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摘要：
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摘要：目的 比较二甲双胍、阿卡波糖及西格列汀治疗2型糖尿病合并非酒精性脂肪性肝病（non-
alcoholic fatty liver disease，NAFLD）患者的临床效果。方法 选择2016年9月到2018年9月于宝鸡市
第二人民医院就诊的2型糖尿病合并NAFLD患者240例，采用随机数字表将其分为阿卡波糖组、西格
列汀组及二甲双胍组，每组80例。所有患者均给予饮食控制及运动指导，二甲双胍组服用二甲双胍
0.5 g/次，3次/d；阿卡波糖组服用阿卡波糖50 mg/次，3次/d；西格列汀组服用西格列汀100 mg/次，
1次/d；3组患者均治疗6个月。检测3组患者空腹血糖（fasting plasma glucose，FPG）、餐后2 h血
糖（2 h postprandial blood glucose，2hPG）、糖化血红蛋白（glycosylated hemoglobin，HbA1c）、
空腹胰岛素水平（fasting insulin，FIns）、胰岛素抵抗指数（homeostasis model assessment-insulin
resistance index，HOMA-IR）、血清脂联素（adiponecti，ADN）、丙氨酸氨基转移酶（alanine
aminotransferase，ALT）、天冬氨酸氨基转移酶（aspartate aminotransferase，AST）、γ-谷氨酰转肽
酶（γ-glutamyl transpeptidase，γ-GT）、肝脂肪含量及受控衰减参数（controlled attenuation parameters，
CAP）；统计3组患者治疗期间不良反应（包括头疼、腹泻、恶心及低血糖）发生率。结果 治疗
前，二甲双胍组、阿卡波糖组及西格列汀组患者的性别 [男性：43（53.75%）vs 41（51.25%）vs 40
（50.00%）]、年龄 [（51.24 ± 5.15）岁 vs（51.13 ± 5.11）岁 vs（51.08 ± 5.10）岁]、糖尿病病
程 [（4.37 ± 0.43）年 vs（4.26 ± 0.43）年 vs（4.42 ± 0.44）年]、轻度脂肪肝比例 [33（41.25%）vs 31
（38.75%）vs 35（43.75%）]、FPG [（7.43 ± 0.74）mmol/L vs（7.59 ± 0.76）mmol/L vs（7.52 ± 0.75）mmol/L]、
2hPG [（12.34 ± 1.21）mmol/L vs（12.34 ± 1.23）mmol/L vs（12.25 ± 1.22）mmol/L]、HbA1c [0.0821 ±
0.0082 vs 0.0843 ± 0.0084 vs 0.0836 ± 0.0083]、FIns [（10.55 ± 1.06）mIU/L vs（10.39 ± 1.04）mIU/L vs
（10.46 ± 1.05）mIU/L]、AST [（67.18 ± 6.72）U/L vs（67.05 ± 6.71）U/L vs（67.23 ± 6.72）U/L]、
ALT [（56.24 ± 5.62）U/L vs（56.11 ± 5.61）U/L vs（56.38 ± 5.64）U/L]、γ-GT [（62.18 ± 6.21）U/L
vs（61.89 ± 6.19）U/L vs（62.05 ± 6.20）U/L]、HOMA-IR [3.50 ± 0.52 vs 3.51 ± 0.53 vs 3.50 ± 0.52]、
ADN [（456.38 ± 45.64）ng/ml vs（452.95 ± 45.29）ng/ml vs（454.67 ± 45.46）ng/ml]、肝脂肪含
量 [（13.17 ± 2.32）% vs（13.06 ± 2.31）% vs（13.14 ± 2.31）%] 及CAP [（274.38 ± 27.44）dB/m vs
（275.16 ± 27.52）dB/m vs （273.08 ± 27.31）dB/m] 的差异无统计学意义（P ＞ 0.05）。治疗后，
二甲双胍组、阿卡波糖组及西格列汀组患者FPG [（6.42 ± 0.64）mmol/L vs（6.11 ± 0.61）mmol/L vs
（5.66 ± 0.56）mmol/L]、2hPG [（10.38 ± 1.04）mmol/L vs（9.42 ± 0.95）mmol/L vs（8.77 ± 0.88）mmol/L]、
HbA1c [0.0749 ± 0.0074 vs 0.0679 ± 0.0068 vs 0.0631 ± 0.0063]、FIns [（9.43 ± 0.94）mIU/L vs（9.11 ±
0.91）mIU/L vs（8.52 ± 0.85）mIU/L]、HOMA-IR [2.70 ± 0.40 vs 2.47 ± 0.35 vs 2.14 ± 0.30]、ADN
[（582.49 ± 58.25）ng/ml vs（643.62 ± 64.36）ng/ml vs（748.39 ± 74.84）ng/ml]、AST [（44.59 ± 4.46）U/L vs
（40.36 ± 4.04）U/L vs（36.14 ± 3.61）U/L]、ALT [（42.58 ± 4.26）U/L vs（40.33 ± 4.03）U/L vs（38.79 ±
3.88）U/L]、γ-GT [（45.38 ± 4.54）U/L vs（40.83 ± 4.08）U/L vs（35.46 ± 3.55）U/L]、肝脂肪含量
[（10.26 ± 1.03）% vs（8.77 ± 0.88）% vs（7.15 ± 0.72）%]及CAP [（250.23 ± 25.02）dB/m vs（241.63 ±
24.16）dB/m vs（233.09 ± 23.31）dB/m]，差异有统计学意义（P均＜ 0.05）。西格列汀组FPG、2hPG、
HbA1c、FIns、HOMA-IR、AST、ALT、γ-GT、肝脂肪含量及CAP值水平均显著低于其他2组，ADN
水平高于其他2组，差异有统计学意义（P均＜ 0.05）。二甲双胍组、阿卡波糖组和西格列汀组患者不
良反应发生率分别为17.50%（14/80）、13.75%（11/80）、11.25%（9/80），差异无统计学意义（χ 2 =
1.300，P = 0.522）。西格列汀组患者治疗后FPG、2hPG、HbA1c、 FIns、HOMA-IR 、ADN、AST、
ALT、γ-GT、肝脂肪含量和CAP均显著低于治疗前（P均＜ 0.001）。结论 西格列汀治疗2型糖尿病合并
NAFLD疗效较好且可有效改善肝功能。
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Abstract: Objective To investigate the clinical curative effects of metformin, acarbose and sitagliptin on
type 2 diabetes mellitus combined with non-alcoholic fatty liver disease (NAFLD). Methods A total of 240
type 2 diabetes mellitus patients combined with NAFLD in Baoji No.2 People’s Hospital from September
2016 to September 2018 were enrolled. The patients were divided into metformin group, acarbose group and
sitagliptin group according to random number method, 80 cases in each group. Dietary control and exercise
guidance were given to all patients. Patients in metformin group were given metformin 0.5 g/time, 3 times/d,
patients in acarbose group were given acarbose 50 mg/time, 3 times/d and patients in siglitatin group were
given siglitatin 100 mg/time, 3 times/d. All patients were treated for 6 months. Fasting plasma glucose (FPG),
2 h postprandial blood glucose (2hPG), glycosylated hemoglobin (HbA1c), fasting insulin (FIns), homeostasis
model assessment-insulin resistance index (HOMA-IR), adiponecti (ADN), alanine aminotransferase (ALT),
aspartate aminotransferase (AST), γ-glutamyl transpeptidase (γ-GT), content of liver fat and controlled
attenuation parameters (CAP) of patients in three groups were detected. The incidence of adverse reactions
(including headache, diarrhea, nausea and hypoglycemia) during treatment of patients in 3 groups were
recorded. Results Before treatment, gender [male: 43 (53.75%) vs 41 (51.25%) vs 40 (50.00%)], age [(51.24 ±
5.15) years vs (51.13 ± 5.11) years vs (51.08 ± 5.10) years], course of diabetes mellitus [(4.37 ± 0.43) years vs
(4.26 ± 0.43) years vs (4.42 ± 0.44) years], ratio of mild fatty liver [33 (41.25%) vs 31 (38.75%) vs 35 (43.75%)],
FPG [(7.43 ± 0.74) mmol/L vs (7.59 ± 0.76) mmol/L vs (7.52 ± 0.75) mmol/L], 2hPG [(12.34 ± 1.21) mmol/L
vs (12.34 ± 1.23) mmol/L vs (12.25 ± 1.22) mmol/L], HbA1c [0.0821 ± 0.0082 vs 0.0843 ± 0.0084 vs 0.0836 ±
0.0083], FIns [(10.55 ± 1.06) mIU/L vs (10.39 ± 1.04) mIU/L vs (10.46 ± 1.05) mIU/L], AST [(67.18 ± 6.72) U/L vs
(67.05 ± 6.71) U/L vs (67.23 ± 6.72) U/L], ALT [ (56.24 ± 5.62) U/L vs (56.11 ± 5.61) U/L vs (56.38 ± 5.64) U/L],
γ-GT [(62.18 ± 6.21) U/L vs (61.89 ± 6.19) U/L vs (62.05 ± 6.20) U/L], HOMA-IR [3.50 ± 0.52 vs 3.51 ± 0.53 vs
3.50 ± 0.52], ADN [(456.38 ± 45.64) ng/ml vs (452.95 ± 45.29) ng/ml vs (454.67 ± 45.46) ng/ml], liver fat content
[(13.17 ± 2.32)% vs (13.06 ± 2.31) % vs (13.14 ± 2.31)%] and CAP [(274.38 ± 27.44) dB/m vs (275.16 ±
27.52) dB/m vs (273.08 ± 27.31) dB/m] of patients in metformin group, acarbose group and sitagliptin group
had no statistically significant difference (all P ＜ 0.05). After treatment, FPG [(6.42 ± 0.64) mmol/L vs (6.11 ±
0.61) mmol/L vs (5.66 ± 0.56) mmol/L], 2hPG [(10.38 ± 1.04) mmol/L vs (9.42 ± 0.95) mmol/L vs (8.77 ±
0.88) mmol/L]、HbA1c [0.0749 ± 0.0074 vs 0.0679 ± 0.0068 vs 0.0631 ± 0.0063], FIns [(9.43 ± 0.94) mIU/L
vs (9.11 ± 0.91) mIU/L vs (8.52 ± 0.85) mIU/L], HOMA-IR [2.70 ± 0.40 vs 2.47 ± 0.35 vs 2.14 ± 0.30], ADN
[(582.49 ± 58.25) ng/ml vs (643.62 ± 64.36) ng/ml vs (748.39 ± 74.84) ng/ml], AST [(44.59 ± 4.46) U/L vs
(40.36 ± 4.04) U/L vs (36.14 ± 3.61) U/L], ALT [(42.58 ± 4.26) U/L vs (40.33 ± 4.03) U/L vs (38.79 ± 3.88) U/L],
γ-GT [(45.38 ± 4.54) U/L vs (40.83 ± 4.08) U/L vs (35.46 ± 3.55) U/L], liver fat content [(10.26 ± 1.03)%
vs (8.77 ± 0.88)% vs (7.15 ± 0.72)%] and CAP [(250.23 ± 25.02) dB/m vs (241.63 ± 24.16) dB/m vs (233.09 ±
23.31) dB/m] of patients in metformin group, acarbose group and sitagliptin group were statistically different
(all P ＜ 0.05). The levels of FPG, 2hPG, HbA1c, FIns, HOMA-IR, AST, ALT, γ-GT, liver fat content and
CAP of patients in sitagliptin group were lower than those in metformin group and acarbose group, the level
of AND was higher than those in the other two groups, the differences were statistically significant (all P ＜
0.05). The incidence of adverse reactions of patients in metformin group, acarbose group and sitagliptin group
were 17.50% (14/80), 13.75% (11/80) and 11.25%(9/80), respectively, the differences were not statistically
significant (χ 2 = 1.300, P = 0.522). After treatment, FPG, 2hPG, HbA1c, FIns, HOMA-IR, ADN, AST, ALT,
γ-GT, liver fat content and CAP of patients in sitagliptin group were significantly lower than those before
treatment (all P ＜ 0.001). Conclusions The curative effect of sitagliptin on type 2 diabetes mellitus combined
with NAFLD is relatively better and can effectively improve liver function of the patients.
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