门冬胰岛素治疗糖尿病【双相门冬胰岛素30对2型糖尿病合并非酒精性脂肪性肝病患者疗效研究】
[摘要] 目的 观察双相门冬胰岛素30治疗糖尿病合并非酒精性脂肪性肝病的临床疗效。 方法 将70例糖尿病合并非酒精性脂肪性肝病患者随机分为两组， 治疗组采用双相门冬胰岛素30皮下注射，对照组采用预混精蛋白生物合成人胰岛素70/30皮下注射，根据血糖水平调整胰岛素剂量，均治疗24周为 1个疗程，疗程结束后，观察谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（ALP）、低密度值蛋白胆固醇（LDL-C）、糖化血红蛋白（HbA1c）、体重指数（BMI）、胰岛素抵抗指数（HOMA-IR）变化。同时观察两组患者ALT、AST、ALP恢复正常水平所需时间。 结果 治疗组治疗后HOMA-IR、BMI、LDL-C水平显著降低，与治疗前及对照组比较，差异有统计学意义（P < 0.05）。治疗组ALT、AST、ALP达标时间较对照组显著缩短（P < 0.05）。 结论 双相门冬胰岛素有较好临床疗效，可以降低糖尿病合并非酒精性脂肪性肝病患者血LDL-C、HOMA-IR水平及BMI，缩短患者ALT、AST、ALP达标时间，值得推广应用。
[关键词] 非酒精性脂肪性肝病；2型糖尿病；双相门冬胰岛素；预混精蛋白生物合成人胰岛素70/30
[中图分类号] R587.1 [文献标识码] A [文章编号] 1673-7210（2012）07（a）-0074-02
Clinical effect of biphasic insulin aspart 30 in the treatment of diabetic patients combined with non-alcoholic fatty liver disease
WANG Lei HU Junling
Department of Endocrinology, the First Affiliated Hospital of Nanyang Medicial College, He"nan Province, Nanyang 473058, China
[Abstract] Objective To observe the clinical efficacy of biphasic insulin aspart 30 in the treatment of diabetic patients combined with non-alcoholic fatty liver disease (NAFLD). Methods 70 cases of diabetic patients combined with NAFLD were randomly divided into two groups. The treatment group was adopted subcutaneous injection of biphasic insulin aspart 30, the control group was adopted subcutaneous injection of premixed human insulin70/30. Insulin dose was adjusted according to blood glucose levels. All patients were treated for 24 weeks as a course of treatment. After treatment changes of ALT, AST, ALP, LDL-C, HbA1c and BMI, HOMA-IR were observed; and the time of ALT, AST, ALP needed for back to normal levels in the two groups were observed. Results Compared with before treatment and the control group, after treatment BMI, HOMA-IR, LDL-C levels significantly decreased in the treatment group (P < 0.05). The recovery time of ALT, AST, ALP in the treatment group was significantly shorten than that of the control group (P < 0.05). Conclusion Biphasic insulin aspart has good clinical effect, which can reduce the blood level of LDL-C,HOMA-IR and BMI of diabetic patients combined with NAFLD, reduce the standard time of ALT, AST, ALP. It is worthy of clinical application.
[Key words] Non-alcoholic fatty fiver disease; Type 2 diabetes mellitus; Biphasic insulin aspart; Premixed human insulin 70/30
目前脂肪肝特别是非酒精性脂肪肝（NAFLD）在人群中的发病率逐年上升，2型糖尿病（T2DM）并发脂肪肝发生率高达46%[1]。本研究对T2DM合并NAFLD患者分别采用双相门冬胰岛素30（诺和锐30）治疗与预混精蛋白生物分成人胰岛素70/30（诺和灵30R）治疗，旨在观察双相门冬胰岛素30R对T2DM合并 NAFLD患者疗效，并对其作用机制进行初步探讨。