2型糖尿病合并代谢相关脂肪性肝病患者葡萄糖目标范围内时间与肝纤维化的相关性  

Relationship between glucose target time in range and liver fibrosis in patients with type 2 diabetes mellitus and metabolic associated fatty liver disease

作　　者：武攸 连明珠 韩冰[1] 吕玲 陈琰[1] WU You;LIAN Mingzhu;HAN Bing;LÜLing;CHEN Yan(Department of Endocrinology,Second Hospital of Jilin University,Changchun 130041,China)

机构地区：[1]吉林大学第二医院内分泌科,长春130041

出　　处：《临床与病理杂志》2021年第8期1753-1758,共6页Journal of Clinical and Pathological Research

基　　金：中国博士后科学基金面上项目(2019M651218);吉林省自然科学基金(20190201031JC)。

摘　　要：目的:探讨2型糖尿病(ty pe 2 diabetes mel l itus,T2DM)合并代谢相关脂肪性肝病(metabol i c associated fatty liver disease,MAFLD)患者葡萄糖目标范围内时间(time in range,TIR)与肝纤维化的相关性。方法:抽取2020年7月至2020年11月就诊于我院内分泌科的T2DM合并MAFLD患者205例。根据瞬时弹性成像技术测得的肝脏硬度值(liver stiffness measurement,LSM)将患者分为非肝肝维化组(LSM<8.0 kPa)和肝纤维化组(LSM≥8.0 kPa)。采集患者的病史,检测血糖、血脂、肝功能、糖化血红蛋白等生化指标数据,计算体重指数(body mass index,BMI)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)和葡萄糖TIR。采用两独立样本t检验和χ2检验进行两组间一般统计资料比较,Pearson线性相关分析比较各变量间的相关关系,以单因素和多因素logistic回归模型进行影响因素的分析。结果:与非肝纤维化组相比,肝纤维化组BMI、三酰甘油(tr iglyceride,TG)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(aspar tate aminotransferase,AST)及HOMA-IR水平较高,TIR水平较低(P<0.05)。肝纤维化程度与患者的BMI、TG、ALT、AST及HOMA-IR水平呈正相关(P<0.05),与TIR水平呈负相关(P<0.001)。BMI、TG、HOMA-IR及TIR是肝纤维化的独立危险因素(均P<0.05)。结论:T2DM合并MAFLD的患者葡萄糖TIR越低,患有肝纤维化的风险越大。Objective:To investigate the relationship between glucose target time in range(TIR)and liver fibrosis in patients with type 2 diabetes mellitus and metabolic associated fatty liver disease.Methods:From July 2020 to November 2020,205 patients with type 2 diabetes(T2DM)and metabolic-associated fatty liver disease(MAFLD)who were hospitalized in the department of endocrinology of our hospital were collected.Patients were divided into a non-hepatic fibrosis group(LSM<8.0 kPa)and a liver fibrosis group(LSM≥8.0 kPa)according to the liver stiffness measurement(LSM)measured by transient elastography.We collected the patients’medical history,detected bio-chemical data such as blood glucose,blood lipids,liver function,glycosylated hemoglobin,and caculated the body mass index(BMI),homeostasis model assessment of insulin resistance(HOMA-IR)and glucose time in range.Using two independent samples t-test andχ2-test to compare the general statistics between the two groups,and Pearson linear correlation analysis was used to compare the correlation between the variables and the single-factor and multi-factor Logistic regression models were utilized to analyze affecting factors.Results:Compared with the non-hepatic fibrosis group,the BMI,triglyceride(TG),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and HOMA-IR of the liver fibrosis group were higher and its TIR level was lower than that of the non-hepatic fibrosis group(P<0.05).The degree of liver fibrosis was positively related to the patient’s BMI,TG,ALT,AST and HOMA-IR levels(P<0.05)but negatively related to the TIR level(P<0.001).BMI,TG,HOMA-IR and TIR were independent risk factors for liver fibrosis(P<0.05).Conclusion:The lower TIR in patients with type 2 diabetes combined with metabolic associated fatty liver disease,the greater the risk of liver fibrosis.

关 键 词：代谢相关脂肪性肝病 目标范围内时间 2型糖尿病 肝纤维化 

分 类 号：R587.2[医药卫生—内分泌] R575.5[医药卫生—内科学]