胰岛素增敏剂二甲双胍对非酒精性脂肪肝疗效

胰岛素抵抗增加是非酒精性脂肪肝的重要致病机制。为此，土耳其加济安泰普大学医学院的A. Kadayifci博士及其同事对胰岛素增敏剂二甲双胍治疗非酒精性脂肪肝的效果进行了研究。

研究人员将36例非酒精性脂肪肝患者随机分为两组。第一组仅采用限制脂肪和热量的食疗，第二组采用二甲双胍850 mg b.d.和食疗，疗程6个月。比较两组的生化、超声、组织学指标。

结果显示，与基础水平相比，二甲双胍组的平均血清丙氨酸/天冬氨酸转氨酶、胰岛素和C肽水平显著降低，胰岛素抵抗指数显著改善。二甲双胍组的上述指标平均改善程度显著大于单纯食疗组。虽然二甲双胍组出现坏死性炎症活性改善的患者多于单纯食疗组患者，但两组的坏死性炎症活性或纤维化均不具有显著性差异。

Kadayifci博士等指出，这些资料提示，采用二甲双胍增强胰岛素敏感性能够改善非酒精性脂肪肝患者的肝脏病情。

Aliment Pharmacol Ther. 2004 Mar;19(5):537-44.

Metformin in the treatment of patients with non-alcoholic steatohepatitis.

Uygun A, Kadayifci A, Isik AT, Ozgurtas T, Deveci S, Tuzun A, Yesilova Z, Gulsen M, Dagalp K.

Department of Gastroenterology, Gulhane Military Medical Academy, Ankara, Turkey.

BACKGROUND: : Increased insulin resistance is the major pathogenic mechanism in the development of non-alcoholic steatohepatitis. AIM: : To investigate the therapeutic effect of metformin, a well-known insulin-sensitizing agent, in the treatment of non-alcoholic steatohepatitis. METHODS: : Thirty-six patients with non-alcoholic steatohepatitis were randomized into two groups. The first group was given lipid and calorie-restricted dietary treatment alone, and the second group was given metformin 850 mg b.d. plus dietary treatment, for 6 months. The changes in biochemical, sonographic and histological parameters were compared. RESULTS: : The mean serum alanine/aspartate aminotransferase, insulin and C-peptide levels decreased and the index of insulin resistance improved significantly from baseline in the group given metformin. The mean changes in these parameters in the metformin group were significantly greater than those in the group given dietary treatment alone. Although more patients in the metformin group showed improvement in the necro-inflammatory activity, compared with the group given dietary treatment alone, no significant differences in necro-inflammatory activity or fibrosis were seen between the groups. CONCLUSION: : The data suggest that improvement of the insulin sensitivity with metformin may improve the liver disease in patients with non-alcoholic steatohepatitis.

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