Effect observation of metform in combined w ith glimepiride in the treatment of obese patient w ith type 2 diabetesmellitus com panied w ith nonalcoholic fatty liver disease
ZHANG Lei1 KE Rui-qiong2▲ OUYANG Can-hui1 LIAO Yue-guang1 HUANGCai-bin1
1.Department of Gastroenterology，the First Affiliate Hospital of Gannan Medical University，Ganzhou 341000，China；
2. Department of Endocrinology and Metabolism，the First Affiliate Hospital of Gannan Medical University，Ganzhou 341000，China
摘要目的 探讨二甲双胍联合格列美脲治疗非酒精性脂肪肝（NAFLD）合并2型糖尿病（T2DM）肥胖患者的临床疗效。方法选取2014年4月～2015年6月本院诊断的62例非酒精性脂肪肝合并肥胖的2型糖尿病患者作为研究对象，随机分为A组（30例）和B组（32例）。在给予二甲双胍治疗的基础上，A组给予格列美脲，B组给予吡格列酮治疗。比较两组治疗前后的肝功能、血糖、血脂、体质指数（BMI）、胰岛素抵抗（HOMA-IR）的变化及不良反应发生情况。结果 两组治疗后的ALT、AST、TC、TG、LDL-C、BMI、FPG、2 h PG、HbA1c、HOMA-IR水平显著低于治疗前，FINS、HOMA-βF水平显著高于治疗前，差异有统计学意义（P＜0.05）。两组治疗前后的HDL-C水平比较，差异无统计学意义（P＞0.05）。A组治疗后的HbA1c、2 h PG及BMI水平显著低于B组治疗后，差异有统计学意义（P＜0.05）。两组均未发生的严重的不良反应。结论 二甲双胍联合格列美脲或吡格列酮治疗肥胖型T2MD合并NAFLD均可显著改善糖脂代谢异常、降酶和减低胰岛素抵抗，但二甲双胍联合格列美脲改善血糖的效果更优，可作为治疗T2MD合并NAFLD的患者有效方案。
Abstract：Objective To explore the clinical effect ofmetformin combined with glimepiride in the treatment of non-alcoholic fatty liver disease（NAFLD）companied with obese type 2 diabetes patients（T2DM）.M ethods 62 patientswith NAFLD with obese T2DM in our hospital from April 2014 to June 2015 were selected and randomly divided into group A（30 cases）and group B（32 cases）.On the basis of the treatment ofmetformin，group A was given glimepiride，group B was treated with pioglitazone.The change of liver function，blood glucose，blood lipid，bodymass index（BMI），insulin resistance （HOMA-IR）and adverse reaction was compared between the two groups before and after treatment.Results The level of ALT，AST，TC，TG，LDL-C、BMI，FPG，2 h PG，HbA1c，HOMA-IR after treatment in the two groups was lower than that before treatment，the level of FINS，HOMA-βF after treatment in the two groupswas higher than that before treatment，with significant difference （P＜0.05）.There was no significant difference in the HDL-C level between the two groups before and after treatment（P＞0.05）.The level of HbA1c，2 h PG and BMIafter treatment in group A was lower than that in group B after treatment，with significant difference （P＜0.05）.There was no serious adverse reaction in each groups.Conclusion The results suggest both therapies could effectively improve glucose and lipid metabolism，reduce enzyme and insulin resistance in NAFLD with obese T2DM patients with metformin combined with glimepiride or pioglitazone，butmetformin combined with glimepiride can improve glucosemore better and can be used to as an effective treatment for patientswith NAFLD combined with T2MD.
张蕾； 柯瑞琼； 欧阳灿晖； 廖跃光； 黄才斌. 二甲双胍联合格列美脲治疗非酒精性脂肪肝合并2型糖尿病肥胖患者的效果观察[J]. 中国当代医药, 2016, 23(20): 132-134.
ZHANG Lei；KE Rui-qiong； OUYANG Can-hui；LIAO Yue-guang；HUANGCai-bin. Effect observation of metform in combined w ith glimepiride in the treatment of obese patient w ith type 2 diabetesmellitus com panied w ith nonalcoholic fatty liver disease. 中国当代医药, 2016, 23(20): 132-134.
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