王晓刚

摘 要：目的 觀察利拉鲁肽联合胰岛素泵强化治疗对2型糖尿病合并肝硬化患者血糖代谢及肝纤维化的影响。方法 选择2017年1月～2018年6月山东医学高等专科学校附属医院收治的2型糖尿病合并肝硬化患者80例按随机数字表法分为对照组和实验组，每组40例。对照组给予单纯胰岛素泵控制血糖，实验组给予利拉鲁肽联合胰岛素泵强化治疗。观察两组患者治疗前后血清c肽、糖化血红蛋白、胰岛素敏感性指数、肝纤维化指标层黏连蛋白、透明质酸、Ⅲ型前胶原、Ⅳ型胶原变化。结果 治疗后，两组患者血清c肽水平、胰岛素敏感性指数均较治疗前升高，糖化血红蛋白较治疗前降低，差异有统计学意义（P<0.05），实验组血清c肽水平、胰岛素敏感性指数较对照组高，糖化血红蛋白较对照组低，差异有统计学意义（P<0.05）。治疗后，两组患者肝纤维化指标层黏连蛋白、透明质酸、Ⅲ型前胶原、Ⅳ型胶原均较治疗前降低，实验组肝纤维化指标层黏连蛋白、透明质酸、Ⅲ型前胶原、Ⅳ型胶原均较对照组低，差异有统计学意义（P<0.05）。结论 2型糖尿病合并肝硬化患者治疗中，利拉鲁肽联合胰岛素泵强化治疗可以更加有效的控制血糖，改善胰岛素抵抗，降低肝脏纤维化水平，进而改善肝脏微环境，降低肝脏应激反应，促进肝脏纤维化的缓解。

关键词：利拉鲁肽；胰岛素泵；肝硬化

中图分类号：R587.1；R657.3+1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.20.041

文章编号：1006-1959（2018）20-0136-03

Abstract：Objective To observe the effects of intensive treatment with liraglutide combined with insulin pump on blood glucose metabolism and liver fibrosis in patients with type 2 diabetes mellitus complicated with cirrhosis.Methods From January 2017 to June 2018，80 patients with type 2 diabetes mellitus complicated with cirrhosis admitted to the affiliated hospital of Shandong Medical College were divided into control group and experimental group by random number table，40 cases in each group.The control group was given a simple insulin pump to control blood glucose，and the experimental group was given intensive treatment with liraglutide combined with insulin pump.The changes of serum c-peptide，glycosylated hemoglobin，insulin sensitivity index，liver fibrosis index laminin，hyaluronic acid，type III procollagen and type IV collagen were observed before and after treatment.Results After treatment， the serum c-peptide level and insulin sensitivity index of the two groups were higher than before treatment，and the glycated hemoglobin was lower than that before treatment，the difference was statistically significant（P<0.05）.The serum c-peptide level and insulin sensitivity index of the experimental group were higher than those of the control group，and the glycated hemoglobin was lower than that of the control group，the difference was statistically significant（P<0.05）.After treatment，the fibrin，hyaluronic acid，type III procollagen and type IV collagen in the liver fibrosis index of the two groups were lower than before treatment.In the experimental group，the fibrin，hyaluronic acid，type III procollagen and type IV collagen were lower than the control group，the difference was statistically significant（P<0.05）.Conclusion In patients with type 2 diabetes mellitus complicated with cirrhosis，intensive treatment with liraglutide combined with insulin pump can more effectively control blood sugar，improve insulin resistance，reduce liver fibrosis， improve liver microenvironment，reduce liver stress response，and promote remission of liver fibrosis.

Key words：Liraglutide；Insulin pump；Cirrhosis

糖尿病（diabetes mellitus）的发病机制为胰岛素分泌缺陷或其生物作用缺陷[1]，患者高血糖状态会进一步导致水、电解质、蛋白质及脂肪的代谢紊乱，造成心血管、消化系统损伤[2]。近年来，糖尿病合并肝硬化的患者越来越多，已经成为临床工作中经常遇到的一大难题。2型糖尿病（type 2 diabetes mellitus，T2DM）患者的高血糖状态以及代谢紊乱，一方面加重了肝糖原的累积，另一方面，糖代谢紊乱带来的氧化应激又进一步加重了肝损伤的发生，进而导致肝硬化的发生。肝硬化可导致糖代谢紊乱进一步加重，形成恶性循环，给2型糖尿病和肝硬化的治疗带来了极大的挑战[3]。临床上多采用胰岛素多次皮下注射控制患者血糖，由于人体胰岛素分泌具有一定的生理节律及短效胰岛素药物动力学等多方面原因导致患者血糖控制欠佳，并且低血糖发生可能性大。……