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1、,安徽医科大学第二附属医院内分泌科 钟 兴,糖尿病合并脂肪肝患者使用利拉鲁肽的病例分析,主诉及现病史,患者，男性，26岁 主诉：多尿伴体重下降半月。 现病史： 1. 患者半月前因多尿伴体重下降，在当地医院就诊查FBS 16.3mmol/L，ALT 206.2 u/L，AST 126.3 u/L，TG 6.65mmol/L。 2. 在当地未经治疗。,既往史/家族史,既往史：否认高血压病史 家族史：否认糖尿病家族史,体 格 检 查,身高：168cm 体重：83.5kg BMI： 29.58 kg/cm2 血压：120/85 其他体查：无多毛、痤疮和紫纹； 无甲状腺肿大及结节。,实 验 室 检 查,
2、血糖及细胞功能：,实 验 室 检 查,HbA1c：11.2% 血 脂：总胆固醇 4.91mmol/L 甘油三酯 4.42mmol/L 肝 功： ALT 135 u/L，AST 87 u/L,实 验 室 检 查,肝炎抗原阴性（甲肝、乙肝、丙肝、戊肝） 肾功能正常,辅 助 检 查,上腹B超提示：脂肪肝。 心电图：正常。 甲状腺B超：正常。,诊 断,1、2型糖尿病 2、脂肪肝 3、肝功能损害,治疗前后血糖、体重、血压、ALT变化,利拉鲁肽1.2mg，门冬胰岛素30： 18u早、8u晚,病 例 特 点,2型糖尿病合并肥胖、脂肪肝 胰岛素抵抗明显 肝功能损害,利拉鲁肽对HbA1C的影响,Diabetes
3、 Obes Metab. 2011 Mar;13(3):207-20.,利拉鲁肽1.8mg可使患者体重降低达3.4Kg,Marre et al. Diabetic Medicine 2009;26;26878 (LEAD-1); Nauck et al. Diabetes Care 2009;32;8490 (LEAD-2); Garber et al. Lancet 2009;373:47381 (LEAD-3); Zinman et al. Diabetes Care 2009;32:122430 (LEAD-4); Russell-Jones et al. Diabetologia 20
4、09;52:2046-2055 (LEAD-5); Buse et al. Lancet 2009;374 (9683):3947 (LEAD-6); Pratley et al. Lancet 2010;375:1447-56 (lira vs. sita),利拉鲁肽减轻的体重大部分是脂肪组织,组织体积的变化(kg),4,2,0,2,4,6,脂肪组织,*,NS,NS,*,瘦组织,LEAD-3,组织体积的变化(kg),4,2,0,2,4,6,脂肪组织,瘦组织,LEAD-2,DEXA, 双能X线吸收测量仪；数据用平均数 倍标准误表示; *p0.01; * p0.001 vs. 格列美脲 +二甲双
5、胍 in LEAD-2 and vs. 格列美脲 in LEAD-3 Jendle et al. Diabet Obes Metabol 2009;11:116372 (LEAD-2 and LEAD-3 substudies).,利拉鲁肽主要减少内脏脂肪,体脂的变化 DEXA扫描,内脏脂肪 vs. 皮下脂肪 CT 扫描,内脏脂肪,皮下脂肪,Jendle et al. Diabetes Obes Metab 2009; 11: 1163-72,The effectiveness of liraglutide in nonalcoholic Fatty liver disease patient
6、s with type 2 diabetes mellitus compared to sitagliptin and pioglitazone. Ohki T, Isogawa A, Iwamoto M, Ohsugi M, Yoshida H, Toda N, Tagawa K, Omata M, Koike K. Source Department of Gastroenterology, Mitsui Memorial Hospital, Kanda-izumicho 1, Chiyoda-ku, Tokyo 101-8643, Japan. Abstract Background.
7、Liraglutide leading to improve not only glycaemic control but also liver inflammation in non-alcoholic fatty liver disease (NAFLD) patients. Aims. The aim of this study is to elucidate the effectiveness of liraglutide in NAFLD patients with type 2 diabetes mellitus (T2DM) compared to sitagliptin and
8、 pioglitazone. Methods. We retrospectively enrolled 82 Japanese NAFLD patients with T2DM and divided into three groups (liraglutide: N = 26, sitagliptin; N = 36, pioglitazone; N = 20). We compared the baseline characteristics, changes of laboratory data and body weight. Results. At the end of follow
9、-up, ALT, fast blood glucose, and HbA1c level significantly improved among the three groups. AST to platelet ratio significantly decreased in liraglutide group and pioglitazone group. The body weight significantly decreased in liraglutide group (81.8 kg to 78.0 kg, P 0.01). On the other hands, the b
10、ody weight significantly increased in pioglitazone group and did not change in sitagliptin group. Multivariate regression analysis indicated that administration of liraglutide as an independent factor of body weight reduction for more than 5% (OR 9.04; 95% CI 1.12-73.1, P = 0.04). Conclusions. Admin
11、istration of liraglutide improved T2DM but also improvement of liver inflammation, alteration of liver fibrosis, and reduction of body weight.,The effectiveness of liraglutide in nonalcoholic Fatty liver disease patients with type 2 diabetes mellitus compared to sitagliptin and pioglitazone,治疗体会及总结,利拉鲁肽是一种从多方面干预2型糖尿病，有效调控血糖的人GLP-1类似物，对血糖、血脂、体重、血压均有一定的作用。 有明显改善胰岛素抵抗作用。 糖尿病合并NAFLD的治疗选择。,Thanks,
