Feng Wenhuan, Gao Caixia, Bi Yan, Wu Min, Li Ping, Shen Shanmei, Chen Wei, Yin Tingting, Zhu Dalong
Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
Nanjing University of Chinese Medicine, Nanjing, China.
J Diabetes. 2017 Aug;9(8):800-809. doi: 10.1111/1753-0407.12555. Epub 2017 May 29.
The aim of the present study was to compare the effects of gliclazide, liraglutide, and metformin in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD).
Eighty-seven subjects were randomized to receive liraglutide, metformin, or gliclazide for 24 weeks. Primary outcomes included HbA1c levels, intrahepatic fat (IHF) content, and liver function.
Both HbA1c levels and IHF content were reduced after treatment in all three groups. However, HbA1c levels were lower in the liraglutide- and metformin-treated groups than in the gliclazide-treated group, and reductions in IHF content were greater with liraglutide than with gliclazide. Liraglutide and metformin treatments reduced weight and improved liver function. Changes in IHF content were positively correlated with reductions in serum alanine aminotransferase and triglyceride levels, as well as weight. At 24 weeks, reductions in IHF content were greater in subjects with weight loss ≥5%, changes in waistline ≤0 cm (including decreases in waistline), HbA1c reductions ≥2.5%, and HbA1c levels <6.5%.
In T2DM patients with NAFLD, compared with liraglutide and metformin, gliclazide resulted in less improvement in liver function, reductions in IHF content and HbA1c levels, and less weight loss; in addition, slightly better improvements were achieved with liraglutide than with metformin.
本研究旨在比较格列齐特、利拉鲁肽和二甲双胍对2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者的影响。
87名受试者被随机分为三组，分别接受利拉鲁肽、二甲双胍或格列齐特治疗24周。主要观察指标包括糖化血红蛋白（HbA1c）水平、肝内脂肪（IHF）含量和肝功能。
三组治疗后HbA1c水平和IHF含量均降低。然而，利拉鲁肽组和二甲双胍组的HbA1c水平低于格列齐特组，利拉鲁肽组IHF含量的降低幅度大于格列齐特组。利拉鲁肽和二甲双胍治疗可减轻体重并改善肝功能。IHF含量的变化与血清丙氨酸氨基转移酶和甘油三酯水平的降低以及体重呈正相关。在24周时，体重减轻≥5%、腰围变化≤0 cm（包括腰围减小）、HbA1c降低≥2.5%且HbA1c水平<6.5%的受试者，其IHF含量降低幅度更大。
在T2DM合并NAFLD患者中，与利拉鲁肽和二甲双胍相比，格列齐特在肝功能改善、IHF含量和HbA1c水平降低以及体重减轻方面效果较差；此外，利拉鲁肽的改善效果略优于二甲双胍。
