诺和力病例精编版

1、主诉及现病史主诉及现病史 患者，男性，患者，男性，26岁岁 主诉：主诉：多尿伴体重下降半月。多尿伴体重下降半月。 现病史现病史： 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。在当地未经治疗。 既往史既往史/ /家族史家族史 既往史：否认高血压病史既往史：否认高血压病史 家族史：否认糖尿病家族史家族史：否认糖尿病家族史体体 格格 检检 查查 身高：身高：168cm 体重：体重：83.5kg BMI： 29.58

2、 kg/cm2 血压：血压：120/85 其他体查：无多毛、痤疮和紫纹；其他体查：无多毛、痤疮和紫纹； 无甲状腺肿无甲状腺肿大及结节。大及结节。实实 验验 室室 检检 查查 血糖及血糖及细胞功能：细胞功能：实实 验验 室室 检检 查查 HbA1c：11.2% 血血 脂：脂：总胆固醇总胆固醇 4.91mmol/L 甘油三酯甘油三酯 4.42mmol/L 肝肝 功：功： ALT 135 u/L，AST 87 u/L实实 验验 室室 检检 查查 肝炎抗原阴性（甲肝、乙肝、肝炎抗原阴性（甲肝、乙肝、丙肝、戊肝）丙肝、戊肝） 肾功能正常肾功能正常辅辅 助助 检检 查查 上腹上腹B B超提示：脂肪肝。超提

3、示：脂肪肝。 心电图：正常。心电图：正常。 甲状腺甲状腺B B超：正常。超：正常。诊诊 断断 1、2型糖尿病型糖尿病 2、脂肪肝、脂肪肝 3、肝功能损害、肝功能损害治疗前后血糖、体重、血压、治疗前后血糖、体重、血压、ALT变化变化利拉鲁肽利拉鲁肽1.2mg，门冬胰岛素，门冬胰岛素30： 18u早、早、8u晚晚病病 例例 特特 点点 2 2型糖尿病合并肥胖、脂肪肝型糖尿病合并肥胖、脂肪肝 胰岛素抵抗明显胰岛素抵抗明显 肝功能损害肝功能损害Diabetes Obes Metab. 2011 Mar;13(3):207-20. 利拉鲁肽利拉鲁肽1.8mg可使患者体重降低达可使患者体重降低达3.4Kg

4、体重的变化 (kg)0.0-0.5-1.0-1.5-2.0-1.8-2.051%43%-2.5-2.8-2.5-3.0-3.2-3.52.52.01.51.00.5-0.2艾塞那肽-2.9安慰剂格列美脲罗格列酮甘精胰岛素格列美脲+1.1+1.6+0.6+1.0 +2.1利拉鲁肽 1.8 mg*与对照相比具有显著差异*-3.4-1.0西格列汀SU联合治疗联合治疗(LEAD-1) Met 联合治疗联合治疗(LEAD-2) Met + TZD 联合治疗联合治疗(LEAD-4) Met + SU 联合治疗联合治疗 (LEAD-5) 单药治疗单药治疗(LEAD-3)Met SU 联合治疗联合治疗(LEA

5、D-6) Met 联合治疗联合治疗(Lira vs. sita) 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 2009;52:2046-2055 (LEAD-5); B

6、use 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利拉鲁肽减轻的体重大部分是脂肪组织利拉鲁肽利拉鲁肽1.2 mg/天天利拉鲁肽利拉鲁肽1.8 mg/天天格列美脲格列美脲 4 mg/天天组织体积的变化组织体积的变化(kg)420246脂肪组织脂肪组织*NSNS*瘦组织瘦组织LEAD-3组织体积的变化组织体积的变化(kg)420246脂肪组织脂肪组织瘦组织瘦组织*LEAD-2利拉鲁肽利拉鲁肽1.2 mg/天天

7、+ 二甲双胍二甲双胍利拉鲁肽利拉鲁肽1.8 mg/天天 +二甲双胍二甲双胍安慰剂安慰剂 +二甲双胍二甲双胍格列美脲格列美脲 8 mg/day +二甲双胍二甲双胍DEXA, 双能双能X线吸收测量仪；线吸收测量仪；数据用平均数数据用平均数 倍标准误表示倍标准误表示; *p0.01; * p0.001 vs. 格列美脲格列美脲 +二甲双胍二甲双胍 in LEAD-2 and vs. 格列美脲格列美脲 in LEAD-3Jendle 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

8、利拉鲁肽主要减少内脏脂肪体脂的变化体脂的变化DEXA扫描扫描内脏脂肪内脏脂肪 vs. 皮下脂肪皮下脂肪CT 扫描扫描内脏脂肪内脏脂肪皮下脂肪皮下脂肪Jendle et al. Diabetes Obes Metab 2009; 11: 1163-72The effectiveness of liraglutide in nonalcoholic Fatty liver disease patients with type 2 diabetes mellitus compared to sitagliptin and pioglitazone.Ohki T, Isogawa A, Iwamoto

9、 M, Ohsugi M, Yoshida H, Toda N, Tagawa K, Omata M, Koike K.SourceDepartment of Gastroenterology, Mitsui Memorial Hospital, Kanda-izumicho 1, Chiyoda-ku, Tokyo 101-8643, Japan.AbstractBackground. Liraglutide leading to improve not only glycaemic control but also liver inflammation in non-alcoholic f

10、atty 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 pioglitazone. Methods. We retrospectively enrolled 82 Japanese NAFLD patients with T2DM and divided int

11、o 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-up, ALT, fast blood glucose, and HbA1c level significantly improved among the three groups. AST to plat

12、elet ratio significantly decreased in liraglutide group and pioglitazone group. The body weight significantly decreased in liraglutide group (81.8kg to 78.0kg, P 0.01). On the other hands, the body weight significantly increased in pioglitazone group and did not change in sitagliptin group. Multivar

13、iate 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. Administration 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 mellituscompared to s