2025 年第 1 期 第 20 卷

达格列净联合二甲双胍对2型糖尿病合并非酒精性脂肪性肝病患者内脏脂肪及血清趋化因子样受体1水平的影响

Effect of dapagliflozin combined with metformin on visceral fat and serum chemokine-like receptor 1 levels in patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease

作者：安盟盟1 刘建凤1 李辉1 张于1 刘金良2 安向莲1 关平1

英文作者：An Mengmeng1 Liu Jianfeng1 Li Hui1 Zhang Yu1 Liu Jinliang2 An Xianglian1 Guan Ping1

单位：1河北省沧州市人民医院内分泌代谢科，沧州061000；2河北省沧州市人民医院影像科，沧州061000

英文单位：1Department of Endocrinology and Metabolism Cangzhou People′s Hospital Heibei Province Cangzhou 061000 China; 2Department of Imaging Cangzhou People′s Hospital Heibei Province Cangzhou 061000 China

关键词：2型糖尿病；  达格列净；  二甲双胍；  非酒精性脂肪性肝病；  趋化因子样受体1

英文关键词：Type2diabetesmellitus;  Dapagliflozin;  Metformin;  Non-alcoholicfattyliverdisease;  Chemokine-likereceptor1

• 摘要：

• 目的  探究达格列净联合二甲双胍对2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者内脏脂肪及血清趋化因子样受体1（CMKLR1）水平的影响。方法  选择2020年1月至2023年1月于河北省沧州市人民医院接受诊治的T2DM合并NAFLD患者80例，采用随机数字表法分为二甲双胍组和达格列净组，各40例。二甲双胍组予盐酸二甲双胍缓释片口服治疗，达格列净组在二甲双胍组的基础上联合达格列净片治疗。比较2组临床疗效、糖脂代谢相关指标、炎症相关指标、血清CMKLR1水平、体脂指标、不良反应发生情况。结果  达格列净组总有效率高于二甲双胍组［97.5%（39/40）比80.0%（32/40）］（χ2=4.507，P=0.034）。治疗后，2组空腹血糖、糖化血红蛋白、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、稳态模型胰岛素抵抗指数水平均低于治疗前，且达格列净组均低于二甲双胍组（均P＜0.05）；2组白细胞介素6、肿瘤坏死因子α、CMKLR1水平均低于治疗前，且达格列净组均低于二甲双胍组（均P＜0.05）；2组内脏脂肪面积、皮下脂肪面积、体重、体重指数均低于治疗前，且达格列净组均低于二甲双胍组（均P＜0.05）。治疗期间，2组不良反应发生率比较差异无统计学意义（P＞0.05）。结论  达格列净联合二甲双胍治疗T2DM合并NAFLD能够有效减掉内脏脂肪，降低血清CMKLR1水平。

• Objective  To investigate the effect of dapagliflozin combined with metformin on visceral fat and serum chemokine-like receptor 1 (CMKLR1) levels in patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD). Methods   A total of 80 patients with T2DM and NAFLD who were diagnosed and treated in Cangzhou People′s Hospital, Hebei Province from January 2020 to January 2023 were selected and divided into metformin group and dapagliflozin group by random number table method, with 40 cases in each group. The metformin group was treated with metformin hydrochloride sustained release tablets, and the dapagliflozin group was treated with dapagliflozin tablets on the basis of the metformin group. The clinical efficacy, glucose and lipid metabolism related indicators, inflammation related indicators, serum CMKLR1 level, body fat indicators, and adverse reactions were compared between the two groups. Results   The total effective rate of dapagliflozin group was higher than that of metformin group ［97.5%（39/40） vs 80.0%（32/40）］（χ2=4.507, P=0.034）. After treatment, the levels of fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride, low-density lipoprotein cholesterol and homeostasis model assessment of insulin resistance index in the two groups were lower than those before treatment, and those in the dapagliflozin group were lower than those in the metformin group (all P<0.05). The levels of interleukin-6, tumor necrosis factor-α and CMKLR1 in the two groups were lower than those before treatment, and those in the dapagliflozin group were lower than those in the metformin group (all P<0.05). The visceral fat area, subcutaneous fat area, body weight and body mass index of the two groups were lower than those before treatment, and those of the dapagliflozin group were lower than those of the metformin group (all P<0.05). During the treatment, there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion   Dapagliflozin combined with metformin in the treatment of T2DM with NAFLD can effectively reduce visceral fat and serum CMKLR1 level.