2型糖尿病合并非酒精性脂肪性肝病的代谢相关危险因素分析
2형당뇨병합병비주정성지방성간병적대사상관위험인소분석
Analysis of metabolic risk factors for developing nonalcoholic fatty liver in patients with type 2 diabetes mellitus
  • 万方数据
    中华肝脏病杂志 중화간장병잡지
    CHINESE JOURNAL OF HEPATOLOGY
    2014年 8期 631-635 ,共5页

    郭敏%郗光霞%杨娜%姚红

    곽민%치광하%양나%요홍

    2型糖尿病%脂肪肝,非酒精性%危险因素 2型糖尿病%脂肪肝,非酒精性%危險因素
    2형당뇨병%지방간,비주정성%위험인소
    Type 2 Diabetes mellitus%Fatty liver,nonalcoholic%Risk factor
    目的 比较并探讨2型糖尿病(T2DM)及其合并非酒精性脂肪性肝病(NAFLD)的代谢相关危险因素. 方法 选取2012年10月至2013年7月住院的T2DM患者389例,其中单纯T2DM (T2DM组)204例,T2DM合并NAFLD(T2DM+NAFLD组)185例.收集两组患者的临床资料;检测血脂、肝功能、尿酸;行口服葡萄糖耐量、胰岛素释放及C肽释放试验,以改良胰岛素C肽指数[HOMA-IR (CP)]和全身胰岛素敏感指数(ISI-comp)评估胰岛素敏感性,以改良胰岛素C肽分泌功能指数[HOMR-islet (CP)]、早期胰岛素分泌功能指数(△I30/△G30)、修正的胰岛β细胞功能指数(MBCI)和葡萄糖处置指数(DI)评估胰岛β细胞功能.组间比较用t检验和重复测量因素方差分析,非条件二分类logistic回归分析筛选T2DM合并NAFLD的危险因素.结果 与T2DM组比较,T2DM+NAFLD组的体质量指数、甘油三酯、ALT、AST、γ-谷氨酰转移酶、尿酸水平均升高,年龄、高密度脂蛋白胆固醇水平均降低(P值均＜ 0.05);糖负荷后30、60、120、180 min的血糖水平均升高,分别为(10.88±2.87) mmol/L对比(12.18±2.79)mmol/L、(14.65±3.69) mmol/L对比(15.99±3.12) mmol/L、(16.56±5.11) mmol/L对比(17.65±4.29) mmol/L、(13.92±5.10) mmol/L对比(14.71±4.91) mmol/L(t值分别为-3.32、-3.46、-2.81和-2.02,P值均＜0.05);糖负荷后60、120 min的胰岛素水平升高,1分别为(28.62±23.51)μIU/ml对比(36.91±33.47)μIU/ml、(36.36±25.60)μIU/ml对比(44.38±34.95)μ IU/ml(t值分别为-3.46和-3.35,P值均＜0.05);糖负荷后30、60、120 min的C肽水平均升高,分别为(2.74±1.70) ng/ml对比(4.30±6.51) ng/ml、(4.17±2.49) ng/ml对比(5.19±2.96) ng/ml、(6.08±2.79) ng/ml对比(6.76±3.10) ng/ml(t值分别为-4.97、-3.29和-2.19,P值均＜0.05);改良胰岛素C肽指数升高,为1.505±0.004对比1.507±0.005 (t=-2.208,P＜ 0.05);修正的胰岛β细胞功能指数和葡萄糖处置指数均降低,分别为4.68±4.31对比3.83±2.41和35.40±71.83对比15.37±13.93(t值分别为2.365和3.730,P值均＜0.05).logistic回归分析结果显示,体质量指数、糖负荷后30min C肽水平、ALT和尿酸是T2DM合并NAFLD的独立危险因素(OR值分别为1.208、2.080、1.041和1.005,P值均＜0.05). 结论 有NAFLD倾向时,T2DM的发病年龄较早;合并NAFLD的T2DM患者较单纯T2DM患者胰岛素抵抗和胰岛功能受损更明显,糖、脂代谢紊乱程度更严重.
    목적 비교병탐토2형당뇨병(T2DM)급기합병비주정성지방성간병(NAFLD)적대사상관위험인소. 방법 선취2012년10월지2013년7월주원적T2DM환자389례,기중단순T2DM (T2DM조)204례,T2DM합병NAFLD(T2DM+NAFLD조)185례.수집량조환자적림상자료;검측혈지、간공능、뇨산;행구복포도당내량、이도소석방급C태석방시험,이개량이도소C태지수[HOMA-IR (CP)]화전신이도소민감지수(ISI-comp)평고이도소민감성,이개량이도소C태분비공능지수[HOMR-islet (CP)]、조기이도소분비공능지수(△I30/△G30)、수정적이도β세포공능지수(MBCI)화포도당처치지수(DI)평고이도β세포공능.조간비교용t검험화중복측량인소방차분석,비조건이분류logistic회귀분석사선T2DM합병NAFLD적위험인소.결과 여T2DM조비교,T2DM+NAFLD조적체질량지수、감유삼지、ALT、AST、γ-곡안선전이매、뇨산수평균승고,년령、고밀도지단백담고순수평균강저(P치균＜ 0.05);당부하후30、60、120、180 min적혈당수평균승고,분별위(10.88±2.87) mmol/L대비(12.18±2.79)mmol/L、(14.65±3.69) mmol/L대비(15.99±3.12) mmol/L、(16.56±5.11) mmol/L대비(17.65±4.29) mmol/L、(13.92±5.10) mmol/L대비(14.71±4.91) mmol/L(t치분별위-3.32、-3.46、-2.81화-2.02,P치균＜0.05);당부하후60、120 min적이도소수평승고,1분별위(28.62±23.51)μIU/ml대비(36.91±33.47)μIU/ml、(36.36±25.60)μIU/ml대비(44.38±34.95)μ IU/ml(t치분별위-3.46화-3.35,P치균＜0.05);당부하후30、60、120 min적C태수평균승고,분별위(2.74±1.70) ng/ml대비(4.30±6.51) ng/ml、(4.17±2.49) ng/ml대비(5.19±2.96) ng/ml、(6.08±2.79) ng/ml대비(6.76±3.10) ng/ml(t치분별위-4.97、-3.29화-2.19,P치균＜0.05);개량이도소C태지수승고,위1.505±0.004대비1.507±0.005 (t=-2.208,P＜ 0.05);수정적이도β세포공능지수화포도당처치지수균강저,분별위4.68±4.31대비3.83±2.41화35.40±71.83대비15.37±13.93(t치분별위2.365화3.730,P치균＜0.05).logistic회귀분석결과현시,체질량지수、당부하후30min C태수평、ALT화뇨산시T2DM합병NAFLD적독립위험인소(OR치분별위1.208、2.080、1.041화1.005,P치균＜0.05). 결론 유NAFLD경향시,T2DM적발병년령교조;합병NAFLD적T2DM환자교단순T2DM환자이도소저항화이도공능수손경명현,당、지대사문란정도경엄중.
    Objective To compare and explore metabolic risk factors related to type 2 diabetes mellitus (T2DM) and the development of nonalcoholic fatty liver disease (NAFLD).Methods A total of 389 in-patients with T2DM (DM group,204 cases) and T2DM with NAFLD (DM+NAFLD group,185 cases) were enrolled in the study between October 2012 and July 2013.Clinical data collected for analysis included levels of blood lipids,liver function markers,uric acid (UA) and insulin,as well as results from the oral glucose tolerance test (OGTT) and C peptide releasing test.Improvements in insulin level,C peptide secretion index [HOMR-IR(CP)] and whole body insulin sensitivity index (ISIcomp) were used to estimate insulin sensitivity.Improvements in insulin level,C peptide secretion index [HOMR-islet(CP)],early insulin secretion index (/△ I30//△ G30),correction of the islet beta cell function index (MBC1) and glucose disposition index (DI) were used to evaluate the function of pancreatic islet 1β ceils.The t-test and repeated measures ANOVA were used for statistical analyses.Risk factors of T2DM with NAFLD were assessed by using logistic regression analysis.Results Compared with the DM group,the DM+NAFLD group had higher body mass index (BMI) and levels of triglyceddes,alanine aminotransferase (ALT),aspartate aminotransferase,gamma glutamine transferase and UA (allP＜ 0.05),but lower age and level of high density lipoprotein cholesterol (bothP ＜ 0.05).Moreover,the DM+NAFLD group had higher postprandial blood glucose levels at 30 min (10.88 ± 2.87 mmol/L vs.12.18 ± 2.79 mmol/L,t =-3.32),60 min (14.65 ± 3.69 mmol/L vs.15.99 ± 3.12 mmol/L,t =-3.46),120 min (16.56 ±5.11 mmol/L vs.17.65 ± 4.29 mmol/L,t =-2.81) and 180 min (13.92 ± 5.10 mmol/L vs.14.71 ±4.91 mmol/L,t=-2.02) (allP ＜ 0.05).The DM+NAFLD group had higher postprandial insulin levels at 60 min (28.62 ± 23.51 μIU/ml vs.36.91 ± 33.47 aIU/ml,t =-3.46) and 120 min (36.36 ± 25.60 μIU/mL vs.44.38 ± 34.95 μIU/mL,t =-3.35) (both P ＜ 0.05).The DM+NAFLD group had higher postprandial C peptide levels at 30 min (2.74 ± 1.70 ng/mL vs.4.30 ± 6.51 ng/ml,t =-4.97),60 min (4.17 ± 2.49 ng/ml vs.5.19 ± 2.96 ng/ml,t =-3.29) and 120 min (6.08 ± 2.79 ng/ml vs.6.76 ± 3.10 ng/ml,t =-2.19) (all P ＜ 0.05).The DM+NAFLD group had higher HOMA-IR(CP) (1.505 ± 0.004 vs.1.507 ± 0.005,t =-2.208,P ＜ 0.05),but lower ISIcomp (90.09 ± 69.31 vs.59.93 ± 24.52,t =5.608),MBCI (4.68 ± 4.31 vs.3.83 ± 2.41,t =2.365) and DI (35.40 ± 71.83 vs.15.37 ± 13.93,t =3.730) (all P ＜ 0.05).Logistic analysis showed that BMI,ALT,postprandial level of C-peptide at 30 min,and UA were the major risk factors of T2DM with NAFLD (OR =1.208,2.080,1.041,and 1.005,respectively; allP＜ 0.05).Conclusion Patients with a propensity for developing nonalcoholic fatty liver disease may experience earlier onet of type 2 diabetes.T2DM patients with NAFLD have more severe glucose metabolism disorders.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문