非诺贝特对非酒精性脂肪性肝病合并2型糖尿病患者血脂、血管内皮功能和肝纤维化指标的影响*

目的 探讨非诺贝特治疗对非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者血脂、血管内皮功能和肝纤维化指标的影响。方法 2017年1月～2018年5月我院收治的112例NAFLD合并T2DM患者,采用随机数字表法将患者分成两组,每组56例。指导对照组患者有氧运动和调节饮食,并接受胰岛素治疗,观察组患者在上述治疗的基础上给予非诺贝特口服治疗,观察3个月。结果 在治疗结束时,观察组和对照组血TG水平分别为(1.9±0.4)mmol/L对(3.5±0.5)mmol/L, TC水平分别为(4.9±0.7)mmol/L对(6.4±0.8)mmol/L,HDLC水平分别为(1.4±0.3)mmol/L对(1.2±0.4)mmol/L,LDLC水平分别为(2.4±0.3)mmol/L对(2.6±0.4)mmol/L,差异显著(P＜0.05);血清内皮素水平分别为(49.5±3.7)pg/mL对(52.4±6.8)pg/mL,血栓素水平分别为(184.5±92.6)pg/mL对(272.7±94.8)pg/mL,前列环素水平分别为(32.1±18.4)pg/mL对(23.5±11.3)pg/mL,一氧化氮水平分别为(64.8±13.6)μmol/L对(53.2±12.4)μmol/L,差异显著(P＜0.05);血清层粘连蛋白水平分别为(170.3±65.3)μg/L对(208.7±77.4)μg/L,透明质酸水平分别为(178.6±83.4)μg/L对(233.6±81.6)μg/L,Ⅳ型胶原水平分别为(6.6±1.4)μg/L对(7.4±1.3)μg/L,Ⅲ型前胶原水平分别为(118.4±22.9)μg/L对(132.5±31.7)μg/L,差异显著(P＜0.05)。结论 应用非诺贝特能有效降低非酒精性脂肪性肝病合并2型糖尿病患者血脂水平,改善血管内皮功能,降低血清肝纤维化指标,值得临床验证。

Effects of fenofibrate on blood lipids,vascular endothelial functions and liver fibrosis in patients with nonalcoholic fatty liver disease and type 2 diabetes mellitus

Objective The aim of this study was to investigate the effects of fenofibrate on blood lipids,vascular endothelial functions and liver fibrosis in patients with nonalcoholic fatty liver disease(NAFLD)and type 2 diabetes mellitus(T2DM).Methods 112 patients with NAFLD and T2MD were enrolled in our hospital between January 2017 and May 2018,and were randomly divided into two two groups,with 56 in each group.The patients in control group was treated with insulin at base of excised and diet modulation,and those in the observation were treated with fenofibrate at the basis of routine treatment in control.Results At the end of three month observation,blood TG levels were(1.9±0.4)mmol/L vs.(3.5±0.5)mmol/L,the TC levels were(4.9±0.7)mmol/L vs.(6.4±0.8),the HDLC levels were(1.4±0.3)mmol/L vs.(1.2±0.4)mmol/L,and the LDLC levels were(2.4±0.3)mmol/L vs.(2.6±0.4)mmol/L,respectively,in the observation group and in the control group,with a significant difference(P<0.05);serum endothelin levels were(49.5±3.7)pg/mL vs.(52.4±6.8)pg/mL,the thromboxane levels were(184.5±92.6)pg/mL vs.(272.7±94.8)pg/mL,the epoprostenol were(32.1±18.4)pg/mL vs.(23.5±11.3)pg/mL,and the nitric oxide levels were(64.8±13.6)μmol/L vs.(53.2±12.4)μmol/L,respectively,with the difference being significant(P<0.05);serum laminin levels were(170.3±65.3)μg/L vs.(208.7±77.4)μg/L,the hyaluronic acid levels were(178.6±83.4)μg/L vs.(233.6±81.6)μg/L,the collage typeⅣlevels were(6.6±1.4)μg/L vs.(7.4±1.3)μg/L,and the procollagen type III levels were(118.4±22.9)μg/L vs.(132.5±31.7)μg/L,respectively,in the two groups,with the difference being significant(P<0.05).Conclusion Fenofibrate could effectively reduce the blood lipid levels,improve vascular endothelial functions and reduce the index of serum liver fibrosis in patients with NAFLD and type 2 diabetes mellitus,which is worthy of clinical application.