非酒精性脂肪性肝病与2型糖尿病患者早期糖尿病肾脏疾病的相关性研究  

Effect of nonalcoholic fatty liver disease on early diabetic kidney disease in type 2 diabetic patients

作　　者：张秀英[1] 李玉凤 邱李 周翔海[1] 韩学尧[1] 纪立农[1] ZHANG Xiuying;LI Yufeng;QIU Li;JI Linong(Department of Endocrinology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院内分泌科,100044 [2]北京市平谷区人民医院内分泌科

出　　处：《中国糖尿病杂志》2020年第12期911-915,共5页Chinese Journal of Diabetes

摘　　要：目的基于社区队列人群探讨非酒精性脂肪性肝病(NAFLD)与T2DM患者早期DKD的相关性。方法选取2013年6月至2014年9月于北京市平谷区采用随机抽样法对4002名25~75岁常住居民进行代谢性疾病调查。采用腹部CT检查识别脂肪肝,行75 g OGTT诊断DM,UACR>30 mg/g为DKD早期筛查指标。结果本研究中共纳入3122名。T2DM、NAFLD患病率分别为18.03%(563例)和22.68%(708例),T2DM合并NAFLD患病率为7.21%(225例)。T2DM患者合并NAFLD比例为39.96%,具有年龄低、高BMI、BG和血脂控制差的特点。早期DKD发生率为27.89%,NAFLD组DKD发生率高于无NAFLD组(32.44%vs 24.85%,P<0.05),男性患者尤为明显(34.62%vs 20.39%,P<0.05)。Logistic逐步回归分析显示,校正性别、年龄和DM病程后NAFLD是DKD发生的影响因素(OR 1.486 95%CI 1.016~2.172,P=0.041)。结论平谷地区T2DM、NAFLD患病率呈上升及年轻化趋势,两病共存增加DKD发生风险,应加强慢性代谢性疾病早期联合防治。Objective To investigate the effects of nonalcoholic fatty liver disease(NAFLD)on the development of early diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM)based on a community cohort.Methods A community-based cohort was established for Metabolic Disease Study in Beijing Pinggu district in 2013-2014 using a random sampling method(n=4002,aged 25~75 years).Abdominal CT examination was used to identify fatty liver.Oral glucose tolerance test(OGTT)was used to diagnose DM.UACR >30 mg/g was used to screen the early onset of DKD.Results A total of 3122 subjects were enrolled in this analysis.The prevalence of T2DM and NAFLD in the analysis population was 18.03%(563)and 22.68%(708)respectively,and 7.21% of the residents(225)had both T2DM and NAFLD.In patients with T2DM,39.96% combined with NAFLD.The patients with both diseases had the characteristics of younger age,higher BMI and poor control of blood glucose and lipids.The incidence of early DKD was 27.89% in T2DM patients.The incidence of DKD was higher in NAFLD group than in non-NAFLD group(32.44% vs 24.85%,P<0.05).This difference was more significant in male patients(34.62% vs 20.39%,P<0.05).Logistic stepwise regression analysis showed that NAFLD was the influencing factor for DKD even after adjusting for gender,age,and DM duration(OR 1.486 95% CI1.016~2.172,P=0.041).Conclusion The prevalence of T2DM and NAFLD is high and with obvious trend of early onset in Pinggu district.The coexistence of the two diseases increases the risk of DKD,suggesting that early joint prevention and treatment of chronic metabolic diseases should be strengthened.

关 键 词：糖尿病 2型 糖尿病肾脏疾病 非酒精性脂肪性肝病 

分 类 号：R575.5[医药卫生—消化系统] R587.2[医药卫生—内科学] R692.9[医药卫生—临床医学]