2型糖尿病患者高发“代谢性炎症综合征”  

High detective rate of ＂metabolic inflammatory syndrome＂ in patients with type 2 diabetes

作　　者：胡仁明[1] 谢颖[1] 鹿斌[1] 陈凤玲[4] 李连喜[5] 黄颖[6] 李琴[7] 叶威巍 张朝云[1] 周丽诺[1] 何敏[1] 范维琥[2] 刘杰[3] 闻杰[1] 陈立立[1] 杨叶虹[1] 李益明[1] 朱禧星[1] 

机构地区：[1]复旦大学附属华山医院内分泌科,复旦大学内分泌糖尿病研究所,上海200040 [2]复旦大学附属华山医院内分泌科心内科,上海200040 [3]复旦大学附属华山医院内分泌科消化科,上海200040 [4]上海交通大学附属第三人民医院内分泌科 [5]上海交通大学附属第六人民医院内分泌科 [6]上海交通大学附属第一人民医院内分泌科 [7]上海交通大学附属第九人民医院内分泌科 [8]上海徐汇区大华医院

出　　处：《中华内分泌代谢杂志》2016年第1期27-32,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金项目（81030014、81270902、81471057）志谢感谢陈家伦、陈家伟、项坤三、潘长玉、陈名道、贾伟平、包玉倩、彭永德、宋怀东和陆颖理参与本课题的讨论和设计.

摘　　要：目的代谢失调所致的产物，如游离脂肪酸、脂多糖等常常诱发慢性低度炎症，称代谢性炎症（Metabolic inflammation或Metflammation），后者参与并导致动脉粥样硬化、2型糖尿病、非酒精性脂肪肝及肥胖等代谢性疾病的发生。这些与代谢性炎症密切相关的代谢性疾病常共生，因此我们提出“代谢炎症性综合征（Metabolic inflammatory syndrome，MIS）”的概念及诊断标准，并建议如果患者伴有2个及2个以上上述代谢性疾病时可诊断MIS。本文旨在分析糖尿病患者MIS及其组分的流行特征，比较MIS与代谢综合征（Ms）的临床意义。方法对上海6家医院的2001例2型糖尿病住院患者进行多中心横断面研究。结果在2型糖尿病患者中，MIS的检出率为96．2％，高于MS的患病率（71．3％）。MIS单组分中动脉粥样硬化的检出率最高（75．6％）。MIS、动脉粥样硬化及Ms均是冠心病的危险因素[DR值分别为2．252（95％CI．026～4．942，P=0．043）、2．726（95％CI．953—3．804，P〈0．01）、1．915（95％C／1．444—2．540，P〈0．01）1。结论以动脉粥样硬化、2型糖尿病、非酒精性脂肪肝及肥胖作为组分，MIS的检出率高，比Ms更有利于识别炎症相关代谢性疾病的患者；MIS的概念及诊断有利于动脉粥样硬化的早期筛查和防治。Objective Metabolites produced by metabolic imbalance such as free fatty acids and lipopolysaccharides can result in a state of chronic low-grade inflammation, or metabolic inflammation, which plays an important role in the pathogenesis of atherosclerosis, type 2 diabetes, non-alcoholic fatty liver disease, and obesity. The above metabolic disorders are closely related with the metabolic inflammation, which always coexist. Therefore, we proposed the concept of＂ metabolic inflammatory syndrome （MIS） ＂. According to our study, patients with two or more metabolic disorders above could be diagnosed as MIS. The current research is aimed to investigate the prevalence of MIS and its components, and to compare the clinical values of MIS and metabolic syndrome （MS）. Methods 2 001 in patients with type 2 diabetes from 6 hospitals in Shanghai were recruited in the current multi-center cross-sectional study. The diagnostic rates of MIS and MS and their components of both syndromes were compared. Results In the patients with type 2 diabetes, the detective rate of MIS was 96.2% , which was higher than that of MS （71.3%）. Among 4 components of MIS, atherosclerosis showed the highest detective rate （75.6%）. MIS [ OR = 2. 252 （ 95 % CI 1. 026-4. 942 ）, P = 0. 043 ], atheroselerosis [ OR = 2. 726 （ 95% CI 1. 953- 3. 804） ,P〈0. 001 ] , and MS[ OR = 1. 915 （95% CI 1. 444-2. 540） ,P〈0.01 ] were the risk factors of coronary heart disease. Conclusion With atherosclerosis, type 2 diabetes mellitus, non-alcoholic fatty liver disease, and obesity as its 4 components, MIS has a high detective rate in patients with metabolic disorders, and seems to be more sensitive than MS to distinguish inflammation-related metabolic diseases. The concept of MIS will promote the screening and prevention of atherosclerosis in its early stage.

关 键 词：代谢性炎症 代谢炎症性综合征 糖尿病 2型 动脉粥样硬化 非酒精性脂肪肝 

分 类 号：R587.1[医药卫生—内分泌]