中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
3期
281-285
,共5页
2型糖尿病%非酒精性脂肪性肝病%丙氨酸氨基转移酶%颈动脉内膜中层厚度
2型糖尿病%非酒精性脂肪性肝病%丙氨痠氨基轉移酶%頸動脈內膜中層厚度
2형당뇨병%비주정성지방성간병%병안산안기전이매%경동맥내막중층후도
Type 2 diabetes%Nonalcoholic fatty liver disease%. Alanine aminotransferase%Carotid intima-media thickness
目的 探讨2型糖尿病(T2DM)患者非酒精性脂肪性肝病(NAFLD)与代谢指标及颈动脉内膜中层厚度(CIMT)的相关性.方法 根据肝脏B超结果,将321例T2DM患者分为合并NAFLD组和单纯T2DM组,比较2组患者的体重指数(BMI)、血压、血糖、血脂、尿酸、胰岛素、C肽、胰岛素抵抗指数(HOMA-IR)等代谢指标,并分析丙氨酸氨基转移酶(ALT)与上述指标的关系;比较合并NAFLD组与单纯T2DM组的CIMT,并通过相关及回归等方法探讨NAFLD及ALT与CIMT之间的相关性.结果 (1)合并NAFLD组BMI、甘油三酯(TG)、尿酸、空腹血糖(FBG)、空腹胰岛素(FIns)、空腹C肽(FCP)、HOMA-IR较单纯T2DM组显著升高,而高密度脂蛋白胆固醇(HDL-C)明显降低,其中BMI(OR=1.25,P＜0.001)、TG(OR=1.74,P=0.008)、HOMA-IR(OR=2.33,P=0.010)是NAFLD的独立危险因素,HDL-C(OR=0.04,P＜0.001)是其保护因素;(2)ALT与BMI(r=0.255,P＜0.001)、TG(r=0.156,P＜0.018)、尿酸(r=0.239,P＜0.001)、FIns(r=0.213,P=0.001)、FCP(r=0.199,P＜0.003)、HOMA-IR(r=0.247,P＜0.001)呈正相关,与HDL-C(r=-0.199,P=0.002)呈负相关,其中BMI(β=0.456,P=0.048)、尿酸(β=0.021,P=0.025)及HOMA-IR(β=3.634,P=0.004)是独立相关因素;(3)合并NAFLD组与单纯T2DM组之间的CIMT差异无统计学意义,而多元回归分析表明ALT与CIMT独立相关(β=0.002,P=0.013).结论 T2DM合并NAFLD患者存在更严重的代谢紊乱及胰岛素抵抗,ALT是T2DM患者颈动脉内膜中层增厚的独立危险因素.
目的 探討2型糖尿病(T2DM)患者非酒精性脂肪性肝病(NAFLD)與代謝指標及頸動脈內膜中層厚度(CIMT)的相關性.方法 根據肝髒B超結果,將321例T2DM患者分為閤併NAFLD組和單純T2DM組,比較2組患者的體重指數(BMI)、血壓、血糖、血脂、尿痠、胰島素、C肽、胰島素牴抗指數(HOMA-IR)等代謝指標,併分析丙氨痠氨基轉移酶(ALT)與上述指標的關繫;比較閤併NAFLD組與單純T2DM組的CIMT,併通過相關及迴歸等方法探討NAFLD及ALT與CIMT之間的相關性.結果 (1)閤併NAFLD組BMI、甘油三酯(TG)、尿痠、空腹血糖(FBG)、空腹胰島素(FIns)、空腹C肽(FCP)、HOMA-IR較單純T2DM組顯著升高,而高密度脂蛋白膽固醇(HDL-C)明顯降低,其中BMI(OR=1.25,P＜0.001)、TG(OR=1.74,P=0.008)、HOMA-IR(OR=2.33,P=0.010)是NAFLD的獨立危險因素,HDL-C(OR=0.04,P＜0.001)是其保護因素;(2)ALT與BMI(r=0.255,P＜0.001)、TG(r=0.156,P＜0.018)、尿痠(r=0.239,P＜0.001)、FIns(r=0.213,P=0.001)、FCP(r=0.199,P＜0.003)、HOMA-IR(r=0.247,P＜0.001)呈正相關,與HDL-C(r=-0.199,P=0.002)呈負相關,其中BMI(β=0.456,P=0.048)、尿痠(β=0.021,P=0.025)及HOMA-IR(β=3.634,P=0.004)是獨立相關因素;(3)閤併NAFLD組與單純T2DM組之間的CIMT差異無統計學意義,而多元迴歸分析錶明ALT與CIMT獨立相關(β=0.002,P=0.013).結論 T2DM閤併NAFLD患者存在更嚴重的代謝紊亂及胰島素牴抗,ALT是T2DM患者頸動脈內膜中層增厚的獨立危險因素.
목적 탐토2형당뇨병(T2DM)환자비주정성지방성간병(NAFLD)여대사지표급경동맥내막중층후도(CIMT)적상관성.방법 근거간장B초결과,장321례T2DM환자분위합병NAFLD조화단순T2DM조,비교2조환자적체중지수(BMI)、혈압、혈당、혈지、뇨산、이도소、C태、이도소저항지수(HOMA-IR)등대사지표,병분석병안산안기전이매(ALT)여상술지표적관계;비교합병NAFLD조여단순T2DM조적CIMT,병통과상관급회귀등방법탐토NAFLD급ALT여CIMT지간적상관성.결과 (1)합병NAFLD조BMI、감유삼지(TG)、뇨산、공복혈당(FBG)、공복이도소(FIns)、공복C태(FCP)、HOMA-IR교단순T2DM조현저승고,이고밀도지단백담고순(HDL-C)명현강저,기중BMI(OR=1.25,P＜0.001)、TG(OR=1.74,P=0.008)、HOMA-IR(OR=2.33,P=0.010)시NAFLD적독립위험인소,HDL-C(OR=0.04,P＜0.001)시기보호인소;(2)ALT여BMI(r=0.255,P＜0.001)、TG(r=0.156,P＜0.018)、뇨산(r=0.239,P＜0.001)、FIns(r=0.213,P=0.001)、FCP(r=0.199,P＜0.003)、HOMA-IR(r=0.247,P＜0.001)정정상관,여HDL-C(r=-0.199,P=0.002)정부상관,기중BMI(β=0.456,P=0.048)、뇨산(β=0.021,P=0.025)급HOMA-IR(β=3.634,P=0.004)시독립상관인소;(3)합병NAFLD조여단순T2DM조지간적CIMT차이무통계학의의,이다원회귀분석표명ALT여CIMT독립상관(β=0.002,P=0.013).결론 T2DM합병NAFLD환자존재경엄중적대사문란급이도소저항,ALT시T2DM환자경동맥내막중층증후적독립위험인소.
Objective To investigate the association between nonalcoholic fatty liver disease (NAFLD) and metabolism or carotid intima-media thickness (CIMT) in Type 2 diabetic(T2DM). Methods According to the liver B-ultrasonography, a total of 321 T2DM patients were divided into two groups, with or without NAFLD. Metabolic indexes such as BMI, BP, blood glucose, blood lipid, uric acid ( UA ), insulin, C-peptipe,insulin resistance index(HOMA-IR) between the two groups were compared, and the relationships between alanine aminotransferase (ALT) and the above indexes were analyzed. Furthermore,the CIMT of the two groups were compared, and the relationships between NAFLD, ALT and CIMT were investigated by correlation and regression analysis. Results Compared with the group without NAFLD, the patients with NAFLD had higher level of BMI, triglyceride ( TG ), UA, fasting blood glucose ( FBG ), fasting insulin ( FIns ), fasting C peptide (FCP) ,HOMA-IR,and lower level of high density lipoprotein ( HDL-C ) significantly; BMI ( OR = 1.25, P ＜0. 001 ), TG ( OR = 1.74, P = 0. 008 ) and HOMA-IR ( OR = 2. 33, P = 0.010) were independent risk factors of NAFLD while H DL-C was independent protective factor; ALT was positively correlated with BMI (r = 0. 255, P ＜0. 001 ) ,TG(r =0. 156,P ＜0. 018) ,UA(r =0. 239,P ＜0. 001 ) ,FIns(r =0. 213,P =0. 001) ,FCP(r =0. 199,P ＜0. 003), HOMA-IR ( r = 0. 247, P ＜ 0. 001 ) and negatively correlated with HDL-C ( r = - 0. 199, P =0. 002) ,and BMI (β =0. 456,P =0. 048) ,UA (β =0. 021 ,P =0. 025) and HOMA-IR(β =3.634 ,P =0. 004)were independent associated facrors. The difference of CIMT between the two groups didn't reach statistical significance, while mutiple regression analysis revealed that ALT was independently associated with CIMT(β =0. 002,P = 0. 013). Conclusion T2DM patients with NAFLD show more serious disorder of metabolism and insulin resistance. ALT is an independent risk factor of CIMT in T2DM patients.
