2型糖尿病合并非酒精性脂肪肝与胰岛素抵抗及心血管病变发生的关系研究  

Relationship between Non-alcohol Fatty Liver Disease and Insulin Resistance/Cardiovascular Diseases in Patients with Type 2 Diabetes Mellitus

作　　者：范慧[1] 张鹏睿[1] 徐援[1] 

机构地区：[1]首都医科大学附属北京朝阳医院内分泌科,北京市100020

出　　处：《中国全科医学》2011年第2期147-150,共4页Chinese General Practice

摘　　要：目的探讨2型糖尿病(T2DM)患者发生非酒精性脂肪肝(NAFLD)的相关因素及其与胰岛素抵抗、心血管病变发生的关系。方法回顾性分析838例住院T2DM患者的一般资料、实验室检查结果,根据B超检查结果诊断NAFLD。比较T2DM合并NAFLD者与T2DM未合并NAFLD者的基本资料、胰岛功能、血脂水平及并发症、合并症发生情况。结果住院T2DM患者中,442例(52.7%)未合并NAFLD(A组),396例(47.3%)合并NAFLD(B组)。与A组比较,B组患者丙氨酸氨基转移酶(ALT)、谷氨酰转酞酶(γ-GT)水平显著升高而AST/ALT显著降低;血清三酰甘油(TG)水平显著升高而高密度脂蛋白胆固醇(HDL-C)水平显著降低;胰岛素及C肽曲线下面积、胰岛素分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)显著增大;合并脑血管病变、糖尿病足、冠心病、高血压、代谢综合征、颈动脉或双下肢动脉粥样硬化的发生率均显著增高,上述差异均有统计学意义(P<0.05)。Lo-gistic回归分析显示,体质指数(BM I)、腰臀比、TG、合并代谢综合征、ALT、HOMA-IR、胰岛素曲线下面积是NAFLD发生的独立危险因素(P<0.05)。结论合并NAFLD的T2DM患者经常同时伴有超重或者肥胖、高血压、脂代谢紊乱等代谢综合征的表现,提示NAFLD与胰岛素抵抗密切相关;合并NAFLD的T2DM人群发生心血管疾病的风险增加。Objective To explore factors that influence the occurrence of non-alcohol fatty liver disease（NAFLD） in patients with type 2 diabetes mellitus（T2DM） and the relationship between NAFLD and insulin resistance/cardiovascular diseases（CVD）.Methods The general data and laboratory test results of 838 T2DM in-patients were analyzed retrospectively,while NAFLD was diagnosed according to ultrasound findings.The general data,functions of pancreatic islet,lipid levels,and complications/comorbilities were compared between T2DM patients with or without NAFLD.Results Of these T2DM inpatients,442（52.7%） had NAFLD（group A） and 396（47.3%） had no NAFLD（group B）.Compared with group A,alanine transarninase（ALT） and γ-Gt levels significantly increased in of group B,while the AST/ALT significantly declined;TG increased but HDL-C reduced;and insulin and c-peptide area under the curve,HOMA-β,and HOMA-IR index significantly increased.In group B,the incidences of cerebrovascular diseases,diabetic foot,coronary heart disease,hypertension,metabolic syndrome,and carotid arteries or double lower limbs of atherosclerosis were significantly higher than in group A（allP〈0.05）.Logistic regression analysis showed that that the body mass index,waist/hip ratio,TG,metabolic syndrome,ALT,HOMA-IR,and area under the curve of insulin were independant risk factors of NAFLD（allP〈0.05）.Conclusion T2DM patients with NAFLD often have overweight/obesity,hypertension,lipid disorders,and other metabolic syndrom-related manifestations,indicating that NAFLD is closely correlated with insulin resistance.Furthermore,T2DM patients with NAFLD are more susceptible to CVDs.

关 键 词：糖尿病 2型 非酒精性脂肪肝 胰岛素抵抗 心血管疾病 

分 类 号：R587.1[医药卫生—内分泌]