目的 探究西格列汀聯(lián)合二甲雙胍治療2型糖尿病合并非酒精性脂肪肝（NAFLD）的臨床效果及安全性。方法 選擇2012年6月-2015年6月渭南市中心醫(yī)院收治的65例2型糖尿病合并NAFLD患者，隨機(jī)分為觀察組32例和對照組33例。對照組患者予以單純二甲雙胍治療，觀察組患者在對照組基礎(chǔ)上加用西格列汀治療，均持續(xù)治療16周。觀察兩組患者治療前及治療后的糖代謝相關(guān)指標(biāo)，包括體質(zhì)指數(shù)（BMI）、空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血紅蛋白（HbA1c）以及胰島素抵抗指標(biāo)（HOMA-IR）和肝功能相關(guān)指標(biāo)，包括天冬氨酸氨基轉(zhuǎn)移酶（AST）、丙氨酸氨基轉(zhuǎn)移酶（ALT）、γ-谷氨酰轉(zhuǎn)肽酶（GGT）、總膽固醇（TC）、三酰甘油（TG）以及肝臟彩超的變化，比較分析兩組的治療有效率及安全性。結(jié)果 治療后，兩組患者的HOMA-IR、FPG、2hPG以及HbA1c均有明顯改善，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；同時(shí)，觀察組患者的HOMA-IR與HbA1c顯著優(yōu)于對照組，組間比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后兩組患者的肝功能相關(guān)指標(biāo)均有顯著性改善，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組的AST、ALT、GGT及TG均明顯優(yōu)于對照組，組間比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。此外，觀察組的脂肪肝治療總有效率為90.9%，顯著高于對照組的42.4%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。用藥期間，觀察組的總不良反應(yīng)發(fā)生率為15.6%，對照組為9.1%，兩組比較差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 西格列汀聯(lián)合二甲雙胍對2型糖尿病合并NAFLD患者的代謝綜合征及肝功能改善作用明顯，治療有效率高且安全性好。

Objective To investigate the clinical efficacy and safety of sitagliptin combined with metformin in treating patients with type 2 diabetes with non-alcoholic fatty liverdiease (NAFLD).Methods Sixty-five patients with type 2 diabetes with non-alcoholic fatty liver admitted into our hospital from June 2012 to June 2015 were randomly divided into two groups. Thirty-three patients in control group were treated with metformin only, and thirty-two patients in observation were treated with sitagliptin combined with metformin. The changes in body mass index (BMI), fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), Hemoglobin Ale (HbAlc), homeostasis model assessment of insulin resistance (HOMA-IR), and liver function index including that aminopherase of alanine acid (ALT), aminopherase of aspartic acid (AST), gamma-glutamyl transterase (GGT), triglyceride (TG), and total cholesterol (TC) were detected before and after 16 weeks of treatment. And the total effective rate and safety were analyzed and compared. Results After treatment, HOMA-IR, FPG, 2hPG, HbA1c, ALT, AST, GGT, TG, and TC were remarkable improvement (P<0.05), and HOMA-IR, HbA1c, AST, ALT, GGT, and TG were significantly better than those of control (P<0.05). Additionally, the total effective rate in observation group with 90.9% was significantly higher than that of control group with 42.4% (P<0.05). And difference in incidences of adverse effect between observation group with 15.6% and control group with 9.1% were not significant. Conclusion Sitagliptin combined with metformin treatment had a good ability on treating patients with type 2 diabetes with NAFLD by improvement of metabolic syndrome and liver function.