老年2型糖尿病患者血清视黄醇结合蛋白与代谢相关脂肪性肝病的关系研究  

The relationship between serum retinol binding protein and metabolic-associated fatty liver disease in elderly patients with type 2 diabetes

作　　者：马艺琳 柯蒋风 王俊薇 王羽洁 李连喜 Ma Yilin;Ke Jiangfeng;Wang Junwei;Wang Yujie;Li Lianxi(Department of Endocrinology and Metabolism,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院内分泌代谢科,200233

出　　处：《中华老年医学杂志》2023年第1期7-11,共5页Chinese Journal of Geriatrics

基　　金：国家重点研发计划(2018YFC1314900,2018YFC1314905);国家自然科学基金(81170759,81770813,82070866)。

摘　　要：目的探讨老年2型糖尿病(T2DM)患者血清视黄醇结合蛋白(RBP)与代谢相关脂肪性肝病(MAFLD)发病的关系及可能代谢机制。方法回顾性分析2003年1月至2012年12月在上海交通大学附属第六人民医院内分泌代谢科住院且临床资料完整的老年T2DM患者3384例。根据血清RBP水平四分位数分为4组:RBP<35 mg/L组844例、35 mg/L≤RBP≤41 mg/L组773例、42 mg/L≤RBP≤51 mg/L组902例和RBP>51 mg/L组865例。收集患者临床资料、实验室检查结果,比较4组患者MAFLD的患病率,采用二元Logistic回归分析RBP与MAFLD的关系。结果校正年龄、性别后,从RBP<35 mg/L组至RBP>51 mg/L组,老年T2DM患者的肥胖比例(χ2=15.222)、降脂药用药比例(χ2=88.552)、收缩压(F=12.002)、舒张压(F=6.872)、腰围(F=9.563)、腰臀比(F=7.972)、体质指数(F=9.057)、血肌酐(χ2=185.445)、血尿酸(χ2=314.691)、24 h尿白蛋白(χ2=91.012)、谷丙转氨酶(χ2=17.049)、γ-谷氨酰转肽酶(χ2=50.514)、总胆固醇(F=45.669)、三酰甘油(χ2=361.269)、低密度脂蛋白胆固醇(F=8.772)、空腹C肽(χ2=165.756)、餐后2 h C肽(χ2=120.690)、胰岛抵抗指数(HOMA2-IR)(χ2=148.884)均呈上升趋势(均P<0.01),MAFLD患病率也逐渐升高,分别为26.5%(224/844)、30.1%(233/773)、36.6%(330/902)和41.8%(362/865)(χ2=52.526,P<0.01)。伴MAFLD的老年T2DM患者HOMA2-IR高于不伴MAFLD患者[2.0(1.31~2.8)比1.39(0.86~2.06),F=220.826,P<0.01]。校正其他混杂因素后,二元Logistic回归分析结果显示,血清RBP与MAFLD发生相关(β=0.209,OR=1.232,95%CI:1.079~1.408,χ2=9.441,P<0.01)。结论血清RBP水平升高是老年T2DM患者MAFLD发生的独立危险因素,其机制可能与RBP增加胰岛素抵抗有关。Objective To explore the relationship between serum retinol binding protein(RBP)and metabolic-associated fatty liver disease(MAFLD)in elderly patients with type 2 diabetes mellitus(T2DM)and possible underlying metabolic mechanisms.Methods A total of 3384 elderly T2DM patients hospitalized and with complete clinical records at the Department of Endocrinology and Metabolism,Sixth People's Hospital Affiliated to Shanghai Jiao Tong University between January 2003 and December 2012 were recruited in this retrospective study.Patients were divided into four groups according to the quartiles of serum RBP levels:the first quartile of serum RBP levels(<35 mg/L,844 cases),the second quartile of serum RBP levels(35 mg/L≤RBP≤41 mg/L,773 cases),the third quartile of serum RBP levels(42 mg/L≤RBP≤51 mg/L,902 cases),and the fourth quartile of serum RBP levels(RBP>51 mg/L,865 cases).Clinical data and laboratory test results were collected.Differences in the prevalence of MAFLD were compared between the four groups.The association between RBP and MAFLD was analyzed via binary logistic regression.Results After adjusting for age and sex,the proportion of obesity(χ2=15.222,P<0.01),the percentage using lipid-lowering drugs(χ2=88.552,P<0.01),systolic blood pressure(F=12.002,P<0.01),diastolic blood pressure(F=6.872,P<0.01),waist circumference(F=9.563,P<0.01),waist-hip ratio(F=7.972,P<0.01),body mass index(F=9.057,P<0.01),serum creatinine(χ2=185.445,P<0.01),serum uric acid(χ2=314.691,P<0.01),24-hour urinary albumin(χ2=91.012,P<0.01),alanine aminotransferase(χ2=17.049,P=0.003),γ-glutamyl transpeptidase(χ2=50.514,P<0.01),total cholesterol(F=45.669,P<0.01),triglycerides(χ2=361.269,P<0.01),low-density lipoprotein(F=8.772,P<0.01),fasting C-peptide(χ2=165.756,P<0.01),2h postprandial C-peptide(χ2=120.690,P<0.01),and the homeostasis model assessment of insulin resistance(HOMA2-IR)(χ2=148.884,P<0.01)in elderly patients with T2DM all showed a clear upward trend.The prevalence of MAFLD also gradually increased across the quartile

关 键 词：糖尿病 2型 代谢相关脂肪性肝病 视黄醇结合蛋白质类 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌] R575.5[医药卫生—内科学]