观察组的脂肪肝治疗总有效率为90.9%,显著高于对照组的42.4%,差异有统计学意义(P<0.05)。用药期间,观察组的总不良反应发生率为15.6%,对照组为9.1%,两组比较差异无统计学意义。结论 西格列汀联合二甲双胍对2型糖尿病合并NAFLD患者的代谢综合征及肝功能改善作用明显,治疗有效率高且安全性好。
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[Abstract]
Objective To investigate the clinical efficacy and safety of sitagliptin combined with metformin in treating patients with type 2 diabetes with non-alcoholic fatty liverdiease (NAFLD).Methods Sixty-five patients with type 2 diabetes with non-alcoholic fatty liver admitted into our hospital from June 2012 to June 2015 were randomly divided into two groups. Thirty-three patients in control group were treated with metformin only, and thirty-two patients in observation were treated with sitagliptin combined with metformin. The changes in body mass index (BMI), fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), Hemoglobin Ale (HbAlc), homeostasis model assessment of insulin resistance (HOMA-IR), and liver function index including that aminopherase of alanine acid (ALT), aminopherase of aspartic acid (AST), gamma-glutamyl transterase (GGT), triglyceride (TG), and total cholesterol (TC) were detected before and after 16 weeks of treatment. And the total effective rate and safety were analyzed and compared. Results After treatment, HOMA-IR, FPG, 2hPG, HbA1c, ALT, AST, GGT, TG, and TC were remarkable improvement (P<0.05), and HOMA-IR, HbA1c, AST, ALT, GGT, and TG were significantly better than those of control (P<0.05). Additionally, the total effective rate in observation group with 90.9% was significantly higher than that of control group with 42.4% (P<0.05). And difference in incidences of adverse effect between observation group with 15.6% and control group with 9.1% were not significant. Conclusion Sitagliptin combined with metformin treatment had a good ability on treating patients with type 2 diabetes with NAFLD by improvement of metabolic syndrome and liver function.
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