二甲双胍联合水飞蓟宾胶囊治疗糖耐量减低合并非酒精性脂肪肝病患者的疗效观察

目的  探讨二甲双胍联合水飞蓟宾胶囊对糖耐量减低（IGT）合并非酒精性脂肪肝病（NAFLD）患者的影响。方法  选取IGT合并NAFLD患者72例。对照组36例，予以饮食及运动治疗；观察组36例，在饮食及运动治疗基础上，联合使用二甲双胍片及水飞蓟宾胶囊口服，疗程均为12周。治疗前及治疗12周后，所有患者进行肝脏CT检查，比较两组临床指标、肿瘤坏死因子-α（TNF-α）、肝脂肪变等的变化。结果  治疗12周后，与治疗前及对照组治疗后比较，观察组体重指数（BMI）、空腹血糖（FBG）、空腹血浆胰岛素（FIN）、糖化血红蛋白（HbA1c）、三酰甘油（TG）、胆固醇（TC）、胰岛素抵抗指数（HOMA-IR）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、TNF-α均明显改善（P <0.05）；观察组总有效率高于对照组（P <0.05）。观察组肝脂肪变的程度与BMI、HOMA-IR、TG、TC、TNF-α呈正相关（P <0.05）。结论  二甲双胍联合水飞蓟宾胶囊能够有效改善胰岛素抵抗、降低肝酶及炎症因子TNF-α水平，减少肝脏脂肪变程度。

Effects of Metformin combined with Silibinin capsule in treatment of patients with impaired glucose tolerance complicated with nonalcoholic fatty liver disease

Objective To investigate the effect of Metformin combined with Silibinin on the serum TNF-α and liver steatosis in patients with impaired glucose tolerance (IGT) complicated with nonalcoholic fatty liver disease (NAFLD). Methods Seventy-two patients were randomly divided into two groups. The control group (n = 36) received routine treatment of diet and exercise for 12 weeks, while the treatment group (n = 36) received routine treatment of diet and exercise combined with Metformin and Silibinin for 12 weeks. Before treatment and 12 weeks after treatment, BMI, FBG, fasting plasma insulin (FIN), HbA1c, TG, TC, HOMA-IR, ALT, AST and TNF-α were compared between both groups; furthermore, all patients had liver CT examination to evaluate the degree of liver steatosis. Results BMI, FBG, FIN, HbA1c, TG, TC, HOMA-IR, ALT, AST and TNF-α in the treatment group decreased significantly after treatment compared with those before treatment and those of the controls after treatment (P < 0.05). After treatment, the total effective rate of the treatment group was 66.67%; the total effective rate of the control group was 36.11%, the difference was statistically significant (P < 0.05). In the treatment group, the degree of liver steatosis was positively correlated with BMI, HOMA-IR, TG, TC and TNF-α (P < 0.05). Conclusions Metformin combined with Silibinin could improve insulin resistance, regulate glucolipid metabolic disorders, reduce the degree of liver steatosis; thus it is effective in the treatment of IGT complicated with NAFLD.