非酒精性脂肪肝患者发生2型糖尿病危险因素及与颈动脉硬化的关系
비주정성지방간환자발생2형당뇨병위험인소급여경동맥경화적관계
Analysis of risk factors of type 2 diabetes mellitus in patients with nonalcoholic fatty liver disease and correlations with carotid atherosclerosis
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2013年 18期 10-14 ,共5页

    郗健伟%陈伟依%王运发%徐琪

    치건위%진위의%왕운발%서기

    脂肪肝,非酒精性%糖尿病,2型%颈动脉疾病%危险因素 脂肪肝,非酒精性%糖尿病,2型%頸動脈疾病%危險因素
    지방간,비주정성%당뇨병,2형%경동맥질병%위험인소
    Fatty liver disease,nonalcoholic%Diabetes mellitus,type 2%Carotid artery disease%Risk factors
    目的 探讨菲酒精性脂肪肝(NAFLD)患者发生2型糖尿病(T2DM)的危险因素及与颈动脉硬化的关系.方法 选择51例NAFLD合并初诊T2DM患者(NAFLD合并T2DM组),与43例单纯NAFLD患者(NAFLD组)及45例健康体检者(对照组)进行比较.观察各组临床生化指标及颈动脉粥样硬化情况.结果 NAFLD合并T2DM组、NAFLD组的体质指数及有吸烟史者所占比例明显高于对照组[(27.25±3.16)、(26.31±2.63) kg/m2比(23.12±3.44) kg/m2,43.1％(22/51)、37.2％(16/43)比13.3％(6/45)],差异有统计学意义(P＜0.05).NAFLD合并T2DM组中有糖尿病家族史者所占比例高于NAFLD组及对照组[66.7％(34/51)比32.6％(14/43)、8.9％(4/45)],差异有统计学意义(P＜0.05).与对照组比较,NAFLD合并T2DM组、NAFLD组总胆固醇、三酰甘油、低密度脂蛋白胆固醇、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、颈动脉内膜-中层厚度(IMT)明显增高[(5.39±0.85)、(5.12±0.77) mmol/L比(4.11±0.64) mmol/L,(2.77±1.11)、(2.32±1.04) mmol/L比(1.21±0.52)mmol/L,(2.98±0.93)、(2.76±0.78) mmol/L比(2.15±0.57) mmol/L,(48.4±18.9)、(43.3土16.5) U/L比(21.4±13.6) U/L,(46.2±16.7)、(42.1±17.5) U/L比(20.5±12.6) U/L,(1.95±0.93)、(1.26±0.51)咖比(0.71±0.22)mm],高密度脂蛋白胆圆醇(HDL-C)明显降低[(1.01±0.35)、(1.13±0.22)mmol/L比(1.31±0.26) mmol/L],差异有统计学意义(P＜0.05),NAFLD合并T2DM组与NAFLD组上述指标比较差异无统计学意义(P＞0.05).NAFLD合并T2DM组空腹蛊糖(FBG)、餐后2h血糖(2 h PBG)、糖化血红蛋白、空腹胰岛素(FINS)、餐后2h胰岛素(2 h PINS)及胰岛素抵抗指数高于对照组和NAFLD组[(8.15±1.48) mmol/L比(5.10士1.32)、(5.62±0.88) mmol/L,(13.67±1.59) mmol/L比(7.31±1.25)、(8.64±1.35) mmol/L,(7.03±0.84)％比(5.16±0.72)％、(5.53±0.61)％,(13.32±4.55) mU/L比(6.06±3.11)、(9.13士4.37) mU/L,(106.37±21.45) mU/L比(33.21±18.87)、(46.34±16.39) mU/L,3.88±2.14比1.13±0.36、2.23±1.15],差异有统计学意义(P＜0.05).NAFLD合并T2DM组颈动脉IMT、斑块检出率及斑块Crouse积分高于NAFLD组[(1.95±0.93) mm比(1.26±0.51) mm、64.7％(33/51)比30.2％(13/43)、(3.11±0.57) mm比(1.35±0.49) mm],差异有统计学意义(P＜0.05).回归分析显示糖尿病家族史、FBG、2 hPBG、FINS、2 hPINS与NAFLD患者发生T2DM有关(P＜0.05).结论 糖尿病家族史、FBG、2 h PBG、FINS、2 h PINS是NAFLD患者发生T2DM的危险因素.NAFLD合并T2DM患者更容易发生颈动脉硬化.
    목적 탐토비주정성지방간(NAFLD)환자발생2형당뇨병(T2DM)적위험인소급여경동맥경화적관계.방법 선택51례NAFLD합병초진T2DM환자(NAFLD합병T2DM조),여43례단순NAFLD환자(NAFLD조)급45례건강체검자(대조조)진행비교.관찰각조림상생화지표급경동맥죽양경화정황.결과 NAFLD합병T2DM조、NAFLD조적체질지수급유흡연사자소점비례명현고우대조조[(27.25±3.16)、(26.31±2.63) kg/m2비(23.12±3.44) kg/m2,43.1％(22/51)、37.2％(16/43)비13.3％(6/45)],차이유통계학의의(P＜0.05).NAFLD합병T2DM조중유당뇨병가족사자소점비례고우NAFLD조급대조조[66.7％(34/51)비32.6％(14/43)、8.9％(4/45)],차이유통계학의의(P＜0.05).여대조조비교,NAFLD합병T2DM조、NAFLD조총담고순、삼선감유、저밀도지단백담고순、병안산안기전이매、천동안산안기전이매、경동맥내막-중층후도(IMT)명현증고[(5.39±0.85)、(5.12±0.77) mmol/L비(4.11±0.64) mmol/L,(2.77±1.11)、(2.32±1.04) mmol/L비(1.21±0.52)mmol/L,(2.98±0.93)、(2.76±0.78) mmol/L비(2.15±0.57) mmol/L,(48.4±18.9)、(43.3토16.5) U/L비(21.4±13.6) U/L,(46.2±16.7)、(42.1±17.5) U/L비(20.5±12.6) U/L,(1.95±0.93)、(1.26±0.51)가비(0.71±0.22)mm],고밀도지단백담원순(HDL-C)명현강저[(1.01±0.35)、(1.13±0.22)mmol/L비(1.31±0.26) mmol/L],차이유통계학의의(P＜0.05),NAFLD합병T2DM조여NAFLD조상술지표비교차이무통계학의의(P＞0.05).NAFLD합병T2DM조공복고당(FBG)、찬후2h혈당(2 h PBG)、당화혈홍단백、공복이도소(FINS)、찬후2h이도소(2 h PINS)급이도소저항지수고우대조조화NAFLD조[(8.15±1.48) mmol/L비(5.10사1.32)、(5.62±0.88) mmol/L,(13.67±1.59) mmol/L비(7.31±1.25)、(8.64±1.35) mmol/L,(7.03±0.84)％비(5.16±0.72)％、(5.53±0.61)％,(13.32±4.55) mU/L비(6.06±3.11)、(9.13사4.37) mU/L,(106.37±21.45) mU/L비(33.21±18.87)、(46.34±16.39) mU/L,3.88±2.14비1.13±0.36、2.23±1.15],차이유통계학의의(P＜0.05).NAFLD합병T2DM조경동맥IMT、반괴검출솔급반괴Crouse적분고우NAFLD조[(1.95±0.93) mm비(1.26±0.51) mm、64.7％(33/51)비30.2％(13/43)、(3.11±0.57) mm비(1.35±0.49) mm],차이유통계학의의(P＜0.05).회귀분석현시당뇨병가족사、FBG、2 hPBG、FINS、2 hPINS여NAFLD환자발생T2DM유관(P＜0.05).결론 당뇨병가족사、FBG、2 h PBG、FINS、2 h PINS시NAFLD환자발생T2DM적위험인소.NAFLD합병T2DM환자경용역발생경동맥경화.
    Objective To investigate the risk factors of type 2 diabetes mellitus(T2DM) in patients with nonalcoholic fatty liver disease (NAFLD) and correlations with carotid atherosclerosis.Methods The clinical data of 51 cases of N AFLD with T2DM (NAFLD with T2DM group),43 cases of NAFLD(NAFLD group) and 45 healthy objects (control group) were collected.The clinical biochemical features,carotid intima-media thickness (IMT) were observed.Results The BMI and smoking rate in NAFLD with T2DM group and NAFLD group were significandy higher than those in control group [(27.25 ±3.16),(26.31 ± 2.63) kg/m2 vs.(23.12 ±3.44) kg/m2,43.1％(22/51),37.2％(16/43) vs.13.3％(6/45)](P＜0.05).The ratio of family history of T2DM in NAFLD with T2DM group was significantly higher than that in NAFLD group and control group[66.7％(34/51)vs.32.6％(14/43),8.9％(4/45)](P ＜ 0.05).Compared with control group,the level of total cholesterol (TC),trigalloyl glycerol (TG),low density lipoprotein cholesterol (LDL-C),alanine transaminase(ALT),aspartic transaminase(AST),IMT in NAFLD with T2DM group and NAFLD group were significantly higher [(5.39 ± 0.85),(5.12 ± 0.77) mmol/L vs.(4.11 ± 0.64) mmol/L,(2.77 ± 1.11),(2.32 + 1.04) mmol/L vs.(1.21 ± 0.52) mmol/L,(2.98 ±0.93),(2.76 +0.78) mmol/L vs.(2.15 ±0.57) mtmol/L,(48.4 ± 18.9),(43.3 ± 16.5) U/L vs.(21.4 ± 13.6) U/L,(46.2 ± 16.7),(42.1 ± 17.5) U/L vs.(20.5 ± 12.6) U/L,(1.95 ±0.93),(1.26±0.51) mmvs.(0.71 ±0.22) mm](P＜ 0.05),while the level of high density lipoprotein cholesterol (HDL-C) was significantly lower [(1.01 ± 0.35),(1.13 + 0.22) mmol/L vs.(1.31 ± 0.26) mmol/L] (P ＜ 0.05).The level of above mentioned index,there were no significant difference between NAFLD with T2DM group and NAFLD group (P ＞ 0.05).The level of fasting blood glucose (FBG),2-hour postprandial blood glucose (2 h PBG),glycosylated hemoglobin (HbA1c),fasting insulin (FINS),2-hour postprandial insulin (2 h PINS) and insulin resistance index of HOMA (HOMA-IR) in NAFLD with T2DM group were significantly higher than those in NAFLD group and control group [(8.15 ± 1.48) mmol/L vs.(5.10 ± 1.32),(5.62 ± 0.88) mmol/L,(13.67 ± 1.59) mmol/L vs.(7.31 ± 1.25),(8.64± 1.35) mmol/L,(7.03 ±0.84)％ vs.(5.16 ±0.72)％,(5.53 ±0.61)％,(13.32 ±4.55) mU/L vs.(6.06 ±3.11),(9.13 ±4.37) mU/L,(106.37 ±21.45) mU/L vs.(33.21 ± 18.87),(46.34 ± 16.39) mU/L,3.88 + 2.14 vs.1.13 ± 0.36,2.23 ± 1.15] (P ＜ 0.05).Carotid IMT,the incidence of carotid plaque and Crouse scores of plaque in NAFLD with T2DM group were significandy higher than those in NAFLD group [(1.95 ±0.93) mm vs.(1.26 ±0.51) mm,64.7％(33/51) vs.30.2％(13/43),(3.11 ±0.57) nn vs.(1.35 ± 0.49) mm] (P ＜ 0.05).The regression analysis showed that family history of T2DM,FBG,2 h PBG,FINS,2 h PINS were independently associated with T2DM.Conclusions Family history of T2DM,FBG,2 h PBG,FINS,2 h PINS are the main risk factors for the onset of T2DM in NAFLD.The risk of carotid atherosclerosis is increased in patients of NAFLD with T2DM.
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