中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2013年
9期
555-559
,共5页
花晓敏%仲英洁%黄洪%王维敏%陈炜%孙燕军%胡云
花曉敏%仲英潔%黃洪%王維敏%陳煒%孫燕軍%鬍雲
화효민%중영길%황홍%왕유민%진위%손연군%호운
糖尿病,2型%非酒精性脂肪性肝病%性激素结合球蛋白
糖尿病,2型%非酒精性脂肪性肝病%性激素結閤毬蛋白
당뇨병,2형%비주정성지방성간병%성격소결합구단백
Diabetes mellitus,type 2%Nonalcoholic fatty liver disease%Sex hormone-binding globulin
目的 分析2型糖尿病患者血清性激素结合球蛋白(SHBG)的影响因素,评估血清SHBG是否可作为非酒精性脂肪性肝病(NAFLD)的血清标记物.方法 选择2009年9月至2012年8月南京鼓楼医院内分泌科诊治的2型糖尿病患者281例,根据腹部B超分为有NAFLD组和无NAFLD组.清晨空腹抽血检测肝酶、血脂、血糖、胰岛素、甲状腺功能及性激素,利用多元线性回归及非条件logistic回归分析血清SHBG与代谢指标及脂肪肝患病率的关系.结果 有NAFLD组125例,男85例,女40例,平均年龄(57±12)岁；无NAFLD组156例,男85例,女71例,平均年龄(61±13)岁.有脂肪肝组血清SHBG显著低于无脂肪肝组[(26±9)比(44±6)nmoIL,t=-10.42,P＜0.05].多元线性回归分析显示,血清SHBG与年龄、高密度脂蛋白胆固醇(HDL-C)独立正相关(β=0.316、0.200,均P＜0.05),与腰围、甘油三酯(TG)、稳态模型胰岛素抵抗指数(HOMA-IR)及促甲状腺素独立负相关(β=-0.175、-0.243、-0.163、-0.205,均P＜0.05).按血清SHBG水平由低到高四等分将患者分成4组,随着SHBG的递增,年龄、HDL-C逐渐递增(趋势P均＜0.05),而体质指数(BMI)、腰围、丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GGT)、TG、空腹血糖(FPG)、空腹胰岛素(FINS)及HOMA-IR逐渐递减(趋势P均＜0.05).将SHBG第一分位患脂肪肝的比值比(OR)设为1.00,随着SHBG四分位数的递增,经全因子校正后,第二至第四分位的OR(95％ CI)分别为0.39(0.14 ～0.88)、0.20(0.07 ～0.57)、0.08(0.02～0.26)(趋势P＜0.05).结论 2型糖尿病患者的血清SHBG水平与年龄、腰围、HDL-C、TG及HOMA-IR显著相关；低水平SHBG是2型糖尿病合并NAFLD的独立危险因素,可能是评估脂肪肝的一项重要血清标记物.
目的 分析2型糖尿病患者血清性激素結閤毬蛋白(SHBG)的影響因素,評估血清SHBG是否可作為非酒精性脂肪性肝病(NAFLD)的血清標記物.方法 選擇2009年9月至2012年8月南京鼓樓醫院內分泌科診治的2型糖尿病患者281例,根據腹部B超分為有NAFLD組和無NAFLD組.清晨空腹抽血檢測肝酶、血脂、血糖、胰島素、甲狀腺功能及性激素,利用多元線性迴歸及非條件logistic迴歸分析血清SHBG與代謝指標及脂肪肝患病率的關繫.結果 有NAFLD組125例,男85例,女40例,平均年齡(57±12)歲；無NAFLD組156例,男85例,女71例,平均年齡(61±13)歲.有脂肪肝組血清SHBG顯著低于無脂肪肝組[(26±9)比(44±6)nmoIL,t=-10.42,P＜0.05].多元線性迴歸分析顯示,血清SHBG與年齡、高密度脂蛋白膽固醇(HDL-C)獨立正相關(β=0.316、0.200,均P＜0.05),與腰圍、甘油三酯(TG)、穩態模型胰島素牴抗指數(HOMA-IR)及促甲狀腺素獨立負相關(β=-0.175、-0.243、-0.163、-0.205,均P＜0.05).按血清SHBG水平由低到高四等分將患者分成4組,隨著SHBG的遞增,年齡、HDL-C逐漸遞增(趨勢P均＜0.05),而體質指數(BMI)、腰圍、丙氨痠轉氨酶(ALT)、穀氨酰轉肽酶(GGT)、TG、空腹血糖(FPG)、空腹胰島素(FINS)及HOMA-IR逐漸遞減(趨勢P均＜0.05).將SHBG第一分位患脂肪肝的比值比(OR)設為1.00,隨著SHBG四分位數的遞增,經全因子校正後,第二至第四分位的OR(95％ CI)分彆為0.39(0.14 ～0.88)、0.20(0.07 ～0.57)、0.08(0.02～0.26)(趨勢P＜0.05).結論 2型糖尿病患者的血清SHBG水平與年齡、腰圍、HDL-C、TG及HOMA-IR顯著相關；低水平SHBG是2型糖尿病閤併NAFLD的獨立危險因素,可能是評估脂肪肝的一項重要血清標記物.
목적 분석2형당뇨병환자혈청성격소결합구단백(SHBG)적영향인소,평고혈청SHBG시부가작위비주정성지방성간병(NAFLD)적혈청표기물.방법 선택2009년9월지2012년8월남경고루의원내분비과진치적2형당뇨병환자281례,근거복부B초분위유NAFLD조화무NAFLD조.청신공복추혈검측간매、혈지、혈당、이도소、갑상선공능급성격소,이용다원선성회귀급비조건logistic회귀분석혈청SHBG여대사지표급지방간환병솔적관계.결과 유NAFLD조125례,남85례,녀40례,평균년령(57±12)세；무NAFLD조156례,남85례,녀71례,평균년령(61±13)세.유지방간조혈청SHBG현저저우무지방간조[(26±9)비(44±6)nmoIL,t=-10.42,P＜0.05].다원선성회귀분석현시,혈청SHBG여년령、고밀도지단백담고순(HDL-C)독립정상관(β=0.316、0.200,균P＜0.05),여요위、감유삼지(TG)、은태모형이도소저항지수(HOMA-IR)급촉갑상선소독립부상관(β=-0.175、-0.243、-0.163、-0.205,균P＜0.05).안혈청SHBG수평유저도고사등분장환자분성4조,수착SHBG적체증,년령、HDL-C축점체증(추세P균＜0.05),이체질지수(BMI)、요위、병안산전안매(ALT)、곡안선전태매(GGT)、TG、공복혈당(FPG)、공복이도소(FINS)급HOMA-IR축점체감(추세P균＜0.05).장SHBG제일분위환지방간적비치비(OR)설위1.00,수착SHBG사분위수적체증,경전인자교정후,제이지제사분위적OR(95％ CI)분별위0.39(0.14 ～0.88)、0.20(0.07 ～0.57)、0.08(0.02～0.26)(추세P＜0.05).결론 2형당뇨병환자적혈청SHBG수평여년령、요위、HDL-C、TG급HOMA-IR현저상관；저수평SHBG시2형당뇨병합병NAFLD적독립위험인소,가능시평고지방간적일항중요혈청표기물.
Objective To investigate the association of serum sex hormone-binding globulin (SHBG) with metabolic variables in type 2 diabetic patients,and to evaluate whether serum SHBG could be a biomarker of nonalcoholic fatty liver disease (NAFLD).Methods Total of 281 type 2 diabetic patients treated in Nanjing Drum Tower Hospital from September 2009 to August 2012 were included in the study.The patients were assigned to the NAFLD group and non-NAFLD group according to the result of liver ultrasound.Fasting blood draw were taken to detect liver enzymes,lipids,insulin levels,thyroid function and sex hormones.The correlations between serum SHBG levels and metabolic parameters as well as the prevalence of NAFLD were analyzed by using muhiple linear regression or unconditional multinomial logistic regression analysis.Results There were 125 subjects in NAFLD group (male 85,female 40,age (57 ±12) yrs) and 156 in non-NAFLD group (male 85,female 71,age (61 ± 13) yrs),respectively.Serum SHBG levels in NAFLD group were significantly lower than that in non-NAFLD group ((26 ± 9) vs (44 ±6) nmol/L,t =-10.42,P ＜ 0.05).In the multiple linear regression model with SHBG as the dependent variable,age and high density lipoprotein cholesterol (HDL-C) were positively associated with SHBG (β =0.316,0.200,all P ＜ 0.05),while waist circumference,triglycerides (TG),homeostasis model assessment of insulin resistance (HOMA-IR) and thyrotropin were inversely associated with SHBG (β =-0.175,-0.243,-0.163,-0.205,all P ＜ 0.05).The patients were divided into 4 groups according to SHBG quartiles.With the increased quartiles of serum SHBG,the age and HDL-C in the patients increased (all P for trend ＜ 0.05),while the body mass index (BMI),waist circumference,alanine aminotransferase (ALT),gamma-glutamyl transpeptidase (GGT),TG,fasting plasma glucose (FPG),fasting insulin (FIns)and HOMA-IR changed in a decreased trend (all P for trend ＜ 0.05).Besides,the proportion of NAFLD also decreased significantly with increased quartiles of SHBG (P for trend ＜ 0.05).In the fully adjusted model,when compared with the first quartile of SHBG (reference,1.00),the odds ratio (OR) and 95％confidence interval (CI) for NAFLD across increasing quartiles of SHBG were 0.39 (0.14-0.88),0.20(0.07-0.57) and 0.08 (0.02-0.26),respectively (P for trend ＜ 0.05).Conclusions Serum SHBG level in type 2 diabetic patients is significantly associated with age,waist circumference,HDL-C,TG and HOMA-IR.Low serum SHBG is an independent risk factor for the presence of NAFLD and might be an important bio-marker of NAFLD in type 2 diabetic patients.
