中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2012年
1期
1-5
,共5页
陈燕铭%王曼曼%王自明%何圣清%任琢琢%唐喜香%曾龙驿
陳燕銘%王曼曼%王自明%何聖清%任琢琢%唐喜香%曾龍驛
진연명%왕만만%왕자명%하골청%임탁탁%당희향%증룡역
糖尿病%非酒精性脂肪性肝病%脂联素%炎性因子%胰岛素抵抗
糖尿病%非酒精性脂肪性肝病%脂聯素%炎性因子%胰島素牴抗
당뇨병%비주정성지방성간병%지련소%염성인자%이도소저항
Diabetes disease%Non-alcoholic fatty liver disease%Adiponectin%Inflammatory factors%Insulin resistance
目的 探讨炎性因子和脂联素在2型糖尿病(T2DM)合并非酒精性脂肪性肝病患者中的变化及意义.方法 共纳入观察者210例,其中健康对照组40名,T2DM组60例,非酒精性脂肪性肝病(NAFLD)组65例,T2DM合并NAFLD组45例.检测各组的血清丙氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶(GGT)、空腹血糖(FPG)、糖化血红蛋白(GHbA1c)、肌酐(Cr)、尿酸(UA)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)以及总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),计算胰岛素抵抗指数(HOMA-IR)、体质量指数(BMI)和腰臀比.测定血清肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)及脂联素.结果 NAFLD组与T2DM合并NAFLD组患者的血清ALT、GGT和BMI、腰臀比高于T2DM和健康对照组[ALT:(43.4±9.3)、(46.2±7.6)、(27.5±5.7)、(28.3±6.5)U/L,GGT:(55.3±10.4)、(54.5±11.3)、(40.3±8.4)、(38.2±10.5) U/L,BMI:(27.9±2.6)、(26.2±2.6)、(23.6±3.6)、(22.7±2.5)kg/m2,腰臀比:(0.94±0.05)、(0.96±0.07)、(0.91±0.08)、(0.89±0.05),P＜0.05或P＜0.01],T2DM组、NAFLD组与T2DM合并NAFLD组的TG、LDL-C均高于健康对照组[TG:(2.9±0.5)、(3.5±0.4)、(4.0±0.8)、( 1.3±0.2)mmol/L,LDL-C:(3.6±0.4)、(3.1±0.5)、(3.9±0.7)、(2.1±0.2)mmol/L,P均＜0.05],其中T2DM合并NAFLD组的TG高于T2DM组(P＜0.05).T2DM与T2DM合并NAFLD组的FPG、GHbAlc高于NAFLD和健康对照组[FPG:(8.5±0.6)、(8.9±0.9)、(4.6±0.7)、(4.7±0.4) mmol/L,GHbAlc:(9.3±3.6)％、(10.1±2.7)％、(5.0±0.2)％、(5.1±0.5)％,p＜0.05或P＜0.01],T2DM组、NAFLD组与T2DM合并NAFLD组的TNF-α、hs-CRP和HOMA-IR高于健康对照组[TNF-α:(90.5±10.5)、(115.3±10.1)、(197.5±13.8)、(34.3±7.5)ng/L,hs-CRP:(4.9±0.5)、(4.6±0.8)、(8.1±0.7)、(2.1±0.4) mg/L,HOMA-IR:(6.7±0.8)、(6.2±1.2)、(11.3±1.7)、(1.8±0.3),P＜0.05或P＜0.01],其中T2DM合并NAFLD组的TNF-α、hs-CRP、HOMA-1R高于单纯T2DM组(P均＜0.05).T2DM组、NAFLD组与T2DM合并NAFLD组患者的血清脂联素均低于健康对照组[(25.3±7.4)、(22.9±4.5)、(17.0±3.2)、(36.9±5.7) μg/L,P均＜0.05],其中T2DM合并NAFLD组的脂联素低于T2DM组(P＜0.05).T2DM合并NAFLD组患者血清脂联素浓度与TNF-α、hs-CRP和HOMA-IR之间呈负相关(r值分别为-0.635、-0.668、-0.752,P均＜0.01),HOMA-IR与TNF-α、hs-CRP之间呈正相关(r值分别为0.667、0.706,P均＜0.01).结论 炎性因子和脂联素参与了T2DM与脂肪性肝病的发病机制,而脂联素可能通过拮抗炎症反应减轻胰岛素抵抗,对脂肪性肝病有一定的改善作用.
目的 探討炎性因子和脂聯素在2型糖尿病(T2DM)閤併非酒精性脂肪性肝病患者中的變化及意義.方法 共納入觀察者210例,其中健康對照組40名,T2DM組60例,非酒精性脂肪性肝病(NAFLD)組65例,T2DM閤併NAFLD組45例.檢測各組的血清丙氨痠氨基轉移酶(ALT)、γ-穀氨酰轉移酶(GGT)、空腹血糖(FPG)、糖化血紅蛋白(GHbA1c)、肌酐(Cr)、尿痠(UA)、餐後2h血糖(2hPG)、空腹胰島素(FINS)以及總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C),計算胰島素牴抗指數(HOMA-IR)、體質量指數(BMI)和腰臀比.測定血清腫瘤壞死因子-α(TNF-α)、超敏C反應蛋白(hs-CRP)及脂聯素.結果 NAFLD組與T2DM閤併NAFLD組患者的血清ALT、GGT和BMI、腰臀比高于T2DM和健康對照組[ALT:(43.4±9.3)、(46.2±7.6)、(27.5±5.7)、(28.3±6.5)U/L,GGT:(55.3±10.4)、(54.5±11.3)、(40.3±8.4)、(38.2±10.5) U/L,BMI:(27.9±2.6)、(26.2±2.6)、(23.6±3.6)、(22.7±2.5)kg/m2,腰臀比:(0.94±0.05)、(0.96±0.07)、(0.91±0.08)、(0.89±0.05),P＜0.05或P＜0.01],T2DM組、NAFLD組與T2DM閤併NAFLD組的TG、LDL-C均高于健康對照組[TG:(2.9±0.5)、(3.5±0.4)、(4.0±0.8)、( 1.3±0.2)mmol/L,LDL-C:(3.6±0.4)、(3.1±0.5)、(3.9±0.7)、(2.1±0.2)mmol/L,P均＜0.05],其中T2DM閤併NAFLD組的TG高于T2DM組(P＜0.05).T2DM與T2DM閤併NAFLD組的FPG、GHbAlc高于NAFLD和健康對照組[FPG:(8.5±0.6)、(8.9±0.9)、(4.6±0.7)、(4.7±0.4) mmol/L,GHbAlc:(9.3±3.6)％、(10.1±2.7)％、(5.0±0.2)％、(5.1±0.5)％,p＜0.05或P＜0.01],T2DM組、NAFLD組與T2DM閤併NAFLD組的TNF-α、hs-CRP和HOMA-IR高于健康對照組[TNF-α:(90.5±10.5)、(115.3±10.1)、(197.5±13.8)、(34.3±7.5)ng/L,hs-CRP:(4.9±0.5)、(4.6±0.8)、(8.1±0.7)、(2.1±0.4) mg/L,HOMA-IR:(6.7±0.8)、(6.2±1.2)、(11.3±1.7)、(1.8±0.3),P＜0.05或P＜0.01],其中T2DM閤併NAFLD組的TNF-α、hs-CRP、HOMA-1R高于單純T2DM組(P均＜0.05).T2DM組、NAFLD組與T2DM閤併NAFLD組患者的血清脂聯素均低于健康對照組[(25.3±7.4)、(22.9±4.5)、(17.0±3.2)、(36.9±5.7) μg/L,P均＜0.05],其中T2DM閤併NAFLD組的脂聯素低于T2DM組(P＜0.05).T2DM閤併NAFLD組患者血清脂聯素濃度與TNF-α、hs-CRP和HOMA-IR之間呈負相關(r值分彆為-0.635、-0.668、-0.752,P均＜0.01),HOMA-IR與TNF-α、hs-CRP之間呈正相關(r值分彆為0.667、0.706,P均＜0.01).結論 炎性因子和脂聯素參與瞭T2DM與脂肪性肝病的髮病機製,而脂聯素可能通過拮抗炎癥反應減輕胰島素牴抗,對脂肪性肝病有一定的改善作用.
목적 탐토염성인자화지련소재2형당뇨병(T2DM)합병비주정성지방성간병환자중적변화급의의.방법 공납입관찰자210례,기중건강대조조40명,T2DM조60례,비주정성지방성간병(NAFLD)조65례,T2DM합병NAFLD조45례.검측각조적혈청병안산안기전이매(ALT)、γ-곡안선전이매(GGT)、공복혈당(FPG)、당화혈홍단백(GHbA1c)、기항(Cr)、뇨산(UA)、찬후2h혈당(2hPG)、공복이도소(FINS)이급총담고순(TC)、감유삼지(TG)、저밀도지단백담고순(LDL-C)、고밀도지단백담고순(HDL-C),계산이도소저항지수(HOMA-IR)、체질량지수(BMI)화요둔비.측정혈청종류배사인자-α(TNF-α)、초민C반응단백(hs-CRP)급지련소.결과 NAFLD조여T2DM합병NAFLD조환자적혈청ALT、GGT화BMI、요둔비고우T2DM화건강대조조[ALT:(43.4±9.3)、(46.2±7.6)、(27.5±5.7)、(28.3±6.5)U/L,GGT:(55.3±10.4)、(54.5±11.3)、(40.3±8.4)、(38.2±10.5) U/L,BMI:(27.9±2.6)、(26.2±2.6)、(23.6±3.6)、(22.7±2.5)kg/m2,요둔비:(0.94±0.05)、(0.96±0.07)、(0.91±0.08)、(0.89±0.05),P＜0.05혹P＜0.01],T2DM조、NAFLD조여T2DM합병NAFLD조적TG、LDL-C균고우건강대조조[TG:(2.9±0.5)、(3.5±0.4)、(4.0±0.8)、( 1.3±0.2)mmol/L,LDL-C:(3.6±0.4)、(3.1±0.5)、(3.9±0.7)、(2.1±0.2)mmol/L,P균＜0.05],기중T2DM합병NAFLD조적TG고우T2DM조(P＜0.05).T2DM여T2DM합병NAFLD조적FPG、GHbAlc고우NAFLD화건강대조조[FPG:(8.5±0.6)、(8.9±0.9)、(4.6±0.7)、(4.7±0.4) mmol/L,GHbAlc:(9.3±3.6)％、(10.1±2.7)％、(5.0±0.2)％、(5.1±0.5)％,p＜0.05혹P＜0.01],T2DM조、NAFLD조여T2DM합병NAFLD조적TNF-α、hs-CRP화HOMA-IR고우건강대조조[TNF-α:(90.5±10.5)、(115.3±10.1)、(197.5±13.8)、(34.3±7.5)ng/L,hs-CRP:(4.9±0.5)、(4.6±0.8)、(8.1±0.7)、(2.1±0.4) mg/L,HOMA-IR:(6.7±0.8)、(6.2±1.2)、(11.3±1.7)、(1.8±0.3),P＜0.05혹P＜0.01],기중T2DM합병NAFLD조적TNF-α、hs-CRP、HOMA-1R고우단순T2DM조(P균＜0.05).T2DM조、NAFLD조여T2DM합병NAFLD조환자적혈청지련소균저우건강대조조[(25.3±7.4)、(22.9±4.5)、(17.0±3.2)、(36.9±5.7) μg/L,P균＜0.05],기중T2DM합병NAFLD조적지련소저우T2DM조(P＜0.05).T2DM합병NAFLD조환자혈청지련소농도여TNF-α、hs-CRP화HOMA-IR지간정부상관(r치분별위-0.635、-0.668、-0.752,P균＜0.01),HOMA-IR여TNF-α、hs-CRP지간정정상관(r치분별위0.667、0.706,P균＜0.01).결론 염성인자화지련소삼여료T2DM여지방성간병적발병궤제,이지련소가능통과길항염증반응감경이도소저항,대지방성간병유일정적개선작용.
Objective To investigate the clinical significance of inflammatory factors and adiponectin in type 2 diabetes milletus complicated with non-alcoholic fatty liver disease.Methods Two hundred and ten subjects aging from 25.0 to 65.0 years old,including 106 men and 104 women,were recruited into this study.They were divided into four groups: Forty cases of healthy control (NC),60 cases with newly-diagnosed type 2 diabetes (T2DM),65 cases with simple non-alcoholic fatty liver disease (NAFLD) and other 45 cases with newly-diagnosed T2DM complicated with NAFLD.The physical examination was performed for each patient.Serum levels of alanine aminotransferase (ALT),gamma-glutamyl transpeptidase (GGT),fasting plasma glucose (FPG),glycation hemoglobin A 1 c ( GHbA1c ),creatinine ( Cr),uric acid ( UA ),2 hours postprandic plasma glucose (2hPG),fasting insulin (FINS),lipid profiles were measured.Insulin resistance index (HOMAIR) was calculated.Tumor necrosis factor-α (TNF-α),high sensitive C-reactive protein (hs-CRP) and adiponectin were also detected.Results The serum levels of ALT and GGT,body mass index and waist/hip ratio were higher in the NAFLD,T2DM with NAFLD patient groups than that in T2DM and NC group ( P ＜0.05or P ＜0.01 ).The serum levels of TG and LDL-C were significantly higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.And serum TG levels in T2DM with NAFLD group were higher than that of T2DM group (P ＜ 0.05).FPG and GHbAl c were higher in T2DM and T2DM with NAFLD groups than that of NAFLD and NC groups.The serum levels of TNF-α,hs-CRP and HOMA-IR were higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.T2DM with NAFLD group had higher levels of TNF-α,hs-CRP and HOMA-IR compared with T2DM group.However,serum adiponectin levels of T2DM,NAFLD and T2DM with NAFLD groups were lower than that of NC group.And it was lower in T2DM with NAFLD group when compared with NC group ( P ＜ 0.05 ).Adiponectin was negatively associated with TNF-α,hs-CRP and HOMA-IR (r =-0.635,-0.668,-0.752 respectively,P ＜ 0.0l ).But HOMA-IR was positively associated with TNF-α,hs-CRP( r =0.667,0.706 respectively,P ＜ 0.01 ).Conclusion Inflammatory factors and adiponectin may play important roles in the pathophysiology and progression of T2DM and NAFLD.The protective effects of adiponectin may come from its anti-inflammatory activity to relieve insulin resistance for NAFLD.
