CAJ | 학술논문

目的分析2型糖尿病合并非酒精性脂肪性肝病( NAFLD)与胰岛素抵抗及血脂代谢紊乱之间的关系,并探讨诱发这些疾病的相关危险因素.方法选取2型糖尿病患者200例,其中合并NAFLD者99例,未合并NAFLD者101例.测量身高、体重、腰围、臀围；检测肝酶、糖脂代谢指标,计算体重指数(BMI)、腰臀比以及改良的胰岛素C肽指数(HOMA-C肽),2组进行比较.结果 NAFLD组体重、BMI、腰围、臀围、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶、甘油三酯(TG)、总胆固醇、低密度脂蛋白胆固醇均明显增高(均P＜0.01),而年龄、病程、高密度脂蛋白胆固醇低于非NAFLD组(均P＜0.05).NAFLD组高脂血症尤以高TG血症发生率明显增加(P＜0.01).NAFLD组空腹和餐后1h血糖[(2.07±0.36对1.83±0.43) mmol/L,(14.04±3.96对12.59±3.90)mmol/L]、空腹及餐后1hC肽[(2.79±1.15对2.08±1.29) ng/ml,(1.33±0.45对1.12±0.54)ng/ml]、HbA1c[(2.09±0.33对1.96±0.28)％]、HOMA-C肽指数均明显增高(P＜0.05或P＜0.01).logistic 回归分析显示TG、BMI、ALT是2型糖尿病合并NAFLD的主要危险因素(P＜0.05或P＜0.01).结论高TG血症、肥胖以及ALT升高增加2型糖尿病合并NAFLD的患病风险.
목적 분석2형당뇨병합병비주정성지방성간병( NAFLD)여이도소저항급혈지대사문란지간적관계,병탐토유발저사질병적상관위험인소.방법 선취2형당뇨병환자200례,기중합병NAFLD자99례,미합병NAFLD자101례.측량신고、체중、요위、둔위；검측간매、당지대사지표,계산체중지수(BMI)、요둔비이급개량적이도소C태지수(HOMA-C태),2조진행비교.결과 NAFLD조체중、BMI、요위、둔위、병안산안기전이매(ALT)、천문동안산안기전이매、감유삼지(TG)、총담고순、저밀도지단백담고순균명현증고(균P＜0.01),이년령、병정、고밀도지단백담고순저우비NAFLD조(균P＜0.05).NAFLD조고지혈증우이고TG혈증발생솔명현증가(P＜0.01).NAFLD조공복화찬후1h혈당[(2.07±0.36대1.83±0.43) mmol/L,(14.04±3.96대12.59±3.90)mmol/L]、공복급찬후1hC태[(2.79±1.15대2.08±1.29) ng/ml,(1.33±0.45대1.12±0.54)ng/ml]、HbA1c[(2.09±0.33대1.96±0.28)％]、HOMA-C태지수균명현증고(P＜0.05혹P＜0.01).logistic 회귀분석현시TG、BMI、ALT시2형당뇨병합병NAFLD적주요위험인소(P＜0.05혹P＜0.01).결론 고TG혈증、비반이급ALT승고증가2형당뇨병합병NAFLD적환병풍험.
Objective To investigate the association of nonalcoholic fatty liver disease (NAFLD) with insulin resistance and dyslipidemia in patients with type 2 diabetes mellitus,and to analyze the risk factors.Methods A total of 200 patients with type 2 diabetes mellitus including 99 with NAFLD and 101 without NAFLD were recruited.Height,weight,waist circumference,hip circumference,liver enzymes,blood lipids,fasting and postprandial blood glucose,insulin,C-peptide,and HbA1C levels were detected.Body mass index ( BMI),waist-hip ratio( WHR),and improved insulin and C-peptide index(HOMA-C-peptide) were calculated and compared between two groups.Results Compared with non-NAFLD group,weight,BMI,waist circumference,hip circumference,alanine aminotransferase ( ALT),aspartate aminotransferase,triglyceride ( TG ),total cholesterol ( TC ),low density lipoprotein-cholesterol(LDL-C) were significantly higher in NAFLD group( all P＜0.01 ),while age,duration,and high density lipoprotein-cholesterol were lower( all P＜0.05 ).The incidence of combined hyperlipidemia,especially hypertriglyceridemia,was significantly higher in NAFLD group( P＜0.01 ).Fasting and postprandial 1 h blood glucose [ ( 2.07 ±0.36 vs 1.83 ±0.43 ) mmol/L,( 14.04 ± 3.96 vs 12.59 ± 3.90 ) mmol/L ],fasting and postprandial 1 h Cpeptide [ (2.79± 1.15 vs 2.08±1.29 ) ng/ml,( 1.33 ±0.45 vs 1.12±0.54) ng/ml ],HbA1C [ (2.09±0.33 vs 1.96±0.28) ％ ],and HOMA-C-peptide index were significantly increased in NAFLD group ( P ＜ 0.05 or P ＜ 0.01 ).Logistic analysis showed that TG,BMI,and ALT were the major risk factors of NAFLD in type 2 diabetes mellitus( P＜0.05 or P＜0.01 ).Conclusion Triglyceridemia,obesity,and raised ALT level were significantly associated with an increased risk of NAFLD in patients with type 2 diabetes mellitus.