CAJ | 학술논문

目的应用肝酶、肝脏超声和肝脏质子核磁共振波谱(1H MRS)3种方法探讨住院2型糖尿病(T2DM)患者肝病构成谱及非酒精性脂肪性肝病(NAFLD)的危险因素.方法采集2009年9月至2011年10月复旦大学附属中山医院内分泌代谢科1069例住院T2DM患者的病史资料、生化指标、肝脏超声检查结果和肝脏1H MRS检查结果进行分析.结果 (1)T2DM人群肝酶升高检出率28.7％(307/1069),其中39.4％ (121/307)由NAFLD引起.排除酒精、肝炎病毒等其他因素后,T2DM人群中肝酶升高检出率26.9％(185/688)；(2) T2DM者超声诊断脂肪肝的检出率为56.7％(500/882),其中72.6％ (363/500)由NAFLD引起,NAFLD的检出率达58.0％(363/626);(3)T2DM者肝脏1H MRS诊断脂肪肝的检出率为72.8％(227/312),其中69.6％(158/227)为NAFLD; (4)T2DM患者中NAFLD的检出率肝脏1H MRS＞肝脏超声＞肝酶检测.以肝脏1H MRS为金标准,联合肝酶和肝脏超声诊断较单纯肝酶或肝脏超声诊断灵敏度增高,丙氨酸转氨酶(ALT)诊断NAFLD的最佳临界值男性为19.7 U/L[受试者工作特征曲线曲线下面积(ROCAUC)=0.689,P＜0.01],女性17.0 U/L(ROCAUC =0.727,P＜0.01)；(5) Logistic逐步回归分析,性别、体质指数、血红蛋白、空腹C肽、尿酸均与NAFLD独立正相关(OR =3.803,1.195,1.037,2.896,1.011,均P＜0.05).糖尿病病程与NAFLD独立负相关(OR =0.948,P ＜0.05).结论 T2DM患者中脂肪肝检出率高,构成以NAFLD为主,且肝酶异常检出率高,提示合并T2DM的NAFLD患者更易发生非酒精性脂肪性肝炎.
목적 응용간매、간장초성화간장질자핵자공진파보(1H MRS)3충방법탐토주원2형당뇨병(T2DM)환자간병구성보급비주정성지방성간병(NAFLD)적위험인소.방법 채집2009년9월지2011년10월복단대학부속중산의원내분비대사과1069례주원T2DM환자적병사자료、생화지표、간장초성검사결과화간장1H MRS검사결과진행분석.결과 (1)T2DM인군간매승고검출솔28.7％(307/1069),기중39.4％ (121/307)유NAFLD인기.배제주정、간염병독등기타인소후,T2DM인군중간매승고검출솔26.9％(185/688)；(2) T2DM자초성진단지방간적검출솔위56.7％(500/882),기중72.6％ (363/500)유NAFLD인기,NAFLD적검출솔체58.0％(363/626);(3)T2DM자간장1H MRS진단지방간적검출솔위72.8％(227/312),기중69.6％(158/227)위NAFLD; (4)T2DM환자중NAFLD적검출솔간장1H MRS＞간장초성＞간매검측.이간장1H MRS위금표준,연합간매화간장초성진단교단순간매혹간장초성진단령민도증고,병안산전안매(ALT)진단NAFLD적최가림계치남성위19.7 U/L[수시자공작특정곡선곡선하면적(ROCAUC)=0.689,P＜0.01],녀성17.0 U/L(ROCAUC =0.727,P＜0.01)；(5) Logistic축보회귀분석,성별、체질지수、혈홍단백、공복C태、뇨산균여NAFLD독립정상관(OR =3.803,1.195,1.037,2.896,1.011,균P＜0.05).당뇨병병정여NAFLD독립부상관(OR =0.948,P ＜0.05).결론 T2DM환자중지방간검출솔고,구성이NAFLD위주,차간매이상검출솔고,제시합병T2DM적NAFLD환자경역발생비주정성지방성간염.
Objective To explore the liver disease spectrum in patients with type 2 diabetes (T2DM) and the risk factors of non-alcoholic fatty liver disease (NAFLD).Methods From September 2009 to October 2011,1069 hospitalized patients with T2DM in Department of Endocrinology and Metabolism were involved in the study.The history informations,results of laboratory examination,hepatic ultrasound and hepatic proton magnetic resonance spectum (1H MRS) of all patients were collected to analysis.Results (1)The detectable rate of raised liver enzymes in T2DM patients was 28.7％ (307/1069),composed mainly of NAFLD (39.4％,121/307).After excluding the factors such as alcoholic abuse,viral hepatitis,the detect rate of raised liver enzymes in T2DM patients was 26.9％ (185/688).(2)The detectable rate of fatty liver by ultrasound in T2DM patients was 56.7％ (500/882),composed mainly of NAFLD (72.6％,363/500),and the detectable rate of NAFLD was 58.0％ (363/626).(3) The detectable rate of fatty liver by hepatic 1H MRS was 72.8％ (227/312),composed mainly of NAFLD (69.6％,158/227).The detectable rate of NAFLD was 69.6％ (158/227).(4) Of the three methods for diagnosing NAFLD,1H MRS had the highest detectable rate,followed by ultrasound,and the hepatic enzymes was the lowest.Set the hepatic 1H MRS as gold diagnosing standrd of NAFLD,the combination of hepatic enzymes and ultrasound increase the sensitivity.The optional cut-off points of ALT were 19.7 U/L (male,ROCAUC =0.689,P ＜ 0.01) and 17.0 U/L (female,ROCAUC =0.727,P ＜ 0.01).(5) Logistic stepwise regression analysis showed sex,BMI,hemoglobin,fasting C-peptide and uric acid(OR =3.803,@@1.195,1.037,2.896,1.011,all P ＜ 0.05)were positively correlated with NAFLD,and diabetes duration (OR =0.948,P ＜ 0.05) was positively correlated with NAFLD independently.Conclusions The detectable rate of fatty liver was high in T2DM which was composed mainly of NAFLD.High abnormal liver enzymes detectable rate indicated that NAFLD with T2DM are prone to NASH.