早发2型糖尿病患者非高密度脂蛋白胆固醇水平与非酒精性脂肪性肝病的关系探讨  

Association of non-high-density lipoprotein cholesterol level with non-alcoholic fatty liver disease in patients with early-onset type 2 diabetes

作　　者：熊海燕 吕国红 Xiong Haiyan;Lyu Guohong(Beijing Chaoyang Diabetes Hospital,Beijing 100025,China)

机构地区：[1]北京朝阳糖尿病医院内科,北京100025

出　　处：《中国基层医药》2023年第3期422-427,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的分析早发2型糖尿病患者非高密度脂蛋白胆固醇(non-HDL-C)水平与非酒精性脂肪性肝病(NAFLD)的关系。方法回顾性分析2008年6月至2012年6月于北京朝阳糖尿病医院住院治疗的早发T2DM患者100例的临床资料,根据是否合并NAFLD将患者分为NAFLD组50例与非NAFLD组50例。收集患者临床资料、生化指标[血脂、血糖、肝功能、血尿酸、高敏C反应蛋白(hs-CPR)]和糖化血红蛋白(HbA1c),并计算体质量指数(BMI)和non-HDL-C。采用logistic回归分析早发T2DM患者non-HDL-C水平与NAFLD的关系,应用受试者工作特征(ROC)曲线评估non-HDL-C对早发T2DM合并NAFLD的预测价值和最佳切点。结果NAFLD组BMI、腰臀比、收缩压、舒张压分别为(28.55±3.47)kg/m^(2)、(0.94±0.05)、(121.00±10.25)mmHg(1 mmHg=0.133 kPa)、(80.00±8.51)mmHg,均高于非NAFLD组[(23.95±2.87)kg/m^(2)、(0.90±0.07)、(115.20±13.36)mmHg、(73.70±7.75)mmHg](t=-7.23、-3.11、-2.44、-3.87,均P<0.05)。NAFLD组non-HDL-C[(4.88±3.01)mmol/L]、总胆固醇[(6.33±3.23)mmol/L]、三酰甘油[(4.50±6.03)mmol/L]、低密度脂蛋白胆固醇[(3.27±1.26)mmol/L]、丙氨酸氨基转移酶[(39.80±23.58)U/L]、天冬氨酸氨基转移酶[(27.72±13.83)U/L]、γ-谷氨酰转肽酶[(52.96±46.16)U/L]、血尿酸[(350.32±102.12)μmol/L]、hs-CPR[(1.26±0.88)mg/L]、HbA1c[(9.3±2.5)%]均高于非NAFLD组[(3.35±1.03)mmol/L、(4.81±1.24)mmol/L、(1.87±2.29)mmol/L、(2.70±0.71)mmol/L、(23.76±13.45)U/L、(21.98±10.13)U/L、(35.24±35.41)U/L、(296.04±88.26)μmol/L、(0.22±1.54)mg/L、(8.2±2.7)%],差异均有统计学意义(t=-3.40、-3.11、-2.88、-2.81,-4.18、-2.36、-2.14、-2.85、-4.12、-2.08,均P<0.05)。logistic回归分析显示,non-HDL-C升高是T2DM合并NAFLD的独立危险因素(OR=3.064,95%CI:1.604~5.852,P=0.001)。ROC曲线分析结果提示non-HDL-C预测NAFLD的最佳切点是3.60 mmol/L,敏感性为0.700,特异性为0.620。结论non-HDL-C水平升高是早发T2DM合并NAFLD的独立危险因素,当non-HDL-Objective To investigate the association of non-high-density lipoprotein cholesterol(non-HDL-C)level with non-alcoholic fatty liver disease(NAFLD)in patients with early-onset type 2 diabetes.Methods The clinical data of 100 patients with early-onset type 2 diabetes who were admitted to Beijing Chaoyang Diabetes Hospital from June 2008 to June 2012 were retrospectively analyzed.These patients were divided into a NAFLD group and a non-NAFLD group,with 50 patients in each group,according to the presence or absence of NAFLD.Clinical data,biochemical indices[blood lipids,blood glucose,liver function,uric acid,high-sensitivity C-reactive protein],and glycosylated hemoglobin were collected.Body mass index and non-HDL-C levels were recorded.The association of non-HDL-C level with NAFLD in patients with early-onset type 2 diabetes was analyzed using logistic regression analysis.The predictive value and optimal cut-off point of non-HDL-C for early-onset T2 diabetes complicated by NAFLD were evaluated using the receiver operating characteristic curve.Results Body mass index,waist-to-hip ratio,systolic blood pressure,and diastolic blood pressure in the NAFLD group were(28.55±3.47)kg/m^(2),(0.94±0.05),(121.00±10.25)mmHg(1 mmHg=0.133 kPa),and(80.00±8.51)mmHg respectively,which were significantly higher than(23.95±2.87)kg/m^(2),(0.90±0.07),(115.20±13.36)mmHg,and(73.70±7.75)mmHg in the non-NAFLD group(t=-7.23,-3.11,-2.44,-3.87,all P<0.05).Non-HDL-C,total cholesterol,triglyceride,low-density lipoprotein cholesterol,alanine aminotransferase,aspartate aminotransferase,γ-glutamyl transpeptidase,uric acid,high-density lipoprotein cholesterol,and glycosylated hemoglobin levels in the NAFLD group were(4.88±3.01)mmol/L,(6.33±3.23)mmol/L,(4.50±6.03)mmol/L,(3.27±1.26)mmol/L,(39.80±23.58)U/L,(27.72±13.83)U/L,(52.96±46.16)U/L,(350.32±102.12)μmol/L,(1.26±0.88)mg/L,and(9.3±2.5)%,respectively,which were significantly higher than(3.35±1.03)mmol/L,(4.81±1.24)mmol/L,(1.87±2.29)mmol/L,(2.70±0.71)mmol/L,(23.76±13.45)U/L,(21

关 键 词：糖尿病 2型 脂蛋白类 HDL 非高密度脂蛋白胆固醇 非酒精性脂肪性肝病 代谢相关脂肪性肝病 危险因素 

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