Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, Haryana, India
Department of Radiology, Medanta-The Medicity Hospital, Gurugram, Haryana, India.
Diabetes Care. 2018 Aug;41(8):1801-1808. doi: 10.2337/dc18-0165. Epub 2018 Jun 12.
Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have been shown to reduce liver fat in rodent models. Data regarding the effect of SGLT-2 inhibitors on human liver fat are scarce. This study examined the effect of empagliflozin (an SGLT-2 inhibitor) on liver fat in patients with type 2 diabetes and nonalcoholic fatty liver disease (NAFLD) by using MRI-derived proton density fat fraction (MRI-PDFF).
Fifty patients with type 2 diabetes and NAFLD were randomly assigned to either the empagliflozin group (standard treatment for type 2 diabetes plus empagliflozin 10 mg daily) or the control group (standard treatment without empagliflozin) for 20 weeks. Change in liver fat was measured by MRI-PDFF. Secondary outcome measures were change in alanine transaminase (ALT), aspartate transaminase (AST), and γ-glutamyl transferase (GGT) levels.
When included in the standard treatment for type 2 diabetes, empagliflozin was significantly better at reducing liver fat (mean MRI-PDFF difference between the empagliflozin and control groups -4.0%; < 0.0001). Compared with baseline, significant reduction was found in the end-of-treatment MRI-PDFF for the empagliflozin group (16.2% to 11.3%; < 0.0001) and a nonsignificant change was found in the control group (16.4% to 15.5%; = 0.057). The two groups showed a significant difference for change in serum ALT level ( = 0.005) and nonsignificant differences for AST ( = 0.212) and GGT ( = 0.057) levels.
When included in the standard treatment for type 2 diabetes, empagliflozin reduces liver fat and improves ALT levels in patients with type 2 diabetes and NAFLD.
钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂已被证明可减少啮齿动物模型中的肝脂肪。关于 SGLT-2 抑制剂对人类肝脂肪影响的数据很少。本研究通过磁共振成像衍生质子密度脂肪分数（MRI-PDFF）检查 SGLT-2 抑制剂依帕格列净对 2 型糖尿病和非酒精性脂肪性肝病（NAFLD）患者肝脂肪的影响。
50 例 2 型糖尿病合并 NAFLD 患者被随机分为依帕格列净组（2 型糖尿病标准治疗加每日依帕格列净 10 毫克）或对照组（无依帕格列净的标准治疗），治疗 20 周。通过 MRI-PDFF 测量肝脂肪的变化。次要终点为丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和 γ-谷氨酰转移酶（GGT）水平的变化。
当依帕格列净纳入 2 型糖尿病的标准治疗时，降低肝脂肪的效果明显更好（依帕格列净组与对照组之间的 MRI-PDFF 差异平均为 -4.0%；<0.0001）。与基线相比，依帕格列净组治疗结束时 MRI-PDFF 显著降低（从 16.2%降至 11.3%；<0.0001），对照组则无显著变化（从 16.4%降至 15.5%；=0.057）。两组间血清 ALT 水平的变化有显著差异（=0.005），AST（=0.212）和 GGT（=0.057）水平无显著差异。
在 2 型糖尿病的标准治疗中加入依帕格列净可降低 2 型糖尿病合并 NAFLD 患者的肝脂肪并改善 ALT 水平。
