诺和力病例课件

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FBS16.3mmol/L，ALT206.2u/L，AST126.3u/L，TG6.65mmol/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：否认糖尿病家族史实验室检查血糖及β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：ALT135u/L，AST87u/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。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晚利拉鲁肽对HbA1C的影响DiabetesObesMetab.2011Mar;13(3):207-20.利拉鲁肽减轻的体重大部分是脂肪组织利拉鲁肽1.2mg/天利拉鲁肽1.8mg/天格列美脲4mg/天组织体积的变化(kg)420–2–4–6脂肪组织**NSNS**瘦组织LEAD-3组织体积的变化(kg)420–2–4–6脂肪组织瘦组织***********LEAD-2利拉鲁肽1.2mg/天+二甲双胍利拉鲁肽1.8mg/天+二甲双胍安慰剂+二甲双胍格列美脲8mg/day+二甲双胍DEXA,双能X线吸收测量仪；数据用平均数±倍标准误表示;**p<0.01;***p<0.001vs.格列美脲+二甲双胍inLEAD-2andvs.格列美脲inLEAD-3

Jendleetal.DiabetObesMetabol2009;11:1163–72(LEAD-2andLEAD-3substudies).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Jendleetal.DiabetesObesMetab2009;11:1163-72TheeffectivenessofliraglutideinnonalcoholicFattyliverdiseasepatientswithtype2diabetesmellituscomparedtositagliptinandpioglitazone.OhkiT,IsogawaA,IwamotoM,OhsugiM,YoshidaH,TodaN,TagawaK,OmataM,KoikeK.SourceDepartmentofGastroenterology,MitsuiMemorialHospital,Kanda-izumicho1,Chiyoda-ku,Tokyo101-8643,Japan.AbstractBackground.Liraglutideleadingtoimprovenotonlyglycaemiccontrolbutalsoliverinflammationinnon-alcoholicfattyliverdisease(NAFLD)patients.Aims.TheaimofthisstudyistoelucidatetheeffectivenessofliraglutideinNAFLDpatientswithtype2diabetesmellitus(T2DM)comparedtositagliptinandpioglitazone.Methods.Weretrospectivelyenrolled82JapaneseNAFLDpatientswithT2DManddividedintothreegroups(liraglutide:N=26,sitagliptin;N=36,pioglitazone;N=20).Wecomparedthebaselinecharacteristics,changesoflaboratorydataandbodyweight.Results.Attheendoffollow-up,ALT,fastbloodglucose,andHbA1clevelsignificantlyimprovedamongthethreegroups.ASTtoplateletratiosignificantlydecreasedinliraglutidegroupandpioglitazonegroup.Thebodyweightsignificantlydecreasedinliraglutidegroup(81.8 kgto78.0 kg,P<0.01).Ontheotherhands,thebodyweightsignificantlyincreasedinpioglitazonegroupanddidnotchangeinsitagliptingroup.Multivariateregressionanalysisindicatedthatadministrationofliraglutideasanindependentfactorofbodyweightreductionformorethan5%(OR9.04;95%CI1.12-73.1,P=0.04).Conclusions.AdministrationofliraglutideimprovedT2DMbutalsoimprovementofliverinflammation,alterationofliverfibrosis,andreductionofbodyweight.TheeffectivenessofliraglutideinnonalcoholicFattyliverdiseasepatientswithtype2diabetesmellit