Mino Masaaki, Kakazu Eiji, Sano Akitoshi, Katsuyama Hisayuki, Hakoshima Mariko, Yanai Hidekatsu, Aoki Yoshihiko, Imamura Masatoshi, Yamazoe Taiji, Mori Taizo, Yoshio Sachiyo, Inoue Jun, Masamune Atsushi, Kanto Tatsuya
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Hepatol Res. 2023 Jul;53(7):618-628. doi: 10.1111/hepr.13898. Epub 2023 Mar 28.
The antidiabetic drugs sodium glucose cotransporter 2 inhibitors (SGLT2is) and thiazolidinediones have beneficial effects on the liver dysfunction of patients with nonalcoholic fatty liver disease and type 2 diabetes mellitus (T2DM). We aimed to determine the efficacy of these drugs for the treatment of liver disease in patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and T2DM.
We undertook a retrospective study of 568 patients with MAFLD and T2DM. Of these, 210 were treating their T2DM with SGLT2is (n = 95), 86 with pioglitazone (PIO), and 29 with both. The primary outcome was the change in Fibrosis-4 (FIB-4) index between baseline and 96 weeks.
At 96 weeks, the mean FIB-4 index had significantly decreased (from 1.79 ± 1.10-1.56 ± 0.75) in the SGLT2i group, but not in the PIO group. The aspartate aminotransferase to platelet ratio index, serum aspartate and alanine aminotransferase (ALT), hemoglobin A1c, and fasting blood sugar significantly decreased in both groups (ALT: SGLT2i group, -17 ± 3 IU/L; PIO group, -14 ± 3 IU/L). The bodyweight of the SGLT2i group decreased, but that of the PIO group increased (-3.2 kg and +1.7 kg, respectively). When the participants were allocated to two groups according to their baseline ALT (>30 IU/L), FIB-4 index significantly decreased in both groups. In patients taking pioglitazone, the addition of SGLT2i improved liver enzymes but not FIB-4 index for 96 weeks.
Treatment with SGLT2i causes a larger improvement in FIB-4 index than PIO in patients with MAFLD over 96 weeks.
抗糖尿病药物钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）和噻唑烷二酮类药物对非酒精性脂肪性肝病和2型糖尿病（T2DM）患者的肝功能障碍具有有益作用。我们旨在确定这些药物对代谢功能障碍相关脂肪性肝病（MAFLD）和T2DM患者肝病的治疗效果。
我们对568例MAFLD和T2DM患者进行了一项回顾性研究。其中，210例患者使用SGLT2i治疗T2DM（n = 95），86例使用吡格列酮（PIO），29例同时使用两者。主要结局是基线至96周时纤维化-4（FIB-4）指数的变化。
在96周时，SGLT2i组的平均FIB-4指数显著降低（从1.79±1.10降至1.56±0.75），而PIO组未降低。两组的天冬氨酸转氨酶与血小板比值指数、血清天冬氨酸和丙氨酸转氨酶（ALT）、糖化血红蛋白和空腹血糖均显著降低（ALT：SGLT2i组，-17±3 IU/L；PIO组，-14±3 IU/L）。SGLT2i组的体重下降，而PIO组的体重增加（分别为-3.2 kg和+1.7 kg）。当参与者根据其基线ALT（>30 IU/L）分为两组时，两组的FIB-4指数均显著降低。在服用吡格列酮的患者中，加用SGLT2i可改善肝酶，但96周时FIB-4指数未改善。
在MAFLD患者中，SGLT2i治疗96周比PIO能更大程度地改善FIB-4指数。
