2026 年第 9 期 第 21 卷

司美格鲁肽对不同体重指数2型糖尿病合并代谢相关脂肪性肝病患者肝脏脂肪含量的影响

Effects of semaglutide on hepatic fat content in patients with type 2 diabetes mellitus complicated with metabolic-associated fatty liver disease across different body mass index

作者：党芳宋康姚勇利张永珍赵玲玲谢延玲王淑琼林丽君王婧媛蒋艳苹马文岩王贝贝魏红

英文作者：Dang Fang Song Kang Yao Yongli Zhang Yongzhen Zhao Lingling Xie Yanling Wang Shuqiong Lin Lijun Wang Jingyuan Jiang Yanping Ma Wenyan Wang Beibei Wei Hong

单位：青海省人民医院内分泌二科，西宁810001

英文单位：Second Department of Endocrinology Qinghai Provincial People′s Hospital Xining 810001 China

关键词：2型糖尿病；代谢相关脂肪性肝病；司美格鲁肽；体重指数

英文关键词：Type2diabetesmellitus;Metabolic-associatedfattyliverdisease;Semaglutide;Bodymassindex

• 摘要：

• 目的 探讨司美格鲁肽对不同体重指数的2型糖尿病（T2DM）合并代谢相关脂肪性肝病（MAFLD）患者肝脏脂肪含量的影响。方法 选取2023年5月至2025年3月在青海省人民医院内分泌科就诊的T2DM合并MAFLD患者60例，根据体重指数分为A组（体重指数＜30.0 kg/m2，30例）、B组（体重指数≥30.0 kg/m2，30例）。2组患者均给予司美格鲁肽治疗24周。比较2组治疗前后血糖、血脂、肝功能指标及胰岛素抵抗指数（HOMA-IR）、脂肪肝指数（FLI）、受控衰减参数（CAP）的变化。结果 治疗24周后，2组患者体重、腰围及体重指数均较治疗前下降（均P＜0.05）。其中B组治疗前后体重、腰围、体重指数下降程度均大于A组［（12.9±1.0）kg比（6.3±0.5）kg、（10.6±0.8）cm比（7.3±0.6）cm、（3.8±0.3）kg/m2比（2.3±0.2）kg/m2］（均P＜0.05）。2组患者治疗后血糖、血脂、肝功能指标及HOMA-IR均显著改善（均P＜0.05），且B组总体改善程度更明显。B组患者治疗前后HOMA-IR、FLI、CAP下降程度均大于A组［（3.04±0.55）比（1.40±0.28）、（29.0±1.4）比（10.3±0.8）、（69.7±2.4）dB/m比（43.1±2.7）dB/m］（均P＜0.05）。结论 司美格鲁肽可有效降低不同体重指数的T2DM合并MAFLD患者肝脏脂肪含量，改善代谢指标，且对肥胖患者的疗效更显著。

• Objective To investigate the effects of semaglutide on hepatic fat content in patients with type 2 diabetes mellitus (T2DM) complicated with metabolic-associated fatty liver disease (MAFLD) with different body mass index (BMI). Methods A total of 60 patients diagnosed with T2DM combined with MAFLD treated in the Department of Endocrinology, Qinghai Provincial People′s Hospital from May 2023 to March 2025 were enrolled and divided into group A (BMI ＜30.0 kg/m2, 30 cases) and group B (BMI ≥30.0 kg/m2, 30 cases) according to BMI. Both groups received semaglutide treatment for 24 weeks. Changes in blood glucose, blood lipid, liver function indicators, homeostatic model assessment for insulin resistance (HOMA-IR), fatty liver index (FLI) and controlled attenuation parameter (CAP) before and after treatment were compared between the two groups. Results After 24 weeks of treatment, body weight, waist circumference and BMI of patients in both groups decreased compared with baseline (all P＜0.05). The reductions in body weight, waist circumference and BMI in group B were greater than those in group A ［(12.9±1.0)kg vs (6.3±0.5)kg, (10.6±0.8)cm vs (7.3±0.6)cm, (3.8±0.3)kg/m2 vs (2.3±0.2)kg/m2］(all P＜0.05). Blood glucose, blood lipid, liver function indicators and HOMA-IR were significantly improved after treatment in both groups (all P＜0.05), with more prominent overall improvements observed in group B. The decreases in HOMA-IR, FLI and CAP in group B were larger than those in group A ［(3.04±0.55) vs (1.40±0.28), (29.0±1.4) vs (10.3±0.8), (69.7±2.4)dB/m vs (43.1±2.7)dB/m］(all P＜0.05). Conclusion Semaglutide can effectively reduce hepatic fat content and ameliorate metabolic indicators in T2DM patients complicated with MAFLD regardless of BMI, and exerts more remarkable therapeutic effects on obese patients.