艾塞那肽对2型糖尿病合并非酒精性脂肪肝患者肝脏脂肪含量及血清chemerin水平的影响

doi:10.6040/j.issn.1671-7554.0.2016.736

摘要/Abstract

摘要： 目的观察艾塞那肽对2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者血糖、肝脏脂肪含量及血清chemerin水平的影响。方法 T2DM合并NAFLD患者60例,随机分为2组,每组30例,艾塞那肽组在原治疗方案基础上加用艾塞那肽10 μg,早晚餐前1 h皮下注射,对照组加用甘精胰岛素,起始剂量0.2 U/kg或6~10 U。治疗12周,观察体质量(BW)、体质量指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血脂(TG、TC、HDL、LDL)、胰岛素抵抗指数(HOMA-IR)、肝酶学指标(ALT、AST)及血清chemerin水平,B超定量肝脏脂肪含量(LFC)变化。结果治疗12周后,艾塞那肽组BW、BMI、腰臀比(WHR)、HbA1c、FPG、TG,2hPG、ALT、AST水平均降低(P<0.05, P<0.01),FINS、HOMA-IR及chemerin水平亦降低(P<0.01),LFC减少(P<0.01)。对照组的HbA1c、FPG较治疗前降低(P<0.01)。相关回归分析显示BMI、TG、HOMA-IR、chemerin与LFC相关;多元逐步回归分析结果显示HOMA-IR、TG的下降纳入回归方程,是LFC下降的独立影响因子(β值分别为1.614、 1.360, P<0.05)。结论艾塞那肽能够改善糖脂代谢、肝功能,同时减轻体质量和肝脏脂肪含量,降低血清chemerin水平,有可能成为治疗T2DM合并NAFLD的有效药物。

关键词: 艾塞那肽, 肝脏脂肪含量, 2型糖尿病, 超声, Chemerin

Abstract: Objective To evaluate the effects of exenatide on the plasma glucose, liver fat content and serum chemerin in type 2 diabetic(T2DM)combined with non-alcoholic fatty liver disease(NAFLD)patients. Methods Sixty patients with T2DM and NAFLD were randomly divided into exenatide group(n=30)and control group(n=30). Exenatide group was treated by exenatide(10 μg subcutaneous injection one hour before breakfast and dinner), and the control group was treated by insulin glargine(the starting dose was 0.2 U/kg or 6-10 U)for 12 weeks. The changes of body weight(BW), body mass index(BMI), fasting plasma glucose(FPG), glycosylated hemoglobin(HbA1c), blood lipid(including TG, TC, HDL and LDL), insulin resistance index(HOMA-IR), liver enzyme index(including ALT and AST)and serum chemerin levels were measured, and the change of liver fat content was quantitated by ultrasound. Results Treated for 12 weeks, the levels of BW, BMI, WHR, HbA1c, FPG, TG, 2hPG, ALT, AST in exenatide group were significantly declined(P<0.05, P<0.01), the levels of FINS, HOMA-IR, chemerin and LFC decresed(P<0.01); the levels of HbA1c and FPG decresed in control group(P<0.01). Correlation analysis showed that BMI, TG, HOMA-IR and chemerin were associated with LFC; the decrease of TG and HOMA-IR were 山东大学学报 (医学版)54卷11期 -于宁,等.艾塞那肽对2型糖尿病合并非酒精性脂肪肝患者肝脏脂肪含量及血清chemerin水平的影响 \=-independently impacting factors for LFC by multiple stepwise regression analysis(β=1.614, 1.360, P<0.05). Conclusion Exenatide can improve the glucolipid metabolism and liver function, and reduce BW, LFC and serum chemerin levels, which may be the effect drugs for the treatment of T2DM combined with NAFLD.

Key words: Liver fat contents, Exenatide, Type 2 diabetes mellitus, Ultrasound, Chemerin

中图分类号:

R587.1

于宁,高燕燕,咸玉欣,牛佳鹏,李莉,王静,曹彩霞. 艾塞那肽对2型糖尿病合并非酒精性脂肪肝患者肝脏脂肪含量及血清chemerin水平的影响[J]. 山东大学学报（医学版）, 2016, 54(11): 51-55.

YU Ning, GAO Yanyan, XIAN Yuxin, NIU Jiapeng, LI Li, WANG Jing, CAO Caixia. Effect of exenatide on serum chemerin level and liver fat contents in type 2 diabetes mellitus combined with non-alcoholic fatty liver disease patients[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(11): 51-55.

参考文献

[1] Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology[J]. Gastroenterology, 2012, 142(7): 1592-1609.
[2] Gupta NA, Mells J, Dunham RM, et al. Glucagon-like peptide-1 receptor is present on human hepatocytes and has a direct role in decreasing hepatic steatosis in vitro by modulating elements of the insulin signaling pathway[J]. Hepatology, 2010, 51(5): 1584-1592.
[3] Mancini M, Prinster A, Annuzzi G, et al. Sonographic hepatic-renal ratio as indicator of hepatic steatosis: comparison with ¹H magnetic resonance spectroscopy[J]. Metabo1ism, 2009, 58(12): 1724-1730.
[4] Xia MF, Yan HM, He WY, et al. Standardized ultrasound hepatic/renal ratio and hepatic attenuation rate to quantify liver fat content: an improvement method[J]. Obesity, 2012, 20(2): 444-452.
[5] Kukla M, Zwirska-Korczala K, Hartleb M, et al. Serum chemerin and vaspin in non-alcoholic fatty liver disease[J]. Scand J Gastroenterol, 2010, 45(2): 235-242.
[6] Ernst MC, Sinal CJ. Chemerin: at the crossroads of inflammation and obesity[J]. Trends Endocrinol Metab, 2010, 21(11): 660-667.
[7] Yang J, Ao N, Du J, et al. Protective effect of liraglutide against ER stress in the liver of high-fat diet-induced insulin-resistant rats[J]. Endocrine, 2015, 49(1): 106-118.
[8] Kanazawa M, Yoshiike N, Osaka T, et al. Criteria and classification of obesity in Japan and Asia-Oceania[J]. World Rev Nutr Diet, 2005, 94: 1-12.
[9] Gao Y, Yoon KH, Chuang LM, et al. Efficacy and safety of exenatide in patients of Asian descent with type 2 diabetes inadequately controlled with metformin or metformin and a sulphonylurea[J]. Diabetes Res Clin Pract, 2009, 83(1): 69-76.
[10] Sudhakaran C, Fathima M, Anjana RM, et al. Effectiveness of exenatide in Asian Indians in a clinical care setting[J]. Diabetes Technol Ther, 2010, 12(8): 613-618.
[11] Sandoval D. CNS GLP-1 regulation of peripheral glucose homeostasis[J]. Physiol Behav, 2008, 94(5): 670-674.
[12] Bunck MC, Diamant M, Corner A, et al. One-year treatment with exenatide improves beta-cell function compared with insulin glargine in metformin-treated type 2 diabetic patients: a randomized, controlled trial[J].Diabetes Care, 2009, 32(5): 762-768.
[13] Pujante AP, Hellin GMD, Roman LM, et al. Metabolic control and weight loss in patients with obesity and type 2 diabetes mellitus,treated with exenatide[J]. Med Clin(Barc), 2012, 139(13): 572 -578.
[14] Klonoff DC, Buse JB, Nielsen LL, et al. Exenatide effects on diabetes, obesity, cardiovascular risk factors and hepatic biomarkers in patients with type 2 diabetes treated for 3 years[J]. Curr Med Res Opin, 2008, 24(1): 275-286.
[15] Lee YS, Shin S, Shigihara T, et al. Glucagon-like peptide-1 gene therapy in obese diabetic mice results in long-term cure of diabetes by improving insulin sensitivity and reducing hepatic gluconeogenesis[J]. Diabetes, 2007, 56(6): 1671-1679.
[16] Samson SL, Bajaj M. Potential of incretin-based therapies for nonalcoholic fatty liver disease[J]. J Diabetes Complications, 2013, 27(4): 401-406.
[17] 王玲艳,魏丽,于浩泳,等.脂肪因子chemerin与肥胖及2型糖尿病的关系[J].中华医学杂志, 2009, 89(4): 235-238. WANG Lingyan, WEI Li, YU Haoyong, et al. Relationship of chemerin to obesity and type 2 diabetes mellitus[J]. National Medical Journal of China, 2009, 89(4): 235-238.
[18] Ress C, Tschoner A, Engl J, et al. Effect of bariatric surgery on circulating chemerin levels[J]. Eur J Clin Invest, 2010, 40(3): 277-280.

相关文章 15

[1]	徐平于国放李霞. 不同类型甲状腺上动脉PSV对Graves病与桥本氏甲状腺炎鉴别诊断的价值[J]. 山东大学学报(医学版), 2209, 47(6): 62-64.
[2]	王艳萍,王玉波,董林,唐娜,徐晴晴,郭广君,郭时金,杨丽梅,徐子贤,张浩天,张文勇,徐倩倩. 响应面优化超声辅助低共熔溶剂提取惠白菊总黄酮工艺[J]. 山东大学学报 (医学版), 2026, 64(5): 29-41.
[3]	孟晓梅,郝亚平,王亮,于晓,唐与晓. 血清Isthmin1、Gremlin2水平与2型糖尿病患者视网膜病变的相关性[J]. 山东大学学报 (医学版), 2025, 63(9): 102-107.
[4]	申路佳,逯天威,巩伟明,赵岩松,王淑康,袁中尚. 代谢风险评分在2型糖尿病人群心血管结局预测中的应用[J]. 山东大学学报 (医学版), 2025, 63(8): 69-78.
[5]	陈莹莹,王鲁,胡锡峰,朱高培,薛付忠. 基于贝叶斯网络的2型糖尿病患者并发脑卒中风险预测[J]. 山东大学学报 (医学版), 2025, 63(8): 94-102.
[6]	李懿原,马珊,李爱华,龙飞. 超声支气管镜引导下碘-125粒子植入治疗肺癌中央区淋巴结转移[J]. 山东大学学报 (医学版), 2025, 63(12): 26-34.
[7]	董向毅,刘昕,刘欣欣,徐亚瑄,赵琳丽,陶国伟. 盆腔深部子宫内膜异位症的超声评价[J]. 山东大学学报 (医学版), 2025, 63(10): 34-42.
[8]	孙婧,杨瑞敏,王聪,张月,罗兵. 基于术前超声、炎症指标及超声影像组学联合模型预测乳腺癌腋窝淋巴结转移[J]. 山东大学学报 (医学版), 2025, 63(1): 73-80.
[9]	卢晓颂,杨瑞敏,王义成,周海丰,罗兵,李晓宇,李娜娜. 含瘤周组织的超声影像组学在鉴别乳腺结节良恶性中的价值[J]. 山东大学学报 (医学版), 2025, 63(1): 90-98.
[10]	冯昌,郭岩,赵杰,赵鑫. 加速康复外科理念下超声引导区域阻滞在骨科手术中的研究进展[J]. 山东大学学报 (医学版), 2024, 62(10): 26-35.
[11]	李红梅,蔡敏,周立,姚欣雨,刘力. 不同膈肌超声功能指标在腹部手术后肺部并发症中的预测价值[J]. 山东大学学报 (医学版), 2024, 62(10): 115-124.
[12]	于婷,李媛,吴梅. 超声诊断羊膜带综合征并胎头离断1例[J]. 山东大学学报 (医学版), 2023, 61(8): 122-124.
[13]	陈天杰,张晓华,王瑞霞,赵淑磊. 超声内镜引导下细针穿刺抽吸术诊断胰腺淋巴管瘤合并术后感染1例[J]. 山东大学学报 (医学版), 2023, 61(7): 121-124.
[14]	吴磊丽,蔡华丽,孙德胜,魏蔚霞. 超声引导穿刺硬化术联合地诺孕素治疗卵巢子宫内膜异位囊肿的疗效[J]. 山东大学学报 (医学版), 2023, 61(6): 65-69.
[15]	李金泉,高美芳,闫飞,董明. 136例2型糖尿病患者肌肉痉挛的发生频率及危险因素[J]. 山东大学学报 (医学版), 2023, 61(5): 20-24.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed