| Objective: To investigate the effect of berberine(BBR)combined with metformin(MET)on body fat distribution and liver fat content of type 2 diabetes mellitus(T2DM)patients with nonalcoholic fatty liver disease(NAFLD).Methods: 128 T2 DM patients complicated with NAFLD,who were treated with stable dose of 1,000-2,000 mg Met every day for over 3 months in the endocrinology clinic of our hospital from January 2018 to June 2019 were selected as the research objects.All the patients had poor blood glucose control,and they were randomly divided into berberine combined group(66 included,2 withdrew,4 lost to follow-up)and placebo combined control group(62 included,1 withdrew,3 lost to follow-up).At 24 weeks after treatment,the changes in liver controlled attenuation parameters(CAP),visceral fat area(VFA),percentage of body fat(PBF),waist to hip ratio(WHR),body mass index(BMI),glucose and lipid metabolism,alanine aminotransferase(ALT),aspertate aminotransferase(AST),gamma-glutamyl transferase(GGT)and homeostasis model assessment-insulin resistance index(HOMA-IR)of patients in both groups were observed.SPSS 22.0 was used to carry out statistic analysis of the data.Results: 1.Comparison of metabolic indexes between the two groups: After treatment,the level of fasting blood-glucose(FPG),glycosylated hemoglobin(Hb Alc),triglyceride(TG),cholesterol and low density lipoprotein(LDL-C)in the two groups showed statistically significant decrease(P<0.05),and the improvement in the treatment group was better than that in the control group.No significant change was found in the level of high-density lipoprotein(HDL-C)in the control group,and the increase in HDL-C in the treatment group was statistically significant(P<0.05).In terms of the function of pancreatic β cells,after treatment,the level of fasting insulin(FINF)and HOMA-IR in the two groups decreased significantly,and the improvement in the treatment group was more significant(P<0.05),suggesting that BBR combined with MET can reduce blood glucose,regulate lipid,save endogenous insulin secretion and improve insulin resistance.2.Comparison of body fat distribution between the two groups: After treatment,the level of BMI and PBF decreased significantly in the control group,while the level of VFA and WHR had no significant change.The level of BMI,PBF,VFA and WHR decreased significantly in the treatment group(P<0.05),and the improvement was better than that in the control group.This indicated that,in addition to reducing weight,BBR combined with Met may better reduce the fat content in the trunk or waist and abdomen.3.Comparison of liver function index and CAP between the two groups: After treatment,there was no significant change in the value of ALT,AST and GGT in the control group,while the CAP value decreased significantly(P<0.05).In the treatment group,the value of ALT,AST,GGT and CAP all decreased significantly(P<0.05),the CAP value decreased more significantly than the control group,the liver steatosis degree was improved significantly(P<0.05),the total therapeutic effective rate of NAFLD was 68.33%.This suggested that BBR combined with Met can effectively improve the liver enzyme level and fat deposition in the liver.4.Safety analysis: No hypoglycemia reaction occurred in the two groups during the treatment,and the incidence rate of gastrointestinal adverse reactions was 10% in the treatment group and 13.79% in the control group,with no significant between-group difference(P>0.05).The main symptoms included nausea,emesis,abdominal pain and constipation.Conclusion: T2 DM patients complicated with NAFLD treated by BBR combined with Met have good gastrointestinal tolerance,and the therapy can effectively reduce weight,improve central obesity,glycolipid metabolism and insulin resistance and reduce liver fat content,thus reducing the severity of fatty liver.The total therapeutic effective rate reached 68.33%. |
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