中老年2型糖尿病病人中非酒精性脂肪性肝病与高血压的关系  

Association between nonalcoholic fatty liver disease and hypertension in Chinese middle aged and elderly patients with type 2 diabetes

作　　者：朱小鹏[1,2] 张林杉 颜红梅[1,2] 常薪霞[1,2] 夏明锋[1,2] 王柳[1,2] 卞华[1,2] 高鑫[1,2] 

机构地区：[1]复旦大学附属中山医院内分泌科 [2]复旦大学代谢性病研究所,上海市200032

出　　处：《实用老年医学》2017年第6期513-516,共4页Practical Geriatrics

基　　金：国家自然科学基金面上项目(81471073);上海市卫计委项目(20164Y0029);上海市科委项目(13441900303);复旦大学附属中山医院优秀骨干计划(2015ZSYXGG15);复旦大学附属中山医院优秀青年基金(2015ZSYXQN20)

摘　　要：目的探讨中国中老年2型糖尿病病人中非酒精性脂肪性肝病(NAFLD)与高血压的关系。方法对年龄≥45岁的中老年2型糖尿病病人1416例进行调查,分为血压正常组和高血压组,常规采集人体学参数和检测相关生化指标,采用肝脏B超检测有无脂肪肝,部分病人磁共振波谱测定肝脏脂肪含量(LFC),肝酶作为评价肝脏炎症程度的简易参数,应用无创性NAFLD纤维化评分系统评价肝纤维化程度。结果血压正常组中NAFLD检出率为51.7%,高血压组中NAFLD检出率为61.3%。高血压组年龄、糖尿病病程、BMI、腰围、收缩压、舒张压、尿酸、甘油三酯(TG)、胰岛素抵抗指数(HOMA-IR)水平较血压正常组增高(P<0.05)。糖化血红蛋白(Hb A1c)较血压正常组降低(P<0.01)。高血压组天冬氨酸氨基转移酶(AST),γ-谷氨酰转移酶(GGT)较血压正常组增高(P<0.05)。NAFLD纤维化的评分系统在高血压组较血压正常组增加(P<0.01)。进一步对未服用降压药物的受试者进行分析,校正了性别、年龄、空腹血糖、TG、总胆固醇(TC)后,LFC与收缩压(r=0.138,P=0.036)和舒张压(r=0.175,P=0.006)呈正相关关系。多因素分析显示,校正了年龄、性别、血糖后,LFC是影响收缩压(P<0.05)和舒张压(P<0.01)的最强的影响因素。结论在中老年2型糖尿病病人中,高血压组NAFLD检出率显著增高,且肝脏炎症、纤维化加重。LFC独立于血糖、血脂,是血压增高的危险因素。Objective To investigate the association between nonalcoholic fatty liver disease （NAFLD） and hypertension in Chinese middle-aged and elderly patients with type 2 diabetes. Methods 1416 middle-aged and elderly patients （aged ≥ 45 years old, male/female： 777/639） with type 2 diabetes were enrolled in this study and divided into normal blood pressure group and hypertension group. All subjects underwent regular physical examination and biochemical parameters detection. B-ultrasound was used to detect fatty liver, 1H-magnetic resonance spectroscopy （1H-MRS） was applied to quantify liver fat content （LFC） in some patients. Liver enzyme was used as a simple parameter for evaluating liver inflammation, and noninvasive NAFLD fibrosis scoring system was carried out to evaluate the degree of liver fibrosis. Results The detection rate of NAFLD in normal blood pressure group and hypertension group was 51.7% and 61.3%, respectively. Age, duration of diabetes, body mass index （BMI）, waist circumference, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, uric acid, triglyceride （TG）, and HOMA-IR in hypertension group were significantly higher than those in normal blood pressure group （P〈0.05）. HbAlc in hypertension group was lower than that in normal blood pressure group （P〈0.01）. Liver enzymes, such as AST and GGT, in hypertension group were higher than those in normal blood pressure group （ P〈0.05 ）. In addition, NAFLD fibrosis scoring system was higher in hypertensive group than that in normal blood pressure group （P〈0. 01 ）. LFC was positively correlated with SBP （r= 0. 138, P= 0. 036） and DBP （r= 0. 175, P= 0. 006）, after adjusting for gender, age, fasting blood glucose, TG, and total cholesterol （TC）. Stepwise regression analysis demonstrated that LFC was the strongest predictor of SBP （ P〈 0. 05 ） and DBP （ P〈 0. 01 ） after adjustment for sex, age and glucose. Conclusions The detection rate of NAFLD in hypertension group is

关 键 词：非酒精性脂肪性肝病 高血压 2型糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R544.1[医药卫生—内科学]