度拉糖肽联合生酮饮食治疗老年2型糖尿病合并非酒精性脂肪肝的临床效果

摘要/Abstract

摘要： 目的探讨度拉糖肽联合生酮饮食治疗老年2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的效果。方法纳入2021年2月至2023年2月收治的94例T2DM合并NAFLD患者,采用摸球法分组,奇数为对照组(n=47),偶数为观察组(n=47),对照组予以胰岛素联合生酮饮食治疗,观察组予以度拉糖肽联合生酮饮食治疗,比较两组临床疗效,评估治疗前后的血糖、血脂、肝功能及氧化应激反应,同时监测不良反应发生率。结果观察组治疗有效率为97.87%(46/47),高于对照组的82.98%(39/47)。观察组FBG(6.10±1.22)mol/L、2hPBG(8.21±1.75)mol/L、HbA1c(6.21±1.25)%,低于对照组的(7.35±1.58)mol/L、(10.23±2.06)mol/L、(7.69±1.58)%。观察组TC(3.22±0.87)mol/L、TG(1.22±0.21)mol/L,低于对照组的(4.69±1.01)mol/L、(2.15±0.57)mol/L。观察组AST(23.54±3.59)U/L、ALT(41.32±4.76)U/L、GGT(31.62±4.01)U/L,低于对照组(32.78±4.27)U/L、(52.36±6.02)U/L、(49.86±5.75)U/L。观察MDA(642.51±90.27)mol/L、8-iso-PGF2α(125.35±11.05)pg/mL,低于对照组的(724.25±95.21)mol/L、(142.58±11.47)pg/mL,而GSH-Px(151.21±15.67)U/mL高于对照组(120.52±12.58)U/mL,差异均有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论度拉糖肽与生酮饮食联合治疗老年T2DM伴NAFLD效果显著,能有效降低血糖、血脂及改善肝功能和氧化应激反应,与胰岛素联合生酮饮食相比,临床疗效更好,且安全性相当。

关键词: 度拉糖肽, 生酮饮食, 老年2型糖尿病, 非酒精性脂肪肝

Abstract: Objective To evaluate the therapeutic effects of dulaglutide in combination with a ketogenic diet in the management of elderly patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD). Methods From February 2021 to February 2023, 94 patients with T2DM and NAFLD were enrolled in this study. Participants were randomly assigned to two groups: by random draw, the control group (n=47), receiving insulin and a ketogenic diet, and the observation group (n=47), treated with dulaglutide and a ketogenic diet. Clinical efficacy was assessed by comparing pre- and post-treatment levels of blood glucose, lipids, liver function, and oxidative stress markers between the two groups. Additionally, the incidence of adverse reactions was monitored. Results Post-treatment, the efficacy rate in the observation group was 97.87%, significantly higher than in the control group (82.98%). The observation group demonstrated significantly lower levels of fasting blood glucose(FBG) (6.10±1.22), 2-hour postprandial blood glucose(2hPBG) (8.21±1.75), and HbA1c (6.21±1.25) compared to the control group (7.35±1.58, 10.23±2.06, 7.69±1.58, respectively). Lipid levels, including total cholesterol(TC) (3.22±0.87) and TG (1.22±0.21) were also lower in the observation group compared to the control group (4.69±1.01 and 2.15±0.57, respectively). Liver function markers such as AST (23.54±3.59), ALT (41.32±4.76), and GGT (31.62±4.01) were significantly reduced in the observation group compared to the control group (32.78±4.27, 52.36±6.02, and 49.86±5.75, respectively). Additionally, oxidative stress markers,including MDA (642.51±90.27) and 8-iso-PGF2α (125.35±11.05), were lower, while GSH-Px (151.21±15.67) was higher in the observation group compared to the control group (724.25±95.21, 142.58±11.47, and 120.52±12.58, respectively), with all differences being statistically significant (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The combination of dulaglutide and a ketogenic diet significantly improves clinical outcomes in elderly patients with T2DM and NAFLD, effectively reducing blood sugar and lipid levels, enhancing liver function, and mitigating oxidative stress responses compared to insulin combined with a ketogenic diet, while maintaining a comparable safety profile.

Key words: Dulaglutide, Ketogenic diet, Elderly type 2 diabetes mellitus, Non-alcoholic fatty liver disease

彭钰涵, 刘子兰, 张潇. 度拉糖肽联合生酮饮食治疗老年2型糖尿病合并非酒精性脂肪肝的临床效果[J]. 肝脏, 2024, 29(9): 1132-1136.

PENG Yu-han, LIU Zi-lan, ZHANG Xiao. Clinical study of dulaglutide combined with a ketogenic diet in the treatment of elderly patients with type 2 diabetes mellitus complicated by non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2024, 29(9): 1132-1136.

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