阿托伐他汀治疗Ⅱ型糖尿病合并非酒精性脂肪性肝病的疗效观察

目的使用阿托伐他汀治疗Ⅱ型糖尿病合并非酒精性脂肪性肝病（NAFLD）患者,观察药物疗效及安全性。方法选取2010年1月至2012年3月在广西百色市人民医院内科门诊及住院的Ⅱ型糖尿病合并NAFLD的患者118例,所有患者随机分为2组,治疗组61例,对照组57例,2组均给予保肝、控制血糖等治疗,但治疗组加用阿托伐他汀20 mg/d。观察2组患者治疗前及治疗后6个月的临床症状、体重指数（BMI）、血总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、ALT、AST及肝脏B超改变。计数资料采用χ2检验,治疗前后比较采用t检验。结果治疗6个月后,治疗组临床症状积分较治疗前有明显下降,差异有统计学意义（t=21.07,P=0.0000）,治疗前后的血TC水平分别为（6.80±1.20）和（5.24±0.67）mmol/L（t=8.87,P=0.000）、LDL-C为（4.38±0.75）和（3.45±0.68）mmol/L（t=7.17,P=0.0000）、TG为（2.14±0.56）和（1.69±0.34）mmol/L（t=5.36,P=0.0000）、ALT为（61±11）和（46±9）U/L（t=8.24,P=0.0000）、AST为（53±14）和（41±12）U/L（t=5.08,P=0.0000）,均有明显下降,差异有统计学意义;血HDL-C有所上升,但差异无统计学意义（t=1.95;P〉0.05）;BMI无明显变化（t=1.84;P=0.0683）。对照组上述指标改变不明显（P〉0.05）。B超观察两组患者的肝脏密度均有不同程度改变,但2组间差异无统计学意义。2组患者均无明显不良反应发生。结论Ⅱ型糖尿病合并NAFLD经阿托伐他汀治疗后能明显改善症状,降低血TC、LDL-C、TG、ALT、AST水平,治疗安全有效。

Therapeutic efficacy of atorvastatin in treatment of non- alcoholic fatty liver disease in patients with type II diabetes mellitus

Objective To observe the therapeutic efficacy of atorvastatin in the treatment of non - alcoholic fatty liver disease （NAFLD） in patients with type Ⅱ diabetes mellitus. Methods A total of 118 patients with type Ⅱdiabetes mellitus complicated by NAFLD, who visited the outpatient department of internal medicine or were hospitalized in our hospital from January 2010 to March 2012, were divided randomly into treatment group （ n = 61 ） and control group （ n = 57）. Both groups received liver protection therapy and blood glucose control, and ator- vastatin （20 mg/d） was administered as an addition in the treatment group. The clinical symptoms, body mass index （BMI）, blood levels of total cholesterol （TC）, triglyceride （TG）, high- density lipoprotein cholesterol （HDL-C）, low- density lipoprotein cholesterol （LDL - C）, alanine aminotransferase （ALT）, and aspartate aminotransferase （AST）, and liver B -mode uhrasound findings were evaluated be- fore and after 6 months of treatment. The enumeration data were analysed by chi - square test, the indices before and after treatment were compared by t - test. Results After 6 months of treatment, the treatment group had a significantly decreased clinical symptom score （ t = 21.07, P = O. 0000）, significantly decreased blood levels of TC （ （6.80 ± 1.20） vs （5.24 ± 0.67 ） mmol/L, t = 8.87, P = 0. 000）, LDL -C （（4.38±0.75） vs（3.45±0.68） mmol/L,t=7.17, P=0.0000）,TG（（2.14±0.56） vs（1.69_0.34） mmol/L, t=5.36, P= 0.0000）, ALT （（61 ± 11） vs （46±9） U/L, t =8.24, P =0. 0000）, and AST （（53 ± 14） vs （41 ± 12） U/L, t =-5.08, P =0.0000）, and increased blood HDL - C level （ t = 1.95, P 〉 0.05 ）, but there was no significant change in BMI （ t = 1.84, P = 0. 0683 ）. No signifi- cant changes in these indices were found in the control group （ P 〉 0.05）. Both groups showed changes in liver density as measured by B - mode ultrasound, hut there was no significant difference between them （ P 〉 0.05 ）. No adverse events occurred in either group. Conclusion Atorvastatin can markedly relieve clinical symptoms and lower blood levels of TC, LDL - C, TG, ALT, and AST and is safe and effective in the treatment of NAFLD in patients with type II diabetes mellitus.