目的：探讨格列美脲联合二甲双胍治疗对新诊断2型糖尿病伴非酒精性脂肪肝病（NAFLD）患者胰岛素抵抗和胰岛β细胞功能的影响。方法选取2012年1月—2013年12月于赣州市人民医院新诊断的2型糖尿病伴NAFLD 患者58例，按随机数字表法将患者分为对照组（28例）及治疗组（30例）。两组均在二甲双胍1500 mg/ d 基础上联合用药，对照组口服格列吡嗪控释片5 mg/ d，治疗组口服格列美脲2 mg/ d，并根据血糖水平调整用量。两组患者分别于入组前及治疗12周停药3 d 后行75 g 口服葡萄糖耐量试验（OGTT），于0、30、60、120、180 min 行血糖、胰岛素水平检测。结果治疗前，两组空腹血糖（FBG）、餐后2 h 血糖（2 h PG）、糖化血红蛋白（HbA1c ）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、肝脏胰岛素抵抗指数（ HRI）、Matsuda 指数（MSI）、胰岛β细胞功能（HOMA-βF）、早相胰岛素分泌指数及晚相胰岛素分泌指数比较，差异均无统计学意义（P ﹥0.05）。治疗12周后，两组 FBG、2 h PG、HbA1c水平比较，差异无统计学意义（P ﹥0.05）；治疗组 FINS、lnMSI、lnHOMA-βF、早相胰岛素分泌指数高于对照组，HOMA-IR、lnHRI、晚相胰岛素分泌指数低于对照组，差异均有统计学意义（ P ﹤0.05）。两组各指标与治疗前比较，差异均有统计学意义（P ﹤0.05）。治疗期间，治疗组3例发生低血糖，对照组9例发生低血糖，两组低血糖发生率比较，差异有统计学意义（χ2＝4.33，P ＝0.037）。结论格列美脲或格列吡嗪控释片联合二甲双胍治疗均能改善2型糖尿病伴 NAFLD 患者的胰岛素抵抗和早相胰岛素分泌，格列美脲联合二甲双胍治疗能更有效改善胰岛素抵抗和早相胰岛素分泌，有利于平稳控制血糖。%Objective To explore the effect of glimepiride combined with metformin on insulin resistance and islet beta cell function in patients with newly diagnosed type 2 diabetes( T2DM)companied with NAFLD. Methods We enrolled 58 patients who were newly diagnosed with T2DM combined with NAFLD in Ganzhou People' s Hospital from January 2012 to December 2013. Using random number table method,the patients were randomly divided into control group( n = 28)and treatment group(n = 30). The two groups were both administrated with metformin by 1 500 mg/ d;the control group was also orally administrated with glipizide controlled release tablets by 5 mg/ d,and the treatment group was also orally given glimepiride 2 mg/ d;the drug dosage was adjusted according to blood glucose. Before intervention and after 12 weeks intervention,75 g OGTT was administrated after drug with drawal for 3 days,and blood glucose and insulin level were measured at 0,30,60,120 and 180 min after OGTT. Results Before treatment,the two groups were not significantly different in FBG,2 h PG,HbA1c , FINS,HOMA-IR,lnHRI,lnMSI,HOMA-βF,early - phase insulin secretion index and late - phase insulin secretion index (P ﹥ 0. 05). After 12 weeks of intervention,the two groups were not significantly different in FBG,2 h PG,HbA1c ( P ﹥0. 05);the treatment group was higher in FINS,lnMSI,lnHOMA-βF,early - phase insulin secretion index,and lower in HOMA-IR,lnHRI,late - phase insulin secretion index( P ﹤ 0. 05). After treatment,the indexes of the two groups were significantly different from those before treatment( P ﹤ 0. 05). During treatment,hypoglycemia occurred in 3 patients in the treatment group and 9 patients in the control group,with significant difference in the incidence of hypoglycemia between the two groups(χ2 = 4. 33,P = 0. 037). Conclusion Glimepiride or glipizide controlled - release tablets combined with metformin both can effectively improve insulin resistance and early phase insulin secretion in patients with newly diagnosed T2DM combined with NAFLD. Glimepiride combined with metformin is more effective in improving insulin resistance and early phase insulin secretion,and is more helpful for blood glucose control.
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