CAJ | 학술논문

目的：研究血浆可溶性CD36（sCD36）与2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）的关系。方法检测正常对照组（A组，39例）、T2DM未合并NAFLD组（B组，39例）和T2DM合并NAFLD组（C组，59例）患者的血浆sCD36水平，计算C组的肝脏脂肪含量（LFC）及NAFLD纤维化评分（NFS），测定上述3组糖脂代谢指标、肝功能指标及炎症指标。方差分析法比较上述指标在3组中的差异；相关分析法分析C组患者上述各项指标与sCD36的相关性；多元逐步回归法分析C组sCD36的影响因素。结果血浆sCD36（μg/L）水平在B组（3.87±1.16）、C组（5.72±1.79）均高于A组（2.57±0.93），且C组高于B组（均P＜0.01）；相关分析示C组的sCD36水平与体质量指数（BMI）、腰围、内脏脂肪面积、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、游离脂肪酸（FFA）、丙氨酸转氨酶（ALT）、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、LFC、NFS呈正相关（均P＜0.05），多元逐步回归分析示FFA、LFC、TNF-α、IL-6是sCD36的影响因素。结论血浆sCD36与脂肪肝严重程度、肝脏损伤以及脂肪性肝纤维化有关，可能成为T2DM合并NAFLD的血浆标志物，CD36可能通过炎症机制参与T2DM合并NAFLD的发生发展。
목적：연구혈장가용성CD36（sCD36）여2형당뇨병（T2DM）합병비주정성지방성간병（NAFLD）적관계。방법검측정상대조조（A조，39례）、T2DM미합병NAFLD조（B조，39례）화T2DM합병NAFLD조（C조，59례）환자적혈장sCD36수평，계산C조적간장지방함량（LFC）급NAFLD섬유화평분（NFS），측정상술3조당지대사지표、간공능지표급염증지표。방차분석법비교상술지표재3조중적차이；상관분석법분석C조환자상술각항지표여sCD36적상관성；다원축보회귀법분석C조sCD36적영향인소。결과혈장sCD36（μg/L）수평재B조（3.87±1.16）、C조（5.72±1.79）균고우A조（2.57±0.93），차C조고우B조（균P＜0.01）；상관분석시C조적sCD36수평여체질량지수（BMI）、요위、내장지방면적、공복이도소（FINS）、이도소저항지수（HOMA-IR）、유리지방산（FFA）、병안산전안매（ALT）、종류배사인자（TNF）-α、백세포개소（IL）-6、LFC、NFS정정상관（균P＜0.05），다원축보회귀분석시FFA、LFC、TNF-α、IL-6시sCD36적영향인소。결론혈장sCD36여지방간엄중정도、간장손상이급지방성간섬유화유관，가능성위T2DM합병NAFLD적혈장표지물，CD36가능통과염증궤제삼여T2DM합병NAFLD적발생발전。
Objective To investigate the relationship between plasma soluble CD36 (sCD36) and nonalcoholic fatty liver disease (NAFLD) in patients combined with type 2 diabetes mellitus (T2DM). Methods Plasma levels of sCD36 were determined in normal control group (group A, n=39), patients of T2DM without NAFLD group (group B, n=39) and T2DM with NAFLD group (group C, n=59). Liver fat content (LFC) and nonalcoholic fatty liver fibrosis score (NFS) were calculated in group C. Glucose and lipid metabolic parameters, liver function parameters and inflammatory parameters were also detect?ed in all three groups. Variance analysis was applied to analyze the differences of the above parameters among three groups;Correlation analysis was used to analyze the relationship between sCD36 level and all the above parameters;Multiple step? wise regression analysis was applied to determine the influencing factors of sCD36 level in patients of group C. Results Plasma sCD36 (μg/L) levels in group B (3.87 ± 1.16) and group C (5.72 ± 1.79) are higher than that of group A (2.57 ± 0.93) (both P<0.01), and it is higher in group C than in group B (each P<0.05);Correlation analysis showed that sCD36 level was positively correlated with body mass index (BMI), waist, visceral adipose tissue,fast insulin (FINS), insulin resistance in?dex (HOMA-IR), free fatty acid (FFA), alanine transaminase (ALT), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), LFC and NFS (P<0.01 or P<0.05);Multiple stepwise regression analysis showed that FFA, LFC, TNF-αand IL-6 were in?fluencing factors of sCD36 level in patients of group C. Conclusion Plasma sCD36 level was related to fatty liver severity, liver injury and fatty liver fibrosis, it might be used as a plasma marker of T2DM combined with NAFLD. CD36 might con?tribute to the development of T2DM combined with NAFLD through inflammatory mechanisms.