AIM： TO evaluate insulin resistance, cytolysis and nonalcoholic steatohepatitis （NASH） score （NAS） using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension, treated with tel...AIM： TO evaluate insulin resistance, cytolysis and nonalcoholic steatohepatitis （NASH） score （NAS） using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension, treated with telmisartan vs valsartan for 20 mo. METHODS： All patients met the NCEP-ATP Ⅲ criteria for metabolic syndrome. Histology confirmed steatohepatitis, defined as a NAS greater than five up to 3 wk prior inclusion, using the current criteria. Patients with viral hepatitis, chronic alcohol intake, drug abuse or other significant immune or metabolic hepatic pathology were excluded. Subjects were randomly assigned either to the valsartan （V） group （standard dose 80 mg o.d., n = 26）, or to the telmisartan （T） group （standard dose 20 mg o.d., n = 28）. Treatment had to be taken daily at the same hour with no concomitant medication or alcohol consumption allowed. Neither the patient nor the medical staff was aware of treatment group allocation. Paired liver biopsies obtained at inclusion （visit 1） and end of treatment （EOT） were assessed by a single blinded pathologist, not aware of patient or treatment group. Blood pressure, BMI, ALT, AST, HOMA-IR, plasma triglycerides （TG） and total cholesterol （TC） were evaluated at inclusion and every 4 mo until EOT （visit 6）. RESULTS： At EOT we noticed a significant decrease in ALT levels vs inclusion in all patients and this decrease did not differ significantly in group T vs group V. HOMA-IR significantly decreased at EOT vs inclusion in all patients but in group T, the mean HOMA-IR decrease per month was higher than in group V. NAS significantly diminished at EOT in all patients with a higher decrease in group T vs group V. CONCLUSION： Angiotensin receptor blockers seem to be efficient in hypertension-associated NASH. Telmisartan showed a higher efficacy regarding insulin resistance and histology, perhaps because of its specific PPAR-gamma ligand effect.展开更多
Liver cirrhosis and diabetes mellitus(DM)are both common conditions with significant socioeconomic burden and impact on morbidity and mortality.A bidirectional relationship exists between DM and liver cirrhosis regard...Liver cirrhosis and diabetes mellitus(DM)are both common conditions with significant socioeconomic burden and impact on morbidity and mortality.A bidirectional relationship exists between DM and liver cirrhosis regarding both etiology and disease-related complications.Type 2 DM(T2DM)is a wellrecognized risk factor for chronic liver disease and vice-versa,DM may develop as a complication of cirrhosis,irrespective of its etiology.Liver transplantation(LT)represents an important treatment option for patients with end-stage liver disease due to non-alcoholic fatty liver disease(NAFLD),which represents a hepatic manifestation of metabolic syndrome and a common complication of T2DM.The metabolic risk factors including immunosuppressive drugs,can contribute to persistent or de novo development of DM and NAFLD after LT.T2DM,obesity,cardiovascular morbidities and renal impairment,frequently associated with metabolic syndrome and NAFLD,may have negative impact on short and long-term outcomes following LT.The treatment of DM in the context of chronic liver disease and post-transplant is challenging,but new emerging therapies such as glucagon-like peptide-1 receptor agonists(GLP-1RAs)and sodium–glucose cotransporter 2 inhibitors(SGLT2i)targeting multiple mechanisms in the shared pathophysiology of disorders such as oxidative stress and chronic inflammation are a promising tool in future patient management.展开更多
目的探讨利拉鲁肽结合二甲双胍对胰岛素抵抗2型糖尿病(T2DM)患者血糖控制效果的影响。方法选取2019年1月至2021年6月收治的100例胰岛素抵抗T2DM患者作为研究对象,将其随机分为对照组(50例,二甲双胍)和观察组(50例,利拉鲁肽+二甲双胍)。...目的探讨利拉鲁肽结合二甲双胍对胰岛素抵抗2型糖尿病(T2DM)患者血糖控制效果的影响。方法选取2019年1月至2021年6月收治的100例胰岛素抵抗T2DM患者作为研究对象,将其随机分为对照组(50例,二甲双胍)和观察组(50例,利拉鲁肽+二甲双胍)。比较两组的血糖、胰岛素功能指标、腹腔内脂肪面积(VFA)、血清指标及不良反应发生情况。结果治疗后,观察组的空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、VFA均低于对照组,空腹C肽(FC-P)水平高于对照组(P<0.05)。治疗后,观察组的同型半胱氨酸(Hcy)、胱抑素C(CysC)、超敏C反应蛋白(hs-CRP)水平均低于对照组(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论利拉鲁肽结合二甲双胍治疗胰岛素抵抗T2DM,能有效改善患者的血糖、胰岛素功能指标、VFA,提升抗氧化能力,且安全性高,值得临床推广和应用。展开更多
基金Supported by A Grant from the Romanian National Authority for Scientifical Research
文摘AIM： TO evaluate insulin resistance, cytolysis and nonalcoholic steatohepatitis （NASH） score （NAS） using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension, treated with telmisartan vs valsartan for 20 mo. METHODS： All patients met the NCEP-ATP Ⅲ criteria for metabolic syndrome. Histology confirmed steatohepatitis, defined as a NAS greater than five up to 3 wk prior inclusion, using the current criteria. Patients with viral hepatitis, chronic alcohol intake, drug abuse or other significant immune or metabolic hepatic pathology were excluded. Subjects were randomly assigned either to the valsartan （V） group （standard dose 80 mg o.d., n = 26）, or to the telmisartan （T） group （standard dose 20 mg o.d., n = 28）. Treatment had to be taken daily at the same hour with no concomitant medication or alcohol consumption allowed. Neither the patient nor the medical staff was aware of treatment group allocation. Paired liver biopsies obtained at inclusion （visit 1） and end of treatment （EOT） were assessed by a single blinded pathologist, not aware of patient or treatment group. Blood pressure, BMI, ALT, AST, HOMA-IR, plasma triglycerides （TG） and total cholesterol （TC） were evaluated at inclusion and every 4 mo until EOT （visit 6）. RESULTS： At EOT we noticed a significant decrease in ALT levels vs inclusion in all patients and this decrease did not differ significantly in group T vs group V. HOMA-IR significantly decreased at EOT vs inclusion in all patients but in group T, the mean HOMA-IR decrease per month was higher than in group V. NAS significantly diminished at EOT in all patients with a higher decrease in group T vs group V. CONCLUSION： Angiotensin receptor blockers seem to be efficient in hypertension-associated NASH. Telmisartan showed a higher efficacy regarding insulin resistance and histology, perhaps because of its specific PPAR-gamma ligand effect.
文摘Liver cirrhosis and diabetes mellitus(DM)are both common conditions with significant socioeconomic burden and impact on morbidity and mortality.A bidirectional relationship exists between DM and liver cirrhosis regarding both etiology and disease-related complications.Type 2 DM(T2DM)is a wellrecognized risk factor for chronic liver disease and vice-versa,DM may develop as a complication of cirrhosis,irrespective of its etiology.Liver transplantation(LT)represents an important treatment option for patients with end-stage liver disease due to non-alcoholic fatty liver disease(NAFLD),which represents a hepatic manifestation of metabolic syndrome and a common complication of T2DM.The metabolic risk factors including immunosuppressive drugs,can contribute to persistent or de novo development of DM and NAFLD after LT.T2DM,obesity,cardiovascular morbidities and renal impairment,frequently associated with metabolic syndrome and NAFLD,may have negative impact on short and long-term outcomes following LT.The treatment of DM in the context of chronic liver disease and post-transplant is challenging,but new emerging therapies such as glucagon-like peptide-1 receptor agonists(GLP-1RAs)and sodium–glucose cotransporter 2 inhibitors(SGLT2i)targeting multiple mechanisms in the shared pathophysiology of disorders such as oxidative stress and chronic inflammation are a promising tool in future patient management.
文摘目的探讨利拉鲁肽结合二甲双胍对胰岛素抵抗2型糖尿病(T2DM)患者血糖控制效果的影响。方法选取2019年1月至2021年6月收治的100例胰岛素抵抗T2DM患者作为研究对象,将其随机分为对照组(50例,二甲双胍)和观察组(50例,利拉鲁肽+二甲双胍)。比较两组的血糖、胰岛素功能指标、腹腔内脂肪面积(VFA)、血清指标及不良反应发生情况。结果治疗后,观察组的空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、VFA均低于对照组,空腹C肽(FC-P)水平高于对照组(P<0.05)。治疗后,观察组的同型半胱氨酸(Hcy)、胱抑素C(CysC)、超敏C反应蛋白(hs-CRP)水平均低于对照组(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论利拉鲁肽结合二甲双胍治疗胰岛素抵抗T2DM,能有效改善患者的血糖、胰岛素功能指标、VFA,提升抗氧化能力,且安全性高,值得临床推广和应用。
