达格列净对超重/肥胖2型糖尿病患者肝脏脂肪含量及肝功能指标影响的回顾性分析

Effects of Dapagliflozin on Liver Fat Content and Function in Overweight/Obese Patients with Type 2 Diabetes: A Retrospective Study

摘要: 目的：回顾性分析达格列净对体重指数(BMI) ≥ 24 kg/m²的2型糖尿病(T2DM)合并代谢相关性脂肪肝病(MAFLD)患者肝脏脂肪含量及肝功能相关指标的影响。方法：回顾性选取2022年7月1日至2023年6月30日于安庆市第一人民医院内分泌科住院的T2DM患者108例，所有患者BMI ≥ 24 kg/m²。根据住院期间是否在常规降糖方案基础上加用达格列净(10 mg/日)分为两组：对照组(n = 54，接受常规降糖治疗)和研究组(n = 54，常规治疗 + 达格列净)。收集并比较两组患者治疗前及治疗6个月后的体重、BMI、空腹血糖(FPG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转移酶(GGT)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及肝脏脂肪指数(采用脂肪肝指数-FLI和肝脂酶指数-HSI评估)。结果：治疗6个月后，与对照组相比，研究组患者的FPG、2hPG、HbA1c、体重、BMI、ALT、AST、GGT、TG、FLI和HSI指数水平均显著降低，HDL-C水平显著升高(P < 0.05)；与治疗前比较，研究组FLI和HSI指数显著下降(P < 0.05)，对照组有改善趋势，但无统计学差异(P > 0.05)。结论：在常规降糖治疗基础上加用达格列净可改善超重/肥胖T2DM患者血糖、体重及血脂，并显著降低肝脏脂肪含量和改善肝功能指标。

Abstract: Objective: To investigate the effects of Dapagliflozin on liver fat content and liver function-related indicators in patients with type 2 diabetes mellitus (T2DM) and Metabolic dysfunction-associated fatty liver disease (MAFLD) who have a body mass index (BMI) ≥ 24 kg/m². Methods: A total of 108 hospitalized T2DM patients with BMI ≥ 24 kg/m² were retrospectively enrolled from the Department of Endocrinology, Anqing First People’s Hospital, between July 1, 2022, and June 30, 2023. Patients were divided into two groups according to whether Dapagliflozin (10 mg/day) was added to their conventional glucose-lowering regimen: the control group (n = 54, conventional therapy) and the study group (n = 54, conventional therapy plus Dapagliflozin). The following parameters were collected and compared at baseline and after 6 months of treatment: body weight, BMI, fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), glycated hemoglobin (HbA1c), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and liver fat indices (assessed using the Fatty Liver Index, FLI, and the Hepatic Steatosis Index, HSI). Results: After 6 months, compared with the control group, the study group showed significant reductions in FPG, 2hPG, HbA1c, body weight, and BMI. Regarding MAFLD-related indicators, the study group exhibited significantly lower levels of ALT, AST, GGT, and TG, along with a significant increase in HDL-C (P < 0.05). Furthermore, the FLI and HSI indices in the study group decreased significantly compared to both baseline and the control group (P < 0.05). The control group showed a trend toward improvement in liver function and fatty liver indices, but the changes were not statistically significant (P > 0.05). Conclusion: The addition of Dapagliflozin to conventional glucose-lowering therapy effectively improves glycemic control, body weight, and lipid profiles in overweight/obese T2DM patients. It also significantly reduces liver fat content and improves liver function, demonstrating a beneficial effect on comorbid MAFLD.