艾塞那肽联合二甲双胍对2型糖尿病合并非酒精性脂肪性肝患者的疗效评价

目的 评价艾塞那肽对2型糖尿病（T₂DM）合并非酒精性脂肪性肝病（NAFLD）患者的疗效，并探讨其作用机制及临床安全性。方法 选取张家港市中医院2014年1月-2015年11月收治的T₂DM伴发NAFLD患者96例，使用数字法随机分为对照组和治疗组，每组48人。对照组患者口服二甲双胍，起始剂量500 mg/次，2次/d，结合具体病情调整药物剂量；治疗组在对照组基础上加用艾塞那肽注射液，早餐前60 min、晚餐前60 min 5 μg皮下注射，均连续用药24周。比较治疗前后两组空腹血糖（FBG）、餐后血糖（PPG）、三酰甘油（TG）、总胆固醇（TC）、丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）的变化，临床有效率及不良反应情况；ELISA法检测成纤维细胞生长因子19（FGF19）和FGF21表达的变化。结果 两组治疗后FBG、PPG、TG、TC、ALT、AST、BMI、腰围、B超肝内贮脂量均显著减低（P<0.05、0.01），且治疗组均显著低于对照组（P<0.05）。两组治疗后FGF19和FGF21表达均显著升高（P<0.05、0.01），且治疗组FGF19和FGF21表达显著高于对照组（P<0.05）。治疗组的临床治疗有效率为85.4%，显著优于对照组的64.6%（P<0.05）；治疗组不良反应率为12.5%，对照组的为10.4%，两组比较无显著性差异（P>0.05）。结论 艾塞那肽联合二甲双胍对T₂DM伴发NAFLD患者的血糖、血脂以及肝功能具有显著的改善作用，临床使用有效且安全。

Clinic effects of exenatide combined with metformin on liver in type 2 diabetes mellitus patients combined with nonalcoholic fatty liver disease

Objective To detect the clinic effects of exenatide on liver in type 2 diabetes mellitus (T₂DM) patients combined with nonalcoholic fatty liver disease (NAFLD) and explore its mechanisms and clinical safety. Methods A total of 96 T₂DM combined with NAFLD patients were enrolled in this study. Patients were randomly divided into fetmormin control group (n=48) and fetmormin+exenatide observation group (n=48). The patients in control group were given metformin, starting dose of 500 mg each time, twice daily, combined with specific patient''s condition to adjust the dose. The patients in treatment group were given metformin and exenatide at 60 min before breakfast and 60 min before dinner, which was treated for 24 weeks. The FBG, PPG, TG, TC, ALT, and AST was compared. FGF19 and FGF21 were detected by ELISA analysis. The rate of adverse reaction was compared. Results After treatment, FBG, PPG, TG, TC, ALT, AST, BMI, waistline, and B ultrasound in liver fat storage were all decreased (P<0.05, 0.01). However, which were all lower in observation group than that in control group (P<0.05). After treatment, FGF19 and FGF21 were both increased (P<0.05, 0.01). However, which were both higher in observation group than those in control group (P<0.05). The clinical effect rate in observation was 85.4%, which was higher than that of 64.6% in control group (P<0.05). The rates of adverse reaction were 12.5% in treatment group and 10.4% in control group. There was no significant difference between the two groups (P>0.05). Conclusion Exenatide has a significant role in the improvement of blood glucose, blood lipid, and liver function in T₂DM combined with NAFLD patients, with significantly clinical efficacy and safety.