2型糖尿病非酒精性脂肪肝患者影响肝脏脂肪含量的相关因素分析  

Analysis of factors correlated with hepatic triglyceride content in type 2 diabetic patients with nonal-coholic fatty liver disease

作　　者：黄银琼[1] 李芳萍[2] 钟镜联[2] 元建鹏[2] 戚以勤[2] 

机构地区：[1]福建医科大学附属第二医院内分泌科,福建省泉州362000 [2]中山大学孙逸仙纪念医院内分泌科,广州510120

出　　处：《中国医师杂志》2017年第10期1469-1473,共5页Journal of Chinese Physician

基　　金：国家自然科学基金（30570886）

摘　　要：目的探讨2型糖尿病伴非酒精性脂肪肝患者肝脏脂肪含量与糖脂代谢、胰岛素抵抗和胰岛B细胞功能的关系。方法采用肝脏质子磁共振波谱法检测32例2型糖尿病（T2DM）伴非酒精性脂肪肝（NAFLD）患者肝脏脂肪含量，同时测量人体学参数，检测肝功能、血脂，进行口服葡萄糖耐量（OGTT）-胰岛素释放试验，采用稳态模型评估胰岛素抵抗指数（HOMA-IR）、肝脏胰岛素抵抗指数（HIR）及Matsuda指数（MSI）以评估胰岛素抵抗性，采用HOMA—B、早相（△I30／△G30）及晚相胰岛素分泌指数（INSAUC／GLUAUC）评估胰岛B细胞功能。结果32例T2DM伴NAFLD患者肝脏脂肪含量与体重指数、腰围、体脂肪率、AST、ALT、TG、HOMA—IR、HIR呈正相关，与MSI呈负相关；肝脏脂肪含量与腰臀比、TC、LDL—C、HDL—C、游离脂肪酸等指标之间没有相关性。多元逐步回归分析显示，体脂肪率和HOMA．IR是肝脏脂肪含量的影响因素。结论肝脏脂肪含量与肥胖、肝功能、甘油三酯及胰岛素抵抗密切相关，其中肥胖与胰岛素抵抗对肝脏脂肪含量影响最大。Objective To investigate the correlation between hepatic triglyceride content and glu- cose lipid metabolism, insulin resistance and β cell function. Methods A total of 32 type 2 diabetic pa- tients with nonalcoholic fatty liver disease was recruited in this study. Hepatic triglyceride content was meas- ured with liver proton magnetic resonance spectroscopy. Oral glucose tolerance test （OGTT） was carried out in all participants, with measurements of plasma glucose and insulin levels. The homeostasis model assess- ment insulin resistance index （HOMA-IR） , hepatic insulin resistance （HIR） , and Matsuda Index （MSI） were used to assess insulin resistance. The homeostasis model assessment beta cell function （HOMA-βF）, early insulin secretion index （EISI） and late insulin secretion index （LISI） were used to assess β cell function. Results Hepatic triglyeeride contents had positive correlations with body mass index （ BMI）, waist circumference, Body fat, aspartate transaminase （AST）, alanine transaminase （ALT）, triglyeerides （TG）, HOMA-IR, HIR, and negative correlations with MSI. Stepwise regression analysis showed that body fat and HOMA-IR were independently risk factors for hepatic triglyceride contents. Conclusions Hepatic triglyceride content is closely correlated with obesity, liver function, blood lipid, and insulin resistance ; especially obesity and insulin resistance are the most important factors.

关 键 词：2型糖尿病 非酒精性脂肪性肝病 肝脏脂肪含量 胰岛素抵抗 质子磁共振波谱分析 

分 类 号：R575.5[医药卫生—消化系统]