诺和力病例PPT课件

,安徽医科大学第二附属医院内分泌科钟兴,糖尿病合并脂肪肝患者使用利拉鲁肽的病例分析,-,2,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。,-,3,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,-,4,体格检查,身高：168cm体重：83.5kgBMI：29.58kg/cm2血压：120/85其他体查：无多毛、痤疮和紫纹；无甲状腺肿大及结节。,-,5,实验室检查,血糖及细胞功能：,-,6,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,-,7,实验室检查,肝炎抗原阴性（甲肝、乙肝、丙肝、戊肝）肾功能正常,-,8,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。,-,9,诊断,1、2型糖尿病2、脂肪肝3、肝功能损害,-,10,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,-,11,病例特点,2型糖尿病合并肥胖、脂肪肝胰岛素抵抗明显肝功能损害,-,12,利拉鲁肽对HbA1C的影响,DiabetesObesMetab.2011Mar;13(3):207-20.,-,13,利拉鲁肽1.8mg可使患者体重降低达3.4Kg,Marreetal.DiabeticMedicine2009;26;26878(LEAD-1);Naucketal.DiabetesCare2009;32;8490(LEAD-2);Garberetal.Lancet2009;373:47381(LEAD-3);Zinmanetal.DiabetesCare2009;32:122430(LEAD-4);Russell-Jonesetal.Diabetologia2009;52:2046-2055(LEAD-5);Buseetal.Lancet2009;374(9683):3947(LEAD-6);Pratleyetal.Lancet2010;375:1447-56(liravs.sita),-,14,利拉鲁肽减轻的体重大部分是脂肪组织,组织体积的变化(kg),4,2,0,2,4,6,脂肪组织,*,NS,NS,*,瘦组织,LEAD-3,组织体积的变化(kg),4,2,0,2,4,6,脂肪组织,瘦组织,LEAD-2,DEXA,双能X线吸收测量仪；数据用平均数倍标准误表示;*p0.01;*p0.001vs.格列美脲+二甲双胍inLEAD-2andvs.格列美脲inLEAD-3Jendleetal.DiabetObesMetabol2009;11:116372(LEAD-2andLEAD-3substudies).,-,15,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;11:1163-72,-,16,TheeffectivenessofliraglutideinnonalcoholicFattyliverdiseasepatientswithtype2diabetesmellituscomparedtositagliptinandpioglitazone.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(81.8kgto78.0kg,P0.01).Ontheotherhands,thebodyweightsignificantlyincreasedinpioglitazonegroupanddidnotchangeinsitagliptingroup.Multivariateregressionanalysisindicatedthatadministrationofliraglutideasanindependentfactorofbodyweightreductionformorethan5%(OR9.04;95%CI1.12-73.1,P=0.04).Conclusions.AdministrationofliraglutideimprovedT2DMbutalsoimprovementofliverinflammation,alterationofliverfibrosis,andreductionofbodyweight.,TheeffectivenessofliraglutideinnonalcoholicFattyliverdiseasepatientswithtype2diabetesmellituscomparedtositag