目的 評(píng)價(jià)艾塞那肽對(duì)2型糖尿?。═₂DM）合并非酒精性脂肪性肝病（NAFLD）患者的療效，并探討其作用機(jī)制及臨床安全性。方法 選取張家港市中醫(yī)院2014年1月-2015年11月收治的T₂DM伴發(fā)NAFLD患者96例，使用數(shù)字法隨機(jī)分為對(duì)照組和治療組，每組48人。對(duì)照組患者口服二甲雙胍，起始劑量500 mg/次，2次/d，結(jié)合具體病情調(diào)整藥物劑量；治療組在對(duì)照組基礎(chǔ)上加用艾塞那肽注射液，早餐前60 min、晚餐前60 min 5 μg皮下注射，均連續(xù)用藥24周。比較治療前后兩組空腹血糖（FBG）、餐后血糖（PPG）、三酰甘油（TG）、總膽固醇（TC）、丙氨酸氨基轉(zhuǎn)移酶（ALT）和天門冬氨酸氨基轉(zhuǎn)移酶（AST）的變化，臨床有效率及不良反應(yīng)情況；ELISA法檢測成纖維細(xì)胞生長因子19（FGF19）和FGF21表達(dá)的變化。結(jié)果 兩組治療后FBG、PPG、TG、TC、ALT、AST、BMI、腰圍、B超肝內(nèi)貯脂量均顯著減低（P<0.05、0.01），且治療組均顯著低于對(duì)照組（P<0.05）。兩組治療后FGF19和FGF21表達(dá)均顯著升高（P<0.05、0.01），且治療組FGF19和FGF21表達(dá)顯著高于對(duì)照組（P<0.05）。治療組的臨床治療有效率為85.4%，顯著優(yōu)于對(duì)照組的64.6%（P<0.05）；治療組不良反應(yīng)率為12.5%，對(duì)照組的為10.4%，兩組比較無顯著性差異（P>0.05）。結(jié)論 艾塞那肽聯(lián)合二甲雙胍對(duì)T₂DM伴發(fā)NAFLD患者的血糖、血脂以及肝功能具有顯著的改善作用，臨床使用有效且安全。

Objective To detect the clinic effects of exenatide on liver in type 2 diabetes mellitus (T₂DM) patients combined with nonalcoholic fatty liver disease (NAFLD) and explore its mechanisms and clinical safety. Methods A total of 96 T₂DM combined with NAFLD patients were enrolled in this study. Patients were randomly divided into fetmormin control group (n=48) and fetmormin+exenatide observation group (n=48). The patients in control group were given metformin, starting dose of 500 mg each time, twice daily, combined with specific patient's condition to adjust the dose. The patients in treatment group were given metformin and exenatide at 60 min before breakfast and 60 min before dinner, which was treated for 24 weeks. The FBG, PPG, TG, TC, ALT, and AST was compared. FGF19 and FGF21 were detected by ELISA analysis. The rate of adverse reaction was compared. Results After treatment, FBG, PPG, TG, TC, ALT, AST, BMI, waistline, and B ultrasound in liver fat storage were all decreased (P<0.05, 0.01). However, which were all lower in observation group than that in control group (P<0.05). After treatment, FGF19 and FGF21 were both increased (P<0.05, 0.01). However, which were both higher in observation group than those in control group (P<0.05). The clinical effect rate in observation was 85.4%, which was higher than that of 64.6% in control group (P<0.05). The rates of adverse reaction were 12.5% in treatment group and 10.4% in control group. There was no significant difference between the two groups (P>0.05). Conclusion Exenatide has a significant role in the improvement of blood glucose, blood lipid, and liver function in T₂DM combined with NAFLD patients, with significantly clinical efficacy and safety.