吡格列酮联合非药物治疗对非酒精性脂肪性肝病的疗效

目的观察吡格列酮联合非药物治疗对非酒精性脂肪性肝病（NAFLD）的临床疗效。方法 64例NAFLD患者随机分成非药物组和联合组,每组32例。非药物组接受中等程度热量限制及中等量有氧运动治疗,联合组接受吡格列酮＋中等程度热量限制及中等量有氧运动治疗。检测并记录患者治疗前及治疗3、6个月后的体重指数（BMI）、天门冬胺酸转胺酶（ALT）、-谷氨酰转肽酶（-GT）、肝脏B超、肝脏CT、空腹血糖（FPG）、空腹胰岛素（FNS）、胰岛素抵抗指数（HOMA-IR）、甘油三脂（TG）、总胆固醇（TC）、高密度脂蛋白（HDL-C）;对比两组治疗3、6个月的疗效;观察治疗期间不良反应的发生情况。结果非药物组治疗6个月BMI和FNS较治疗前降低（P〈0.05）。联合组治疗后3、6个月的BMI、ALT、-GT、FPG、FNS、HOMA-IR、TG、TC、HDL-C及肝/脾CT比值较治疗前改善（P〈0.05）。联合组治疗3个月及6个月的总有效率均高于同期的非药物组（34.4%vs 12.5%,81.3%vs 21.9%,均P〈0.05）。治疗期间,联合组仅1例女性患者发生双下肢轻度水肿。结论吡格列酮联合非药物治疗可有效改善NAFLD及合并代谢综合征的多项临床指标,该治疗方法安全、有效。

Therapeutic efficacy of pioglitazone combined with non-drug treatment on nonalcoholic fatty liver disease

Objective To evaluate the therapeutic efficacy of pioglitazone combined with non-drug treatment on nonalcoholic fatty liver disease（NAFLD）. Methods A total of 64 patients with NAFLD were enrolled in the study. The patients were divided randomly into 2 groups of 32 patients each. Patients in non-drug theatment groups received moderate caloric restriction and moderate aerobic exercise therapy. Drug treatment group received pioglitazone combined with the non-drug therapy. Clinical parameters, including body mass index（BMI）, aspartate aminotransferase（ALT）, - glutamyl endopeptidase（-GT）, liver/spleen ratio, fasting plasma glucose（FPG）, fasting insulin（FNS）, insulin resistance index（HOMA-IR）, triglycerides（TG）, total cholesterol（TC）, and high density lipoprotein（HDL-C）, were documented before and 3 and 6 months after treatment. The effectiveness was compared between the two groups. The adverse reactions were observed during the treatment and followup period. Results Treatment with pioglitazone combined with non-drug therapy produced a significant improvement in BMI, ALT, -GT, liver/spleen ratio, FPG, FNS, HOMA-IR, TG, TC, and HDL-C both 3 and 6 months later（P〈0.05）; whereas treatment with non-drug therapy produced a significant decrease in BMI and FNS 6 months later（P〈0.05）. The total effective rates in pioglitazone group were significantly higher than that in non-drug group on both 3 and 6 months after treatment（34.4% vs 12.5% for 3 month, P〈0.05; 81.3% vs 21.9%, P〈0.05）. Mild lower extremity edema occurred in 1 patient in pioglitazone group during the follow-up period. Conclusion Pioglitazone combined with non-drug therapy led to multiple clinical indicator improvement in NAFLD patients, which was a safe and effective treatment for NAFLD.