Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Diabetes Obes Metab. 2024 Dec;26(12):5857-5869. doi: 10.1111/dom.15958. Epub 2024 Sep 24.
Many patients with type 1 diabetes mellitus (T1DM) met the histological criteria for non-alcoholic steatohepatitis (NASH), which leads to cardiovascular disease morbidity and mortality. Matrix metalloproteinase-14 (MMP-14) is involved in cardiovascular disease and atherosclerosis.
To assess the impact of oral dipeptidyl peptidase-4 inhibitor, vildagliptin, as adjunctive therapy on NASH in adolescents with T1DM and its effect on glycaemic control, MMP-14 levels and carotid intima media thickness (CIMT).
Sixty adolescents with T1DM and NASH were randomly assigned to receive oral vildagliptin (50 mg once daily) for 6 months or not. Glycated haemoglobin, lipid profile, hepatic steatosis index, triglyceride glucose (TyG) index and MMP-14 levels were assessed. Transient elastography with controlled attenuation parameter (CAP) was performed together with measuring CIMT.
By transient elastography, 12 (20%) patients with T1DM with NASH had elevated liver stiffness ≥7 kPa (F2 stage or higher). Baseline MMP-14 was positively correlated to insulin dose (p = 0.016), triglycerides and TyG index, CIMT, liver stiffness and CAP levels among the studied patients (p < 0.001 for all). After 6 months, patients with T1DM on vildagliptin therapy had significantly lower glycated haemoglobin, lipid profile, hepatic steatosis index and TyG index, as well as MMP-14 (p < 0.001). CIMT, liver stiffness and CAP were significantly decreased post-therapy compared with baseline levels and compared with the control group (p < 0.001). Vildagliptin was safe and well-tolerated.
Administration of vildagliptin for adolescents with T1DM and NASH improved glycaemic control, dyslipidaemia and MMP-14 levels and decreased liver stiffness and CIMT; hence, reducing subclinical atherosclerosis and disease progression.
许多 1 型糖尿病（T1DM）患者符合非酒精性脂肪性肝炎（NASH）的组织学标准，这导致心血管疾病发病率和死亡率增加。基质金属蛋白酶-14（MMP-14）与心血管疾病和动脉粥样硬化有关。
评估口服二肽基肽酶-4 抑制剂维格列汀作为辅助治疗对 T1DM 青少年 NASH 的影响及其对血糖控制、MMP-14 水平和颈动脉内膜中层厚度（CIMT）的影响。
60 例 T1DM 合并 NASH 的青少年患者被随机分为口服维格列汀（50mg，每日一次）组或非治疗组，疗程 6 个月。评估糖化血红蛋白、血脂谱、肝脂肪变性指数、甘油三酯葡萄糖（TyG）指数和 MMP-14 水平。采用受控衰减参数（CAP）行瞬时弹性成像，同时测量 CIMT。
根据瞬时弹性成像，12 例（20%）T1DM 合并 NASH 患者的肝硬度≥7kPa（F2 期或更高）。MMP-14 基线值与胰岛素剂量呈正相关（p=0.016），与研究患者的甘油三酯和 TyG 指数、CIMT、肝硬度和 CAP 水平呈正相关（p<0.001）。6 个月后，接受维格列汀治疗的 T1DM 患者的糖化血红蛋白、血脂谱、肝脂肪变性指数和 TyG 指数以及 MMP-14 均显著降低（p<0.001）。与基线相比，治疗后 CIMT、肝硬度和 CAP 显著降低，与对照组相比也显著降低（p<0.001）。维格列汀安全且耐受良好。
对于 T1DM 合并 NASH 的青少年，给予维格列汀治疗可改善血糖控制、血脂异常和 MMP-14 水平，并降低肝硬度和 CIMT，从而减少亚临床动脉粥样硬化和疾病进展。
