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非酒精性脂肪性肝病(NAFLD)已成为国内外常见慢性肝脏疾病之一,由于胰岛素抵抗在NAFLD发病机制中的重要作用,胰岛素增敏剂逐渐成为有前景的NAFLD治疗药物。本文分析总结了近年来胰岛素增敏剂治疗NAFLD的文献,结果提示,吡格列酮(PGZ)、罗格列酮(RGZ)和二甲双胍(MF)均能改善NAFLD患者肝酶水平和胰岛素抵抗;在改善肝脏组织学方面,PGZ有随机双盲对照研究证据的支持,显示出良好的应用前景;而MF与RGZ,缺少有力的人体研究支持。大多数研究中患者可以耐受胰岛素增敏剂,未见明显不良反应。目前已有研究的样本量均不大,疗程大多不超过2年,因此,仍需要设计良好的临床试验来进一步评价胰岛素增敏剂对NAFLD的疗效和安全性。
Non-alcoholic fatty liver disease (NAFLD) has become one of the common chronic liver diseases both at home and abroad. Because of its important role in the pathogenesis of NAFLD, insulin sensitizer gradually becomes a promising therapeutic agent for NAFLD. This review summarizes the recent literature on the use of insulin sensitizers in the treatment of NAFLD. The results suggest that both pioglitazone (PGZ), rosiglitazone (RGZ) and metformin (MF) can improve liver enzyme levels and insulin resistance in NAFLD patients; Histologically, PGZ is supported by evidence from a randomized, double-blind, controlled study showing good prospects for application. MF and RGZ, however, lack strong body-research support. In most studies, patients tolerated insulin sensitizers and showed no significant adverse effects. So far, there are still a few well-designed clinical trials to further evaluate the efficacy and safety of insulin sensitizers for NAFLD.