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目的:研究吡格列酮对合并代谢综合征(MS)的非酒精性脂肪性肝病(NAFLD)患者血清肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)水平的影响及其意义。方法:连续收集2012年1月—2013年6月在长江航运总医院治疗的合并MS的NAFLD患者。患者分别接受非药物治疗(中等程度热量限制和中等量有氧运动)或吡格列酮(30 mg·d~(-1))联合非药物治疗6个月。比较治疗后2组病例的TNF-α、IL-6、NAFLD/MS相关指标和疗效的差异,并分析TNF-α、IL-6与胰岛素抵抗指数(HOMA-IR)、疗效之间的关系。结果:共收集合并MS的HAFLD患者64例,每组各32例。非药物组治疗后6个月仅体重指数和空腹胰岛素显著性降低(P<0.05),吡格列酮联合非药物组治疗后TNF-α、IL-6水平及NAFLD/MS指标均显著改善(P<0.05)。联合治疗组的总有效率显著优于非药物组(81.3%vs 21.9%)。患者治疗前后血清TNF-α和IL-6水平差值与HOMA-IR差值显著性正相关(分别为r=0.676,P<0.001;r=0.498,P<0.001);HOMA-IR差值与疗效级别亦呈显著性正相关(r=0.608,P<0.001)。结论:吡格列酮可有效降低合并MS的NAFLD患者血清TNF-α、IL-6水平。TNF-α、IL-6可能通过影响胰岛素敏感性参与病变治疗过程。
AIM: To investigate the effect of pioglitazone on serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in patients with non-alcoholic fatty liver disease (NAFLD) complicated with metabolic syndrome (MS) Methods: We collected consecutive NAFLD patients with MS who were treated in the Changjiang Shipping General Hospital from January 2012 to June 2013. Patients received non-medical therapy (moderate heat restriction and moderate aerobic exercise) or pioglitazone (30 mg · d -1) in combination with non-drug therapy for 6 months. The difference between the two groups in the treatment of TNF-α, IL-6, NAFLD / MS-related indicators and the efficacy difference, and analysis of TNF-α, IL-6 and insulin resistance index (HOMA-IR), the efficacy of the relationship. Results: A total of 64 cases of HAFLD with MS were collected, 32 cases in each group. Body mass index and fasting insulin decreased significantly (P <0.05) at 6 months after treatment in non-drug group, and TNF-α and IL-6 levels and NAFLD / MS index in pioglitazone combined with non-drug group were significantly improved ). The total effective rate of the combination therapy group was significantly better than the non-drug group (81.3% vs 21.9%). The difference of serum TNF-α and IL-6 level before and after treatment was positively correlated with HOMA-IR difference (r = 0.676, P <0.001, r = 0.498, P <0.001 respectively) The level of efficacy was also significantly correlated (r = 0.608, P <0.001). Conclusion: Pioglitazone can effectively reduce the levels of serum TNF-α and IL-6 in NAFLD patients with MS. TNF-α, IL-6 may participate in the pathological process by influencing insulin sensitivity.