超重肥胖2型糖尿病患者肝酶异常的现况调查及危险因素分析  

A cross-sectional survey on prevalence and risk factors for abnormal plasma liver enzymes in overweight or obese patients with type 2 diabetes mellitus

作　　者：王娇[1] 熊周怡 孙嘉[1] 严婷[2] 陈容平[1] 张如意[1] 杨帆[3] 杨锐[1] 蔡德鸿[1] 

机构地区：[1]南方医科大学珠江医院内分泌科,广州510282 [2]中山大学附属第六医院临床营养科 [3]桂林医学院附属医院内分泌科

出　　处：《中华医学杂志》2013年第46期3680-3684,共5页National Medical Journal of China

基　　金：广东省肥胖及超重T2DM现况调查专项基金（2011-DM-01）

摘　　要：目的 探讨超重肥胖2型糖尿病患者中肝酶异常的患病率,并分析其相关危险因素.方法 2011年8月至2012年3月期间,对广东省各地区二级以上医院门诊就诊及住院的已确诊2型糖尿病且合并超重或肥胖的省内常住居民进行横断面调查.肝酶异常的诊断标准：丙氨酸转氨酶＞40 U/L和（或）门冬氨酸转氨酶＞40 U/L.采用二分类Logistic回归分析肝酶异常的相关危险因素.结果 本研究3543例超重肥胖2型糖尿病患者中,709例患者检测到肝酶异常,肝酶异常的患病率为20.0％.二分类Logistic回归分析结果显示,男性（OR=1.603,95％ CI：1.247 ～2.061）、糖化血红蛋白（HbA1c）（OR=1.049,95％ CI：1.005 ～1.096）、体质指数（OR=1.058,95％ CI：1.014 ～1.103）、腰围（OR=1.019,95％ CI：1.006～1.032）、甘油三酯（OR=1.053,95％ CI：1.008～1.100）和脂肪肝（OR=1.543; 95％CI：1.244～1.914）是肝酶异常的危险因素,规律运动（OR=0.591,95％ CI：0.472～0.740）、控制饮食（OR=0.794,95％ CI：0.635～0.993）是肝酶异常的保护因素.结论 肝酶异常在超重肥胖2型糖尿病患者中的患病率较高,降低体重、腰围、甘油三酯和HbA1c水平及坚持规律运动、控制饮食可能降低肝酶异常的患病率.Objective To explore the prevalence and risk factors for abnormal plasma liver enzymes in patients with type 2 diabetes mellitus.Methods Overweight or obese patients with type 2 diabetes were recruited from 60 tertiary and secondary hospitals in Guangdong Province between August 2011 and March 2012.The abnormal plasma liver enzymes was diagnosed as alanine aminotransferase 〉 40 U/L and/or aspartate aminotransferase 〉 40 U/L.Binary Logistic regression was used to assess the associations between abnormal plasma liver enzymes and associated risk factors.Results The abnormal plasma liver enzymes were detected in 709/3543 diabetics with overweight or obesity.And the prevalence of abnormal plasma liver enzymes was 20.0%.According to binary Logistic regression analysis,the presence of abnormal plasma liver enzymes was associated with male gender （OR =1.603,95% CI：1.247-2.061）,higher HbA1c（OR =1.049,95% CI：1.005-1.096）,higher body mass index （OR =1.058,95% CI：1.014-1.103）,higher waist circumference （OR =1.019,95% CI：1.006-1.032）,higher triglyceride level （OR =1.053,95% CI：1.008-1.100）,adiposis hepatica （OR =1.543; 95% CI：1.244-1.914）,regular exercises （OR =0.591,95% CI：0.472-0.740）and diet control （OR =0.794,95% CI：0.635-0.993）.Conclusions There is a high prevalence of abnormal plasma liver enzymes in overweight/obese with diabetics.And decreasing the levels of HbA1c,body mass index,waist circumference and triglycerides,regular exercises and diet control may decrease its prevalence.

关 键 词：糖尿病 2型 超重 肥胖症 肝酶异常 危险因素 

分 类 号：R587.1[医药卫生—内分泌]