[1]王慧,李忠淑.二甲双胍联合恩替卡韦治疗2型糖尿病合并HBV感染并发NAFLD的疗效分析[J].国际内分泌代谢杂志,2022,42(02):124-128.[doi:10.3760/cma.j.cn121383-20200711-07031]
　Wang Hui,Li Zhongshu..Therapeutic effect of metformin combined with entecavir on type 2 diabetes mellitus complicated with HBV infection and NAFLD[J].International Journal of Endocrinology and Metabolism,2022,42(02):124-128.[doi:10.3760/cma.j.cn121383-20200711-07031]
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二甲双胍联合恩替卡韦治疗2型糖尿病合并HBV感染并发NAFLD的疗效分析()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
42
期数:
2022年02期
页码:
124-128
栏目:
论著
出版日期:
2022-03-20

文章信息/Info

Title:
Therapeutic effect of metformin combined with entecavir on type 2 diabetes mellitus complicated with HBV infection and NAFLD
作者:
王慧; 李忠淑
自贡市第一人民医院内分泌科 643000
Author(s):
Wang Hui;  Li Zhongshu.
Department of Endocrinology, Zigong First People's Hospital, Zigong 643000, China
关键词:
二甲双胍;  2型糖尿病;  乙型肝炎病毒感染;  非酒精性脂肪性肝病
Keywords:
Metformin;  Type 2 diabetes mellitus;  HBV infection;  Nonalcoholic fatty liver disease
DOI:
10.3760/cma.j.cn121383-20200711-07031
摘要:
目的 对比二甲双胍联合恩替卡韦与胰岛素联合恩替卡韦治疗2型糖尿病合并乙型肝炎病毒(HBV)感染并发非酒精性脂肪性肝病(NAFLD)的疗效。方法 回顾性收集2010年3月至2018年12月自贡市第一人民医院收治的符合2型糖尿病合并慢性乙型病毒性肝炎同时并发NAFLD的患者,随访患者半年、1年时间段的病史、辅助检查、实验室检查结果,采用SPSS23统计软件,对比二甲双胍联合恩替卡韦组与胰岛素联合恩替卡韦组二者相关统计数据之间的差异。结果 剔除不符合要求的患者,最终纳入165例,其中使用二甲双胍联合恩替卡韦患者50例,胰岛素联合恩替卡韦患者115例。二者基线特征中男女比例、吸烟人数、糖化血红蛋白、C肽、谷草转氨酶(AST)、谷丙转氨酶(ALT)、脂肪衰减指数、AST/血小板比值(APRI)指数、纤维化-4(FIB-4)指数、总胆固醇、低密度脂蛋白-胆固醇、γ-谷氨酰转肽酶(γ-GT)、白蛋白、NAFLD纤维化积分、空腹血糖差异无统计学意义。随访半年,二者在糖化血红蛋白(t=3.239, P=0.03)、γ-GT(t=1.345, P=0.03)、NAFLD纤维化积分(t=1.256, P=0.04)、空腹血糖(t=2.157, P=0.02)指标差异有统计学意义。两组随访1年后,糖化血红蛋白(t=2.314, P=0.04)、FIB-4指数(χ2=1.782, P=0.03)、脂肪衰减指数(t=2.279, P=0.04)、γ-GT(t=4.263, P=0.01)、NAFLD纤维化积分(t=4.256, P=0.01)、白蛋白(t=2.231, P=0.03)、空腹血糖(t=2.157, P=0.02)差异有统计学意义。结论 对比胰岛素联合恩替卡韦组,二甲双胍联合恩替卡韦有助于降低2型糖尿病合并HBV感染并发NAFLD患者的肝纤维化风险,但对于强化血糖控制效果稍低于胰岛素联合恩替卡韦组患者。服用二甲双胍有可能减少乙肝肝硬化进程,降低肝硬化发病风险。
Abstract:
Objective To compare the efficacy of metformin combined with entecavir and insulin combined with entecavir in the treatment of type 2 diabetes mellitus complicated with HBV infection and nonalcoholic fatty liver disease(NAFLD).Methods From March 2010 to December 2018, the patients with type 2 diabetes mellitus complicated with chronic hepatitis B and NAFLD in our hospital were collected retrospectively, and the results of medical history, auxiliary examination and laboratory examination were followed up for half a year and one year. The statistical differences between metformin combined with entecavir group and insulin combined with entecavir group were compared by SPSS23 software.Results Unqualified patients were excluded, and finally 165 cases were included, including 50 cases of metformin combined with entecavir and 115 cases of insulin combined with entecavir. There was no significant difference in the ratio of male to female, smoking number, glycosylated hemoglobin, C-peptide, AST, ALT, fat attenuation index, APRI index, FIB-4 index, total cholesterol, low density lipoprotein, γ-GT, albumin, NAFLD fibrosis score and fasting blood glucose between the two baseline characteristics. At half a year's follow-up, the levels of glycosylated hemoglobin(t=3.239, P=0.03), γ-GT(t=1.345, P=0.03), NAFLD fibrosis score(t=1.256, P=0.04), and fasting blood glucose(t=2.157, P=0.05)were significantly higher than those of the two groups. After one year's follow-up, the glycosylated hemoglobin(t=2.314, P=0.04), FIB-4 index(χ2=1.782, P=0.03), fat attenuation index(t=2.279, P=0.04), and γ-GT(t=4.263, P=0.02)were significantry different between the two groups.Conclusion Compared with insulin combined with entecavir, metformin combined with entecavir can reduce the risk of liver fibrosis in patients with type 2 diabetes complicated with HBV infection and NAFLD, but the effect of blood glucose control is slightly lower than that of insulin combined with entecavir. Taking metformin may reduce the progression and risk of hepatitis B related cirrhosis.

参考文献/References:

[1] World Health Organization.Diabetes[EB/OL].[2020-7-10].https://www.who.int/news-room/fact-sheets/detail/diabetes.
[2] 刘大凤,冉兴无,王林,等.病毒性肝炎合并糖尿病的流行病学特征分析[J].中华实验和临床感染病杂志(电子版),2012,06(2):121-124.DOI:10.3877/cma.j.issn.1674-1358.2012.02.009.
[3] 中国研究型医院学会肝病专业委员会,中国医师协会脂肪性肝病专家委员会,中华医学会肝病学分会脂肪肝与酒精性肝病学组,中华医学会内分泌学分会肝病与代谢学组.脂肪性肝病诊疗规范化的专家建议(2019年修订版)[J].临床肝胆病杂志,2019,35(11):2426-2430.DOI:10.3969/j.issn.1001-5256.2019.11.007.
[4] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,(7):447-498.DOI:10.3760/cma.j.issn.1674-5809.2014.07.004.
[5] 中华医学会感染病学分会,中华医学会肝病学分会.慢性乙型肝炎防治指南(2019年版)[J].中华肝脏病杂志,2019,27(12):938-961.DOI:10.3760/cma.j.issn.1007-3418.2019.12.007.
[6] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南(2010年修订版)[J].中华肝脏病杂志,2010,18(3):163-166.DOI:10.3760/cma.j.issn.1007-3418.2010.03.002.
[7] Chalasani N,Younossi Z,Lavine JE,et al.The diagnosis and management of non-alcoholic fatty liver disease:practice guideline by the American Gastroenterological Association,American Association for the Study of Liver Diseases,and American College of Gastroenterology[J].Gastroenterology,2012,142(7):1592-1609.DOI:10.1053/j.gastro.2012.04.001.
[8] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会感染病学分会.肝纤维化诊断及治疗共识(2019年)[J].胃肠病学,2019,24(9):546-556.DOI:10.3969/j.issn.1008-7125.2019.09.007.
[9] Crowley MJ,Diamantidis CJ,McDuffie JR,et al.Clinical outcomes of metformin use in populations with chronic kidney disease,congestive heart failure,or chronic liver disease:a systematic review[J].Ann Intern Med,2017,166(3):191-200.DOI:10.7326/M16-1901.
[10] Handzlik G,Holecki M,Kozaczka J,et al.Evaluation of metformin therapy using controlled attenuation parameter and transient elastography in patients with non-alcoholic fatty liver disease[J].Pharmacol Rep,2019,71(2):183-188.DOI:10.1016/j.pharep.2018.10.013.
[11] Vilar-Gomez E,Calzadilla-Bertot L,Wong VW,et al.Type 2 diabetes and metformin use associate with outcomes of patients with nonalcoholic Ssteatohepatitis-related,Child-Pugh A cirrhosis[J].Clin Gastroenterol Hepatol,2021,19(1):136-145.e6.DOI:10.1016/j.cgh.2020.04.083.
[12] Vilar-Gomez E,Vuppalanchi R,Desai AP,et al.Long-term metformin use may improve clinical outcomes in diabetic patients with non-alcoholic steatohepatitis and bridging fibrosis or compensated cirrhosis.[J].Aliment Pharmacol Ther,2019,50(3):317-328.DOI:10.1111/apt.15331.
[13] 张利利,李玉芳,张驰,等.乙型肝炎肝硬化合并2型糖尿病发生原发性肝癌的风险研究[J].中华肝脏病杂志,2019,27(10):788-792.DOI:10.3760/cma.j.issn.1007-3418.2019.10.010.
[14] Musi N,Hirshman MF,Nygren J,et al.Metformin increases AMP-activated protein kinase activity in skeletal muscle of subjects with type 2 diabetes[J].Diabetes,2002,51(7):2074-2081.DOI:10.2337/diabetes.51.7.2074.
[15] Su JR,Lu ZH,Su Y,et al.Relationship of serum adiponectin levels and metformin therapy in patients with type 2 diabetes[J].Horm Metab Res,2016,48(2):92-98.DOI:10.1055/s-0035-1569287.
[16] Zulian A,Cancello R,Girola A,et al.In vitro and in vivo effects of metformin on human adipose tissue adiponectin[J].Obes facts,2011,4(1):27-33.DOI:10.1159/000324582.

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通信作者:王慧,Email:37911311@qq.com
更新日期/Last Update: 2022-04-20