HBV感染合并2型糖尿病患者肝功能损害与骨代谢指标的关系  

Relationship between damage of liver function and bone metabolism indexes of HBV infection patients complicated with type 2diabetes mellitus

作　　者：邢雪[1] 刘洋[1] 孙赫[1] 樊春艳 金凤华 XING Xue;LIU Yang;SUN He;FAN Chun-yan;JIN Feng-hua(Affiliated Hospital of Jilin Medical University,Jilin,Jilin 132000,China)

机构地区：[1]吉林医药学院附属医院内分泌科,吉林吉林132000

出　　处：《中华医院感染学杂志》2021年第17期2594-2598,共5页Chinese Journal of Nosocomiology

基　　金：吉林省科研基金资助项目(2019364)。

摘　　要：目的分析慢性乙型肝炎病毒(HBV)感染合并2型糖尿病(T2DM)患者肝功能损害情况及其与骨代谢指标的关系。方法选取2018年1月-2020年1月吉林医药学院附属医院128例合并慢性HBV感染的T2DM患者为研究对象,根据丙氨酸氨基转移酶(ALT)水平分为ALT异常组及ALT正常组,比较两组患者糖代谢指标空腹血糖(FPG)、糖化血红蛋白(HbA1c);胰岛功能指标空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及骨代谢指标Ⅰ型胶原交联C-末端肽(CTX)、25-羟基维生素D[25-(OH)D3]和骨密度(BMD)差异。并根据患者BMD水平分为骨质疏松组与非骨质疏松组,采用Losigtics回归分析合并慢性HBV感染的T2DM患者发生骨质疏松的危险因素。结果ALT异常组FPG、HbA1c、25-(OH)D3及股骨BMD、腰椎BMD均低于ALT正常组(P<0.05),而FINS、CTX高于ALT正常组(P<0.05)。128例合并慢性HBV感染的T2DM患者中骨质疏松组45例(35.16%),非骨质疏松组83例(64.84%);两组腰臀比、FPG、HbA1c、FINS、HOMA-IR水平比较,差异均无统计学意义;但骨质疏松组女性占比、年龄、T2DM病程及ALT水平高于非骨质疏松组(P<0.05),体质量指数(BMI)低于非骨质疏松组(P<0.05);Logistics回归分析结果,女性、年龄≥65岁、T2DM病程≥8年、BMI<18.50kg/m^(2)、ALT>40U/L是合并慢性HBV感染T2DM患者发生骨质疏松独立危险因素。结论合并慢性HBV感染的T2DM患者骨代谢与肝功能受损、性别、年龄、病程及BMI均相关,临床应积极防控患者骨质疏松,避免发生骨折等严重不良事件。OBJECTIVE To observe the relationship between the damage of liver function and the bone metabolism indexes of the hepatitis B virus(HBV)infection patients complicated with type 2diabetes mellitus(T2DM).METHODS A total of 128HBV infection patients complicated with T2DM who were treated in the Affiliated Hospital of Jilin Medical University from Jan 2018to Jan 2020were recruited as the study subjects and divided into the abnormal ALT group and the normal ALT group according to the level of alanine aminotransferase(ALT).The glucose metabolism indexes fasting plasma glucose(FPG)and glycosylated hemoglobin(HbA1c),islet function indexes fasting insulin(FINS),homeostasis model assessment of insulin resistance(HOMA-IR),bone metabolism indexes type Ⅰ collagen cross-linked C-terminal peptide(CTX),25-hydroxyvitamin D[25-(OH)D3]and bone mineral density(BMD)were observed and compared between the two groups of patients.The patients were divided into the osteoporosis group and the non-osteoporosis group on the basis of BMD level.Logistic regression analysis was performed for the risk factors for the osteoporosis in the HBV infection patients complicated with T2DM.RESULTS The FPG,HbA1c,25-(OH)D3,femoral BMD and lumbar spine BMD of the abnormal ALT group were significantly lower than those of the normal ALT group(P<0.05),while the FINS and CTX of the abnormal ALT group were significantly higher than those of the normal ALT group(P<0.05).Among the 128T2DM patients complicated with chronic HBV infection,there were 45(35.16%)cases in the osteoporosis group and 83(64.84%)cases in the non-osteoporosis group.There were no significant differences in the waist-hip ratio,FPG,HbA1c,FINS and HOMA-IR levels between the two groups.The percentage of the female patients,age,course of T2DM and ALT level of the osteoporosis group were significantly higher than those of the non-osteoporosis group(P<0.05);the body mass index(BMI)of the osteoporosis group was significantly lower than that of the non-osteoporosis group(P<0.05).The result of logisti

关 键 词：2型糖尿病 乙型肝炎病毒 肝功能 骨代谢 骨质疏松 

分 类 号：R373[医药卫生—病原生物学]