西格列汀与甘精胰岛素应用于二甲双胍控制不佳的 2 型糖尿病合并非酒精性脂肪性肝病的疗效及安全性比较

目的比较二甲双胍单药治疗血糖控制不佳的2型糖尿病合并非酒精性脂肪性肝病（NAFLD）患者加用二肽基肽酶-4（DPP-4）抑制剂西格列汀和基础胰岛素（甘精胰岛素）的疗效和安全性。方法二甲双胍单药治疗（≥1500mg／d，1〉6月）血糖控制不佳7％〈糖化血红蛋白（HbAlc）≤10．0％]的2型糖尿病合并NAFLD患者55例，分为加用西格列汀组（n=33，西格列汀100mgQD）和甘精胰岛素组（n=22，QD剂量滴定）。观察治疗3月后的体重指数（BMI）、HbAlc、空腹血糖（FPG）和餐后2小时血糖（PPG）、甘油三酯（TG）、总胆固醇（Tc）、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL—C）、谷草转氨酶（AST）、谷丙转氨酶（A1月）、谷氨酰转移酶（GGT）的变化。结果与治疗前相比较，两组患者的HbAlC、FPG，PPG、TG、LDL—C、AST、ALT、GGT均明显下降（P〈0．001），甘精胰岛素组BMI升高（P〈0．05），西格列汀组BMI下降（P〈0．05）。治疗后与西格列汀组相比较，甘精胰岛素组低血糖事件更明显（P〈0．05），降低FPG更显著（P〈0．05）。结论西格列汀和甘精胰岛素加用于单用Z-甲双胍治疗失败的2型糖尿病合并NAFLD患者，均能降低I-IbMC、FPG和2hi？-PG，安全性良好。

Comparison of clinical efficacy and safety between sitagliptin and glargine in type 2 diabetic patients with non-alcoholic fatty liver disease having poor glycemic control by metforminmonotherapy

Objective To compare the clinical efficacy and safety of dipeptidyl peotidase-4（DPP-4） inhibitor and sitagliptin in treatment of type 2 diabetic pttients with non-alcoholic fatty liver disease （NAFLD） who had poor glyeemic control with metformin monotherapy. Methods Fifty- five type 2 diabetes patients with NAFLD having poor glyeemic control （glyeosylated hemoglobin （HbAle） 〉7.0% 〈 10. 0% ） after treatment with mefformin （ 1〉 1500 mg/d, 〉6months） were randomly divided into two groups：sita- gliptin group （ n = 33 ） and glargine group （ n = 22 ）. The changes of body mass index （ BMI ）, HbA1 e, fasting plasma glucose （ FPG ）, postprandial plasma glucose （ PPG）, triglyceride （TG）, total cholesterol （ TC ）, low- density lipoprotein cholesterol （ LDL- C ）, high- density lipoprotein cholesterol （ HDL- C ）, aspartate aminotransferase （ AST）, alanine aminotransferase （ ALT）, gamma- glutamyltrans- ferase （GGT） and adverse-reactions were compared between the two groups. Results After 3 months of treatment, the levels of FPG, PPG, HbA1 c, TG, LDL-C, AST, ALT and GGT were significantly decreased in the both groups （ P 〈 0. （J01）. The BMI was decreased in the sitagliptin group while increased in the glargine group （P 〈 0. 05 ）. Sitagliptin had more effect on the decrease of FPG and glyee- mia （ all P 〈 0. 05 ） when compared to the glargine group. Conclusion Glargine and sitagliptin could significantly reduce the levels of FPG, PPG, and HbA1 c in type 2 diabetic patients with NAFLD who have poor glycemia control with mefformin monotherapy.