CAJ | 학술논문

目的：分析2型糖尿病（T2DM）患者血糖波动和8-异前列腺素F2α（8-iso-PGF2α）水平变化对非酒精性脂肪性肝病（NAFLD）的作用。方法选取2012年10月至2013年11月山西医学科学院山西大医院内分泌科住院的单纯T2DM患者（DM组）30例，T2DM合并NAFLD患者（DM＋NAFLD组）32例，另选取体检中心查体健康者30例作为正常糖耐量组（NGT组），三组的年龄、性别、病程、血压、体质量指数（BMI）、血脂差异均无统计学意义（ P ＞0.05）。收集患者临床资料，检测血脂、糖化血红蛋白（HbA1c），均行口服葡萄糖耐量试验（OGTT），用葡萄糖氧化酶法测定各点血糖，以餐后血糖波动幅度（PPGE）、血糖水平标准差（SDBG）和平均血糖（MBG）作为评价血糖波动指标，采用酶联免疫吸附法（ELISA）检测血清8-iso-PGF2α评价氧化应激水平，多组比较采用单因素方差分析，对其影响因素进行相关分析。结果⑴DM组和DM＋NAFLD组的PPGE[（7.34±2.23）mmol／L，（8.52±2.43）mmol／L]、SDBG[（2.43±0.90）mmol／L，（2.80±0.78）mmol／L]、MBG[（11.06±1.76）mmol／L，（13.65±2.83）mmol／L]、HbA1c[（7.59±1.02）％，（8.05±1.52）％]水平较NGT组显著升高，差异有统计学意义（ P ＜0.05）；与DM组相比，DM＋NAFLD组的PPGE、SDBG、MBG水平显著升高，差异有统计学意义（ P ＜0.05），但HbA1c差异无统计学意义（ P ＞0.05）；⑵三组血清8-iso-PGF2α比较：NGT组[（33.45±8.60）pg／ml]、DM组[（47.33±15.30）pg／ml]及DM＋NAFLD组[（56.07±13.10）pg／ml]水平依次升高，差异有统计学意义（ P ＜0.05）；⑶Person相关分析：血清8-iso-PGF2α含量与PPGE、SDBG、MBG呈正相关（ r ＝0.796，0.778，0.712， P ＜0.01）。结论血清8-iso-PGF2α能更好反映机体氧化应激水平，在2型糖尿病患者中随着血糖波动幅度的增大氧化应激水平越高，是导致NAFLD发生的重要机制之一。目的：分析2型糖尿病（T2DM）患者血糖波動和8-異前列腺素F2α（8-iso-PGF2α）水平變化對非酒精性脂肪性肝病（NAFLD）的作用。方法選取2012年10月至2013年11月山西醫學科學院山西大醫院內分泌科住院的單純T2DM患者（DM組）30例，T2DM閤併NAFLD患者（DM＋NAFLD組）32例，另選取體檢中心查體健康者30例作為正常糖耐量組（NGT組），三組的年齡、性彆、病程、血壓、體質量指數（BMI）、血脂差異均無統計學意義（ P ＞0.05）。收集患者臨床資料，檢測血脂、糖化血紅蛋白（HbA1c），均行口服葡萄糖耐量試驗（OGTT），用葡萄糖氧化酶法測定各點血糖，以餐後血糖波動幅度（PPGE）、血糖水平標準差（SDBG）和平均血糖（MBG）作為評價血糖波動指標，採用酶聯免疫吸附法（ELISA）檢測血清8-iso-PGF2α評價氧化應激水平，多組比較採用單因素方差分析，對其影響因素進行相關分析。結果⑴DM組和DM＋NAFLD組的PPGE[（7.34±2.23）mmol／L，（8.52±2.43）mmol／L]、SDBG[（2.43±0.90）mmol／L，（2.80±0.78）mmol／L]、MBG[（11.06±1.76）mmol／L，（13.65±2.83）mmol／L]、HbA1c[（7.59±1.02）％，（8.05±1.52）％]水平較NGT組顯著升高，差異有統計學意義（ P ＜0.05）；與DM組相比，DM＋NAFLD組的PPGE、SDBG、MBG水平顯著升高，差異有統計學意義（ P ＜0.05），但HbA1c差異無統計學意義（ P ＞0.05）；⑵三組血清8-iso-PGF2α比較：NGT組[（33.45±8.60）pg／ml]、DM組[（47.33±15.30）pg／ml]及DM＋NAFLD組[（56.07±13.10）pg／ml]水平依次升高，差異有統計學意義（ P ＜0.05）；⑶Person相關分析：血清8-iso-PGF2α含量與PPGE、SDBG、MBG呈正相關（ r ＝0.796，0.778，0.712， P ＜0.01）。結論血清8-iso-PGF2α能更好反映機體氧化應激水平，在2型糖尿病患者中隨著血糖波動幅度的增大氧化應激水平越高，是導緻NAFLD髮生的重要機製之一。
목적：분석2형당뇨병（T2DM）환자혈당파동화8-이전렬선소F2α（8-iso-PGF2α）수평변화대비주정성지방성간병（NAFLD）적작용。방법선취2012년10월지2013년11월산서의학과학원산서대의원내분비과주원적단순T2DM환자（DM조）30례，T2DM합병NAFLD환자（DM＋NAFLD조）32례，령선취체검중심사체건강자30례작위정상당내량조（NGT조），삼조적년령、성별、병정、혈압、체질량지수（BMI）、혈지차이균무통계학의의（ P ＞0.05）。수집환자림상자료，검측혈지、당화혈홍단백（HbA1c），균행구복포도당내량시험（OGTT），용포도당양화매법측정각점혈당，이찬후혈당파동폭도（PPGE）、혈당수평표준차（SDBG）화평균혈당（MBG）작위평개혈당파동지표，채용매련면역흡부법（ELISA）검측혈청8-iso-PGF2α평개양화응격수평，다조비교채용단인소방차분석，대기영향인소진행상관분석。결과⑴DM조화DM＋NAFLD조적PPGE[（7.34±2.23）mmol／L，（8.52±2.43）mmol／L]、SDBG[（2.43±0.90）mmol／L，（2.80±0.78）mmol／L]、MBG[（11.06±1.76）mmol／L，（13.65±2.83）mmol／L]、HbA1c[（7.59±1.02）％，（8.05±1.52）％]수평교NGT조현저승고，차이유통계학의의（ P ＜0.05）；여DM조상비，DM＋NAFLD조적PPGE、SDBG、MBG수평현저승고，차이유통계학의의（ P ＜0.05），단HbA1c차이무통계학의의（ P ＞0.05）；⑵삼조혈청8-iso-PGF2α비교：NGT조[（33.45±8.60）pg／ml]、DM조[（47.33±15.30）pg／ml]급DM＋NAFLD조[（56.07±13.10）pg／ml]수평의차승고，차이유통계학의의（ P ＜0.05）；⑶Person상관분석：혈청8-iso-PGF2α함량여PPGE、SDBG、MBG정정상관（ r ＝0.796，0.778，0.712， P ＜0.01）。결론혈청8-iso-PGF2α능경호반영궤체양화응격수평，재2형당뇨병환자중수착혈당파동폭도적증대양화응격수평월고，시도치NAFLD발생적중요궤제지일。
Objective To investigate the level change of glucose excursion , 8-iso prostaglandin F 2α( 8-iso-PGF2α) in type 2 diabetes mellitus(T2DM), and its effects on nonalcoholic fatty liver disease (NAFLD).Methods A total of 62 inpatients with type 2 diabetes mellitus including T2DM group(DM, 30 cases) and T2DM with NAFLD group(DM+NAFLD, 32 cases) were recruited from October 2012 to November 2013 , normal glucose tolerance group had normal glucose tolerance ( NGT;30 cases ) with normal physical examination results.The age, gender, duration, blood pressure, body mass index (BMI), and blood lipid among three groups were no statistical difference .The clinical data of each patient were collected by professional people .Blood lipids and glycated hemoglobin (HbA1c) were detected.Oral glucose tolerance test (OGTT) were taken in all groups.The Postprandial glucose excursion (PPGE), blood glucose standard deviation (SDBG), mean blood glucose and (MBG) and HbA1c were used to evaluate the glucose excursion.Serum 8-iso-PGF2αwas detected by enzyme-linked immunosorbent (ELISA) to evaluate oxidative stress.Inter-group com-parison was conducted with analysis of variance ( ANOVA) .Correlation analysis was used to evaluate the factors of influence .Results⑴The levels of PPGE[(7.34 ±2.23) mmol/L vs (8.52 ±2.43) mmol/L],SDBG[(2.43 ±0.90) mmol/L vs (2.80 ±0.78) mmol/L], MBG[(11.06 ±1.76) mmol/L vs (13.65 ±2.83) mmol/L], and HbA1c [(7.59 ±1.02)% vs (8.05 ±1.52)%] in T2DM group and T2DM with NAFLD group were significantly higher than that in NGT group (both P <0.05); and that in NAFLD group have significantly rise than that in DM group ( P <0.05), but there was no significant difference in HbA 1c between groups.⑵ The level of serum 8-iso-PGF2αwas gradually increased from NGT group [(33.45 ±8.60) pg/ml], DM group [(47.33 ±15.30) pg/ml], to DM +NAFLD group [(56.07 ±13.10) pg/ml], with statistically significant difference ( P <0.05);⑶The Person corre-lation analysis showed that the content of serum 8-iso-PGF2αwas positively correlated with PPGE, SDBG, and MBG ( r =0.796, 0.778 , 0.712 , P <0.01 ) .Conclusions Serum 8-iso-PGF2αis a better parameter to reflect the status of body oxidative stress .The level of oxidative stress is increased with the increase of glucose excursion in T 2DM, which is the important mechanism of its complica-tions of NAFLD.