Mills Elizabeth P, Brown K Paige D, Smith Jennifer D, Vang Phillip W, Trotta Katie
Campbell University College of Pharmacy & Health Sciences, Pharmacy Practice, PO Box 1090, Buies Creek, NC 27506, USA.
Campbell University College of Pharmacy & Health Sciences, Pharmacy Practice, Buies Creek, NC, USA.
Ther Adv Endocrinol Metab. 2018 Jan;9(1):15-28. doi: 10.1177/2042018817741852. Epub 2017 Dec 7.
To review current literature for the efficacy and safety of treatment for nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).
A PubMed literature search from January 1990 to June 2017 was conducted using the search terms nonalcoholic fatty liver disease, diabetes mellitus, type 2, therapy, treatment, treat, therapeutics, nonalcoholic fatty liver, nonalcoholic hepatosteatosis, NASH, NAFLD, metformin, and statin. Bibliographies of chosen articles were reviewed.
Relevant articles on metformin, thiazolidinediones (TZD), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and statins for the treatment of NAFLD which included patients with T2DM were reviewed. A total of 23 relevant studies were found and included randomized controlled, observational, and open-label designs, as well as three meta-analyses.
Metformin combined with weight loss provides a modest improvement in steatosis and no improvement in fibrosis in patients with NAFLD and T2DM. TZDs showed positive results on fibrosis and resolution of NASH but at least half of patients studied were nonresponders. GLP-1 RAs also showed favorable results on reductions in transaminases and steatosis and improvements in insulin sensitivity and weight loss but lack efficacy data for resolution of NASH or improvement in fibrosis scores. Statins showed favorable results on reductions in transaminases but mixed results for improvement in steatosis and fibrosis scores.
All reviewed treatment options are safe for management of NAFLD in patients with T2DM but long-term histological improvements are minimal. TZDs are efficacious for resolution of NASH and improvements in fibrosis but long-term use is required to maintain these results.
回顾当前关于2型糖尿病（T2DM）患者非酒精性脂肪性肝病（NAFLD）治疗的疗效和安全性的文献。
使用搜索词“非酒精性脂肪性肝病”“糖尿病”“2型”“疗法”“治疗”“医治”“治疗学”“非酒精性脂肪肝”“非酒精性肝脂肪变性”“非酒精性脂肪性肝炎”“NAFLD”“二甲双胍”和“他汀类药物”，对1990年1月至2017年6月的PubMed文献进行检索。对所选文章的参考文献进行了回顾。
对有关二甲双胍、噻唑烷二酮类（TZD）、胰高血糖素样肽-1受体激动剂（GLP-1 RA）和他汀类药物治疗NAFLD（包括T2DM患者）的相关文章进行了回顾。共发现23项相关研究，包括随机对照、观察性和开放标签设计，以及三项荟萃分析。
二甲双胍联合体重减轻对NAFLD和T2DM患者的脂肪变性有适度改善，但对纤维化无改善。TZD对纤维化和非酒精性脂肪性肝炎的消退显示出阳性结果，但至少一半的研究患者无反应。GLP-1 RA对转氨酶降低、脂肪变性减轻、胰岛素敏感性改善和体重减轻也显示出良好效果，但缺乏非酒精性脂肪性肝炎消退或纤维化评分改善的疗效数据。他汀类药物对转氨酶降低显示出良好效果，但对脂肪变性和纤维化评分改善的结果不一。
所有审查的治疗方案对T2DM患者的NAFLD管理都是安全的，但长期组织学改善很小。TZD对非酒精性脂肪性肝炎的消退和纤维化改善有效，但需要长期使用以维持这些结果。
