2型糖尿病患者合并非酒精性脂肪性肝病的患病率及危险因素分析  

Analysis of prevalence and risk factors of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

作　　者：徐静[1] 卜宁[1,2] 焦杨 董鹏[1] 孔颖[1] 张春虹[1] 魏嘉[1] XU Jing;BU Ning;JIAO Yang;DONG Peng;KONG Ying;ZHANG Chunhong;WEI Jia(Department of Endocrinology,the Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an,Shaanxi 710004,China;Department of Anesthesiology,the First Affiliated Hospital of Xi ′an Jiaotong University,Xi′an,Shaanxi 710004,China)

机构地区：[1]西安交通大学第二附属医院内分泌科,西安710004 [2]西安交通大学第一附属医院麻醉科,西安710004

出　　处：《重庆医学》2020年第14期2284-2288,2294,共6页Chongqing medicine

基　　金：陕西省重点研发计划一般项目(2017SF-046)。

摘　　要：目的探讨2型糖尿病(T2DM)患者合并非酒精性脂肪性肝病(NAFLD)的患病率及其危险因素,为临床防治T2DM合并NAFLD的发生、发展提供理论依据。方法选取2014年7月至2015年4月在西安交通大学第二附属医院内分泌科住院的T2DM患者808例,通过腹部超声分为T2DM组(n=431)和T2DM合并NAFLD组(n=377),收集患者基本资料,检测血糖、血脂等生化指标进行分析。结果46.66%的T2DM患者合并NAFLD,男性患者NAFLD患病率高于女性,差异无统计学意义(48.47%vs.43.36%,P>0.05);病程5~10年(44.9%)、>10年的患者(33.5%)NAFLD患病率明显低于病程小于5年(56.2%)的患者(P<0.01);logistic回归分析发现,体重指数(BMI)、腰围(WC)、胱抑素C(Cys-C)、空腹C肽(FCP)是T2DM合并NAFLD的独立危险因素(OR=1.039、1.076、0.184、1.919,P<0.05),经性别分层发现,女性患者T2DM合并NAFLD的独立危险因素是BMI、载脂蛋白B(apoB)、FCP(OR=1.533、27.416、3.859,P<0.05),男性患者T2DM合并NAFLD的独立危险因素是WC、Cys-C、FCP(OR=1.096、0.073、1.700,P<0.05)。结论T2DM患者约一半合并NAFLD,尤其以年轻、病程短的男性患者易合并NAFLD,肥胖、血糖控制差、血脂紊乱、肝细胞炎症及肾功能异常是NAFLD的主要危险因素。Objective To explore the prevalence and risk factors of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM),in order to provide theoretical references for prevention and treatment of T2DM combined with NAFLD.Methods A total of 808 patients with T2DM who hospitalized in Department of Endocrinology of the Second Affiliated Hospital of Xi′an Jiaotong University were enrolled from July 2014 to April 2015.All patients were divided into the T2DM group(n=431)and the T2DM combined with NAFLD group(n=377)according to the results of abdominal ultrasound imaging.The demographic data were collected,and the blood sugar,blood lipids and other biochemical indicators were detected for analysis.Results 46.66%of these T2DM patients had NAFLD,and the prevalence of NAFLD in male patients was higher than that in females,but there was no statistically significant difference(48.47%vs.43.36%,P>0.05).The prevalence of NAFLD in patients with a course of 5-10 years(44.9%)and more than 10 years(33.5%)was significantly lower than that of patients with a course of less than 5 years(56.2%),and the difference was statistically significant(P<0.01).Logistic regression analysis found that the body mass index(BMI),waist circumference(WC),cystatin-C(Cys-C),fasting C peptide(FCP)were independent risk factors for T2DM combined with NAFLD(OR=1.039,1.076,0.184,1.919,P<0.05).According to gender stratification,the independent risk factors for T2DM combined with NAFLD in female patients were BMI,apolipoprotein B(apoB)level and FCP(OR=1.533,27.416,3.859,P<0.05),and those were WC,Cys-C and FCP in males(OR=1.096,0.073,1.700,P<0.05).Conclusion Nearly half of T2DMpatients suffered from NAFLD,especially in new-onset and young male patients.Obesity,poorly controlled blood sugar,dyslipidemia,hepatocyte inflammation and renal dysfunction are major risk factors for the formation and progression of NAFLD.

关 键 词：糖尿病 2型 非酒精性脂肪性肝病 患病率 危险因素 性别差异 

分 类 号：R587.1[医药卫生—内分泌]