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[目的]探讨二甲双胍联合利拉鲁肽治疗对2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪肝(nonalicoholic fatty liver disease,NAFLD)患者胰岛β细胞功能、肝功能及外周血Treg细胞的影响.[方法]选择2015年1月至2016年12月在本院诊治的T2DM合并NAFLD患者93例,随机分为观察组(n=47)和对照组(n=46).两组患者均口服二甲双胍,观察组同时给予利拉鲁肽皮下注射,对照组患者同时给予甘精胰岛素皮下注射,疗程为3个月.比较两组治疗前、后糖化血红蛋白(HbAlc)、空腹血糖(FPG)、餐后2小时血糖(2hPG)、空腹胰岛素(FINS)水平、胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HOMA-β)、血清谷丙转氨酶(ALT)、血清谷草转氨酶(AST)、血清γ谷氨酰转肽酶(GGT)、血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平及外周血Treg细胞占CD4+T细胞比例.[结果]与治疗前比较,两组患者治疗后HbAlc、FPG、2hPG水平、HOMA-IR值均降低(P＜0.05),HOMA-β值升高(P＜0.05);观察组治疗后HbA1c水平低于对照组,且差异具有统计学意义(t=2.230,P=0.028),其余指标比较差异无统计学意义(P＞0.05).两组患者治疗前肝功能和脂代谢指标比较差异均无统计学意义(P＞0.05);观察组患者治疗后肝功能指标ALT、AST及GGT水平与治疗前比较均下降,其差异均有统计学意义(P＜0.05),而对照组患者ALT、AST及GGT水平与治疗前比较差异无统计学意义(P＞0.05);两组脂代谢指标TC、TG、HDL-C及LDL-C水平较治疗前均下降,差异均具有统计学意义(P＜0.05),且观察组下降更显著(P＜0.05).两组患者治疗前外周血Treg/CD4+分别为(5.62±1.80)％、(5.74±1.53)％,两组比较差异无统计学意义(P＞0.05);观察组、对照组患者治疗后外周血Treg/CD4+比例分别为(4.01±1.39)％、(4.88±1.42)％,与治疗前比较均降低(P＜0.05),且观察组治疗后Treg/CD4+低于对照组,其差异具有统计学意义(P＜0.05).[结论]二甲双胍联合利拉鲁肽治疗T2DM合并NAFLD患者,可有效恢复胰岛β细胞功能,减轻机体胰岛素抵抗程度,达到控制血糖的目的,值得临床推广应用.“,”[Objective]To investigate the effects of metformin combined with liraglutide on islet β cell function,liver function and Treg cells in peripheral blood of patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver (NAFLD).[Methods]From January 2015 to December 2016,93 patients with T2DM complicated with NAFLD were selected and were randomly divided into the observation group (n =47) and the control group (n =46).Two groups of patients were treated with metformin,the observation group received subcutaneous injection of liraglutide,the control group were given subcutaneous injection of insulin glargine.The course of treatment was 3 months.The levels of HbAlcN,FPGN,2hPGN,FINS,HOMA-IR,HOMA-β,ALT,AST,GGT,TC,TG,HDL-C,LDL-C,and the ratio of Treg cells in peripheral blood to CD4+ T cells were compared between the two groups before and after treatment,the decrease in the observation group was more significant than that in the control group (P ＜0.05).The Treg/CD4+ in peripheral blood of the two groups before treatment was 5.62 ± 1.80 ％ and 5.74 ± 1.53％ respectively,there was no significant difference between the two groups (P ＞0.05).[Results]Compared with that before treatment,the level of HbAlc,FPG,2hPG and HOMA-IR decreased after treatment in both groups (P ＜ 0.05) and the value of HOMA βincreased significantly(P ＜0.05).The level of HbA1c in the observation was lower than that of the control group after treatment,the difference was significant (t =2.230,P =0.028),and the rest indexes has no statistical significance(P ＞0.05).There was no significant difference in liver function and lipid metabolism between the two groups before treatment (P ＞0.05).The levels of ALT,AST and GGT in the observation group were lower than those before treatment,and the difference was statistically significant (P ＜0.05).The levels of ALT,AST and GGT in the control group were not significantly different from those before treatment (P ＞0.05).The levels of TC,TG,HDL-C and LDL-C in the two groups were lower than those before treatment,the difference was statistically significant (P ＜0.05),and the Treg/CD4+ in the observation group was significantly lower than that in the control group (P ＜0.05),the difference was statistically significant (P ＜0.05).[Conclusion]Metformin combined with Lilalutide in the treatment of T2DM patients with NAFLD can effectively restore the function of islet β cells,reduce the degree of insulin resistance,and achieve the purpose of blood glucose control,which is worthy of clinical application.