达格列净对2型糖尿病并发非酒精性脂肪性肝病患者肝功能的改善作用及其机制

目的：探讨达格列净对2型糖尿病（T2DM）并发非酒精性脂肪性肝病（NAFLD）患者肝功能的影响，分析其对T2DM患者肝损伤的改善作用。方法：回顾性分析68例T2DM并发NAFLDS且未曾接受过任何治疗患者的临床资料，其中阿卡波糖组30例，达格列净组38例，分别给予阿卡波糖150 mg·d^-1+二甲双胍2000 mg·d^-1和达格列净10 mg·d^-1+二甲双胍2000 mg·d^-1治疗24周。收集2组患者治疗前后一般资料，入院后抽取患者空腹静脉血，检测患者血清生化指标和肝功能指标。血清生化指标包括空腹血糖（FBG）和糖化血红蛋白（HbA1c）水平，计算HOMA2法胰岛素抵抗指数（HOMA2-IR）；肝功能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）、碱性磷酸酶（ALP）、总胆红素（TBIL）和直接胆红素（DBIL），计算非酒精性脂肪性肝纤维化评分（NAFLDFS）。对2组患者各项检测指标进行对比分析。结果：与治疗前比较，治疗后阿卡波糖组患者FBG、HbA1c、AST、GGT和ALP水平及HOMA2-IR均明显降低（P<0.01），TBIL水平明显升高（P<0.01）。与治疗前比较，治疗后达格列净组患者FBG、HbA1c、AST、ALT、GGT和ALP水平及HOMA2-IR和NAFLDFS明显降低（P<0.01），TBIL和DBIL水平明显升高（P<0.01）。治疗后，与阿卡波糖组比较，达格列净组患者FBG、AST、ALT、GGT及ALP水平和NAFLDFS均明显降低（P<0.01）。结论：达格列净能改善T2DM并发NAFLD患者的肝功能，其机制可能与其降低血糖和体质量的作用有关。

Improvement effect of dapagliflozin on liver function in patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver diseaseand itsmechanism

Objective: To investigate the effect of dapagliflozin on the liver function of the patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD), and to analyze its improvement effect on liver injury of the T2DM patients. Methods: The clinical data of 68 T2DM patients complicated with NAFLDS who did not receive any treatment were retrospectively analyzed, including 30 patients in acarbose group and 38 patients in dapagliflozin group, and the patients in two groups received acarbose 150 mg·d^-1+ metformin 2 000 mg·d^-1 and dapagliflozin 10 mg·d^-1 + metformin 2 000 mg·d^-1 treatment for 24 weeks, respectively. The general data of the patients before and after treatment were collected.The fasting venous blood of the patients in two groups was collected and the serum biochemical indexes and liver function indexes were detected.The serum biochemical indexes included fasting blood glucose(FBG) and glycosylated hemoglobin (HbA1c),and the homeostasis model assessment 2-insulin resistance index(HMOA2-IR) was calculated.The liver function indexes included aspartic transaminase (AST), alanine aminotransferase (ALT), glutamyltranspeptidase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL),and direct bilirubin (DBIL);the non-alcoholic fatty liver disease fibrosis score (NAFLDFS) was calculated.The each detection index of the patients in two groups was compared and analyzed. Results: Compared with before treatment, the levels of FBG, HbA1c, AST, GGT, and ALP and HOMA2-IR in acarbose group after treatment were significantly decreased(P<0.01) and the levels of TBIL was significantly increased (P<0.01). Compared with before treatment, the levels of FBG, HbA1c, AST, ALT, GGT, and ALP and HOMA2-IR,NAFLDFS in dapagliflozin group were significantly decreased after treatment (P<0.01) and the levels of TBIL and DBIL were significantly increased (P<0.01). The levels of FBG, AST, ALT, GGT, and ALP and NAFLDF in dapagliflozin group after treatment were significantly decreased compared with acarbose group (P<0.01). Conclusion: Dagliflozin can improve the liver function of the patients with T2DM complicated with NAFLD, and its mechanism may be related to the effect of dapagliflozin decreasing the blood glucose and body weight.