Effect of Dapagliflozin on Alanine Aminotransferase Improvement in Type 2 Diabetes Mellitus with Non-alcoholic Fatty Liver Disease.
Effect of Dapagliflozin on Alanine Aminotransferase Improvement in Type 2 Diabetes Mellitus with Non-alcoholic Fatty Liver Disease.
复制标题
DOI：
10.3803/enm.2018.33.3.387
复制
发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Kim BY
中科院分区：
文献类型：
--
作者：
Choi DH;Jung CH;Mok JO;Kim CH;Kang SK;Kim BY
钠-葡萄糖协同转运蛋白-2抑制剂（SGLT 2 i）有望通过其特有的机制改善非酒精性脂肪性肝病（NAFLD）合并2型糖尿病（T2 DM）患者的肝功能。本研究旨在探讨SGLT 2 i之一达格列净与二甲双胍联合用药对T2 DM合并NAFLD患者肝功能的影响。在诊断为NAFLD的3个月内接受双重口服降糖药的患者中，包括丙氨酸氨基转移酶（ALT）水平异常（>40 IU/L）的患者。患者分为两组：二甲双胍+达格列净组和二甲双胍+二肽基肽酶-4抑制剂（DPP 4 i）组。所有患者的人口统计学资料、生化资料、临床和治疗史均进行了回顾。共纳入102例患者（达格列净组，n=50; DPP 4 i组，n=52）。达格列净组的体重减轻和ALT下降幅度大于DPP 4 i组（分别为−2.9 kg vs. −0.4 kg，P=0.005; −21.1 U/L vs. −9.5 U/L，P=0.008），达格列净组治疗后ALT恢复正常的患者比例也显著较高（80.0% vs. 61.5%，P=0.041）。在校正包括体重减轻在内的混杂变量后，达格列净联合二甲双胍对ALT正常化的影响仍然显著（比值比，3.489; P=0.046）。当与二甲双胍联合使用时，达格列净组的ALT改善比DPP 4 i组具有统计学显著性，并且在调整混杂变量（包括体重减轻）后，结果一致。
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are expected to improve the liver function of patients with non-alcoholic fatty liver disease (NAFLD) combined type 2 diabetes mellitus (T2DM) by its characteristic mechanism. This study was designed to investigate the effect of dapagliflozin, one of the SGLT2i, on the liver function of T2DM with NAFLD when combined with metformin. Among patients who received dual oral hypoglycemic agents within the 3 months of diagnosing NAFLD, patients who had abnormal alanine aminotransferase (ALT) level (>40 IU/L) were included. Patients were divided into two groups: metformin+dapagliflozin group and metformin+dipeptidyl peptidase-4 inhibitors (DPP4i) group. Demographic data, biochemical data and the clinical and treatment histories of all patients were reviewed. A total of 102 patients were included (dapagliflozin group, n=50; DPP4i group, n=52). Dapagliflozin group showed more weight loss and more ALT decline than DPP4i group (−2.9 kg vs. −0.4 kg, P=0.005; −21.1 U/L vs. −9.5 U/L, P=0.008, respectively) and the proportion of patients with ALT normalization after treatment was also significantly higher in the dapagliflozin group (80.0% vs. 61.5%, P=0.041). The effect of dapagliflozin with metformin on ALT normalization remained significant after adjustment for confounding variables including body weight loss (odds ratio, 3.489; P=0.046). ALT improvement was statistically significant in the dapagliflozin than the DPP4i when combined with metformin and the result was consistent after adjustment for confounding variables including body weight loss.