2型糖尿病合并非酒精性脂肪肝肝纤维化与血清25-羟维生素D水平的关系研究  

Relationship between liver fibrosis and serum 25-(OH)D in patients with type 2 diabetes and nonalcoholic fatty liver disease

作　　者：杨丽弘 廖鑫[1] 张晗[1] 阳琰[1] 张琳[1] 袁世英 高琳[1] 李思成[1] 廖玉兰[1] 

机构地区：[1]遵义医学院附属医院内分泌科,563003

出　　处：《中国糖尿病杂志》2018年第2期117-122,共6页Chinese Journal of Diabetes

基　　金：国家自然科学基金(81660142);贵州省科技支撑计划项目社会发展攻关项目[黔科合SY字合(2013)3033号]

摘　　要：目的探讨T2DM合并非酒精性脂肪肝(NAFLD)肝纤维化与血清25-羟维生素D[25-(OH)D]水平的关系。方法选取T2DM患者359例,其中单纯T2DM(T2DM组)患者158例,依据腹部超声诊断NAFLD的T2DM(T2DM+NAFLD)患者201例,再根据非酒精性脂肪肝肝纤维化评分(NFS)分为<-1.455亚组(可排除肝纤维化亚组)、-1.455~0.676亚组(不确定亚组)、>0.676亚组(肝纤维化亚组)。分别测定FPG、FIns、FC-P、HbA1c、血脂、肝功能、肾功能、血常规及血清25-(OH)D,计算BMI、胰岛素抵抗指数(HOMA-IR)、NFS。结果 T2DM+NAFLD组25-(OH)D、HDL-C、AST/ALT水平低于T2DM组(P<0.05);肝纤维化亚组25-(OH)D水平低于不确定亚组、可排除肝纤维化亚组[(9.78±3.39)、(11.85±4.34)vs(12.72±4.51)ng/ml,P<0.05]。NFS评分与病程、Scr、胱抑素C(Cys-C)呈正相关(r=0.328、0.160、0.354,P<0.05),与ALT、GGT、载脂蛋白B(ApoB)、25-(OH)D呈负相关(r=-0.306、-0.154、-0.235、-0.179,P<0.05)。BMI、25-(OH)D、HOMA-IR及SUA是NAFLD的影响因素;ALT(OR=0.965,P=0.045)、Cys-C(OR=1.005,P=0.006)、ApoB(OR=0.086,P=0.032)、25-(OH)D(OR=0.865,P=0.026)及病程(OR=1.171,P=0.006)是肝纤维化的影响因素。结论 T2DM合并NAFLD患者血清25-(OH)D水平的降低与肝纤维化相关,且低水平的25-(OH)D为NAFLD及肝纤维化的危险因素。Objective To investigate the relationship between hepatic fibrosis and serum 25-hydroxyvitamin D [ 25-（ OH ） D] in type 2 diabetes mellitus （T2DM） patients complicated with nonalcoholic fatty liver disease （NAFLD）. Methods 359 T2DM patients were divided simple T2DM group （n= 158）and T2DM＋ NAFLD group （n= 201）according to abdominal ultrasound diagnosis. According to nonalcoholic fatty liver fibrosis score （NFS）, 201 T2DM＋ NAFLD were divided into three subgroups：45 without hepatic fibrosis （NFS^--I. 455）, 52 with hepatic fibrosis（NFS^0. 676）, 104 with uncertain hepatic fibrosis （NFS --1. 455~0. 676）. Fasting blood glucose （FPG）, fasting insulin （Fins）, fasting C peptide （FC-P）, glycosylated hemoglobin （HbA1 c）, blood lipid, liver function, renal function, blood routine and serum 25-（OH）D were measured. The body mass （BMI）, insulin resistance index （HOMA-IR）and NFS were calculated. Results The levels of 25-（OH）D, HDL-C and AST/ALT of T2DM＋NAFLD group were significantly lower than those of T2DM group （P〈0.05）. 25-（OH）D level of the liver fibrosis subgroup was significantly lower than patients with uncertain hepatic fibrosis and patients without hepatic fibrosis,[（9.78±3.39） vs （11.85±4.34） vs （12.72±4. 51）ng/ml,P〈0. 05]. NFS was positively correlated with course of disease, Scr and cystatin C （Cys-C）, with r= 0. 328,0. 160 and 0. 354,respectively （P〈0.05）, and negatively correlated with GGT, ALT, ApoB and 25-（OH） D, with r=-0. 306,--0. 154, -0. 235 and -0. 179, respectively （P%0.05）. BMI, 25-（OH）D, HOMA-IR and SUA were influencing factors of NAFLD. ALT （OR = 0. 965, P = 0. 045）, Cys-C （OR-- 1. 005, P = 0. 006） ,APOB（OR=O. 086,P=0. 032）, 25-（OH）D（OR= 0. 865, P= 0. 026）and course of disease（OR= 1.171, P= 0. 006）were the related factors of hepatic fibrosis. Conclusion The decrease in serum 25-（OH）D levels was associated with hepatic fibrosis in patients with T2DM combin

关 键 词：糖尿病 2型 非酒精性脂肪肝病 肝纤维化 25-羟维生素D 

分 类 号：R575.5[医药卫生—消化系统] R587.1[医药卫生—内科学]