CAJ | 학술논문

目的：探讨二甲双胍对2型糖尿病（ DM）合并非酒精性脂肪肝病（ NAFLD）患者血清nesfatin-1及肝脂肪变的影响。方法选取2型DM合并NAFLD患者60例，随机分为观察组和对照组各30例。对照组给予饮食及运动治疗；观察组在饮食及运动治疗基础上加用二甲双胍，疗程为12周。比较2组治疗前及治疗12周后体质量指数（BMI）、空腹血糖（FPG）、空腹胰岛素（FIN）、糖化血红蛋白（HbA1c）、TC、TG、LDL-C、HDL-C、胰岛素抵抗指数（HOMA-IR）、nesfatin-1等指标变化。治疗前及治疗12周后，所有患者进行肝脏CT检查，评价肝脂肪变的程度。结果与治疗前比较，治疗12周后观察组BMI、FPG、HOMA-IR、HbA1c、TG、TC、nesfatin-1均明显改善，差异有统计学意义（ P ＜0构．05）；对照组BMI、FPG、HOMA-IR、HbA1c、TG、TC略下降，FIN、nesfatin-1、HDL-C、LDL-C无明显改善，差异均无统计学意义（ P ＞0．05）；与对照组比较，观察组BMI、FPG、HOMA-IR、HbA1c、TG、TC、nesfatin-1均改善明显，差异有统计学意义（ P ＜0．05）。治疗12周后，观察组总有效率为71．43％，高于对照组的35．71％（ P ＜0．05）。观察组肝脂肪变的程度与BMI、HOMA-IR、TG、TC 呈正相关（ r ＝0．396、0．369、0．347、0．428， P均＜0．05），与nesfatin-1呈负相关（r ＝-7．37， P ＜0．05）。结论二甲双胍可以改善胰岛素抵抗、调节糖脂代谢紊乱、减少肝脏脂肪变程度。而nesfa-tin-1可调节胰岛素的分泌和肝糖合成，可能是二甲双胍调节糖脂代谢、改善肝脏胰岛素抵抗的作用位点之一，有望成为2型DM合并NAFLD治疗的新靶点。
목적：탐토이갑쌍고대2형당뇨병（ DM）합병비주정성지방간병（ NAFLD）환자혈청nesfatin-1급간지방변적영향。방법선취2형DM합병NAFLD환자60례，수궤분위관찰조화대조조각30례。대조조급여음식급운동치료；관찰조재음식급운동치료기출상가용이갑쌍고，료정위12주。비교2조치료전급치료12주후체질량지수（BMI）、공복혈당（FPG）、공복이도소（FIN）、당화혈홍단백（HbA1c）、TC、TG、LDL-C、HDL-C、이도소저항지수（HOMA-IR）、nesfatin-1등지표변화。치료전급치료12주후，소유환자진행간장CT검사，평개간지방변적정도。결과여치료전비교，치료12주후관찰조BMI、FPG、HOMA-IR、HbA1c、TG、TC、nesfatin-1균명현개선，차이유통계학의의（ P ＜0구．05）；대조조BMI、FPG、HOMA-IR、HbA1c、TG、TC략하강，FIN、nesfatin-1、HDL-C、LDL-C무명현개선，차이균무통계학의의（ P ＞0．05）；여대조조비교，관찰조BMI、FPG、HOMA-IR、HbA1c、TG、TC、nesfatin-1균개선명현，차이유통계학의의（ P ＜0．05）。치료12주후，관찰조총유효솔위71．43％，고우대조조적35．71％（ P ＜0．05）。관찰조간지방변적정도여BMI、HOMA-IR、TG、TC 정정상관（ r ＝0．396、0．369、0．347、0．428， P균＜0．05），여nesfatin-1정부상관（r ＝-7．37， P ＜0．05）。결론이갑쌍고가이개선이도소저항、조절당지대사문란、감소간장지방변정도。이nesfa-tin-1가조절이도소적분비화간당합성，가능시이갑쌍고조절당지대사、개선간장이도소저항적작용위점지일，유망성위2형DM합병NAFLD치료적신파점。
Objective To investigate the effects of metformin on the serum nesfatin 1 and liver steatosis in type 2 dia-betic patients with nonalcoholic fatty liver disease .Methods Selected 60 cases of type 2 DM patients with NAFLD , they were randomly divided into observation group and control group with each group of 30 cases.The control group received diet and ex-ercise therapy;observation group therapy based on diet and exercise plus metformin treatment for 12 weeks.Before and 12 weeks after treatment, compared of the two groups'body mass index (BMI), fasting plasma glucose (FPG), fasting plasma insulin (FIN), glycated serum protein (HbA1c), TC, TG, LDL-C, HDL-C, insulin resistance index(HOMA-IR),nesfatin-1 and other indicators of change .Before treatment and 12 weeks after treatment , all patients received liver CT examination , evaluate the degree of hepatic steatosis .Results Compared with before treatment , after 12 weeks of treatment , BMI, FPG, HOMA-IR, HbA1c , TG, TC, nesfatin-1 in the observation group were significantly improved , and the difference was statisti-cally significant ( P <0.05);the control group BMI, FPG, HOMA-IR, HbA1c, TG, TC decreased slightly,FIN,nesfatin-1, HDL-C, LDL-C showed no significant improvement , there was no statistical difference significance ( P >0.05).Compared with the control group , the observation group BMI , FPG, HOMA-IR, HbA1c , TG, TC, nesfatin-1 have improved significant-ly, and the difference was statistically significant ( P <0.05).After 12 weeks of treatment, total effective rate was 71.43%, higher than the 35.71%in control group( P <0.05).Hepatic steatosis's extent and BMI,HOMA-IR,TG,TC was positively correlated( r =0.396,0.369,0.347,0.428, P <0.05),and nesfatin-1 was negatively correlated ( r =-7.37, P <0.05). Conclusion Metformin can improve insulin resistance , regulate glucose and lipid metabolism , reduce the degree of hepatic steatosis.The nesfatin-1 can regulate the secretion of insulin and glycogen synthesis , probably Metformin, one of the sites of action to improve hepatic insulin resistance , is expected to become a new target for the treatment of type 2 DM merger of NAFLD.