罗格列酮联合二甲双胍治疗2型糖尿病患者肝内脂肪沉积临床分析

目的 观察罗格列酮与二甲双胍联合治疗2型糖尿病患者肝内脂肪沉积的疗效。方法 未使用口服降糖药且伴有肝内脂肪浸润的33例2型糖尿病患者分为单独罗格列酮治疗组（罗格列酮组，n=16）和罗格列酮联合二甲双胍治疗组（罗格列酮+二甲双胍组，n=17）。于治疗开始前和治疗后24周末时点，所有患者接受体格测量（体质量、腰围、臀围并计算体质量指数和腰臀比）；空腹采血后进行代谢相关指标及细胞因子检测，包括空腹血糖、血脂水平及血清脂联素和肿瘤坏死因子α（TNFα）等；采用影像学技术检测腹内和腹部皮下脂肪分布（面积）以及肝内脂肪含量。对相关指标进行治疗前后及组间比较。结果 在体质量、体质量指数、腰围、腰臀比及腹内脂肪面积和腹部皮下脂肪面积等方面，罗格列酮+二甲双胍组治疗后较治疗前明显下降（P<0.05或P<0.01），而罗格列酮组治疗前后比较无明显变化。与治疗前比较，两组空腹血糖、肝内脂肪含量和血清TNF-α水平明显降低（P<0.05或P<0.01），血清脂联素水平显著升高（P<0.01）；上述改变罗格列酮+二甲双胍组较罗格列酮组更为显著（P<0.05）。结论 单独应用罗格列酮或与二甲双胍联合应用均可显著减轻2型糖尿病患者肝内脂肪浸润，但联合治疗效果更好。

Effect of combined therapy of roglitazone and metformin on hepatic fat content in type 2 diabetic patients with central obesity

Objective To observe efficacy of combined treatment of rosiglitazone and metformin on intrahepatic fat deposition in type 2 diabetic patients. Methods Thirty-three type 2 diabetic patients with intrahepatic lipid but without the use of oral hypoglycemic agents were divided into rosiglitazone group (n=16) and rosiglitazone combined with metformin group (n=17). Physical parameters (body weight, waist circumstance, hip circumstance, body mass index, and waist-hip ratio) were measured before treatment and 24 weeks after treatment. Fasting blood was collected to measure levels of fasting blood glucose, lipid level, serum adiponectin, and TNF-α. Imaging techniques were used to assess intraabdominal fat area, subcutaneous abdominal fat area, and intrahepatic lipid content. The parameters before and after treatment were compared between the two groups. Results In rosiglitazone combined with metformin group, body weight, body mass index, waist circumstance, waist-hip ratio, intraabdominal fat area, and subcutaneous abdominal fat area decreased significantly compared to those before treatment (P<0.05 or P<0.01), while such changes were not observed in rosiglitazone group. After treatment, in both groups, fasting blood glucose, intrahepatic fat content, and serum TNF-α decreased (P<0.05 or P<0.01), but serum adiponectin increased (P<0.01). And changes were more significant in rosiglitazone combined with metformin group (P<0.05). Conclusion Intrahepatic lipid was decreased by treatment of rosiglitazone alone and combined with metformin, while the combined treatment was more effective.