摘要
目的探讨在2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)患者中,西格列汀联合二甲双胍的疗效及其对患者心肌损伤、心功能的影响。方法选择2020年1月至2023年12月于安阳市人民医院就诊的522例T2DM合并NAFLD患者,使用随机数字表法进行分组,对照组261例(给予二甲双胍治疗),研究组261例(给予西格列汀联合二甲双胍治疗),比较两组临床治疗疗效,血糖、肝功能、心肌损伤、心功能,以及不良反应发生情况。结果与对照组比较,研究组治疗总有效率更高(90.80%vs75.86%)(P<0.05)。与治疗前比较,两组治疗后空腹血糖(fasting blood glucose,FPG)、餐后2 h血糖(2 hours plasma glucose,2h PG)、糖化血红蛋白(glycated hemoglobin,Hb A1c)、谷草转氨酶(aspartate aminotransferase,AST)、谷丙转氨酶(alanine aminotransferase,ALT)、γ-谷氨酰转肽酶(gamma-glutamyltransferase,GGT)、B型利钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-pro BNP)、心肌肌钙蛋白T(cardiac troponin T,c Tn T)均显著降低(P<0.05)。且治疗后,研究组FPG(5.97±1.23)mmol/L、2h PG(8.87±1.3)mmol/L、Hb Alc(7.69±1.28)%、AST(34.82±7.52)IU/L、ALT(38.54±11.25)IU/L、GGT(36.81±7.05)IU/L、NT-pro BNP(75.58±20.47)pg/m L、c-Tn T(11.22±1.35)ng/L下降均较对照组更显著(P<0.05)。与治疗前比较,两组治疗后心率(heart rate,HR)显著降低(P<0.05),二尖瓣环舒张早期峰值速度(E)与舒张晚期峰值速度(A)比值(E/A)、左室射血分数(left ventricular ejection fraction,LVEF)显著升高(P<0.05)。研究组治疗后左室舒张末前后径(left ventricular end dia‐stolic dimension,LVDD)显著升高(P<0.05),且治疗后研究组HR(81.54±7.63)次/min、E/A(1.06±0.19)、LVEF(64.44±1.59)%变化均较对照组更显著(P<0.05)。研究组(12.64%)和对照组(8.81%)不良反应发生情况差异无统计学意义(P?0.05)。结论在T2DM合并NAFLD患者中,西格列汀联合二甲双胍治疗可提高临床疗效,降低血糖,改善肝功能,减轻心肌损伤,改善心功能,且安全性较高。
Objective To investigate the efficacy of sitagliptin combined with metformin in patients with type 2 diabetes melli⁃tus(T2DM)and nonalcoholic fatty liver disease(NAFLD),and its effect on myocardial injury and cardiac function.Methods A total of 522 T2DM patients with NAFLD who were treated at Anyang People's Hospital from January 2020 to December 2023 were randomly divided into two groups using a random number table method:a control group of 261 patients(treated with metformin)and a study group of 261 patients(treated with sitagliptin combined with metformin).The clinical treatment efficacy,blood glucose,liver func⁃tion,myocardial injury,heart function,and incidence of adverse reactions were compared between the two groups.Results Com⁃pared with the control group,the total effective rate of the study group was higher(90.80%vs 75.86%)(P<0.05).Compared with before treatment,both groups showed significant reductions in fasting blood glucose(FPG),2-hour plasma glucose(2hPG),glycated hemoglobin(HbA1c),aspartate aminotransferase(AST),alanine aminotransferase(ALT),gamma glutamyltransferase(GGT),Nterminal pro-B-type natriuretic peptide(NT proBNP),cardiac troponin T(cardiac troponin T),and cardiac troponin T(cTnT)after treatment(P<0.05).After treatment,the study group showed more significant decreases in fasting plasma glucose(FPG:5.97±1.23)mmol/L,2-hour plasma glucose(2hPG:8.87±1.3)mmol/L,glycated hemoglobin(HbA1c:7.69±1.28)%,aspartate amino⁃transferase(AST:34.82±7.52)IU/L,alanine aminotransferase(ALT:38.54±11.25)IU/L,gamma glutamyltransferase(GGT:36.81±7.05)IU/L,N-terminal pro-B-type natriuretic peptide(NT-proBNP:75.58±20.47)pg/mL,and cardiac troponin T(c-TnT:11.22±1.35)ng/L compared to the control group(P<0.05).Compared with before treatment,both groups showed a significant decrease in heart rate(HR)after treatment(P<0.05),a significant increase in the ratio of early diastolic peak velocity(E)to late diastolic peak velocity(A)of the mitral annulus(E/A),and left ventricular ejection fraction(LVEF)(P<0.05).After treatment,the left ventricular end diastolic dimension(LVDD)mm in the study group increased significantly(P<0.05).After treatment,the study group showed more significant changes in heart rate(HR:81.54±7.63)beats/min,the E/A ratio(1.06±0.19),and left ventricular ejection fraction(LVEF:64.44±1.59)%compared to the control group(P<0.05).There was no significant difference in the occur⁃rence of adverse reactions between the study group(12.64%)and the control group(8.81%)(P˃0.05).Conclusion In patients with type 2 diabetes mellitus(T2DM)complicated by non-alcoholic fatty liver disease(NAFLD),the combination therapy of sita⁃gliptin with metformin can improve clinical outcomes,lower blood glucose levels,ameliorate liver function,reduce myocardial damage,and improve cardiac function,with a high level of safety.
作者
潘红博
穆玉晶
姜丽燕
杨璐
张月翡
PAN Hongbo;MU Yujing;JIANG Liyan;YANG Lu;ZHANG Yuefei(Department of Endocrinology,Anyang People's Hospital,Anyang 455000,China)
出处
《西南医科大学学报》
2025年第2期192-197,共6页
Journal of Southwest Medical University
关键词
西格列汀
二甲双胍
非酒精性脂肪肝
2型糖尿病
心肌损伤
心功能
Sigliptin
Metformin
Nonalcoholic fatty liver
Type 2 diabetes mellitus
Myocardial injury
Cardiac function
