2型糖尿病患者非酒精性脂肪肝及进展肝纤维化与骨质疏松的关系  

Association of non-alcoholic fatty liver disease and advanced liver fibrosis with osteoporosis in type 2 diabetes mellitus

作　　者：周静芳[1] 杨晓钟[1] 刘媛媛[2] 汪为民[3] 谭娟[4] Zhou Jingfang;Yang Xiaozhong;Liu Yuanyuan;Wang Weimin;Tan Juan(Department of Gastroenterology,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian 223300,China;Department of Endocrinology,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian 223300,China;Department of Geriatrics,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian 223300,China;Department of General Practice,the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University,Huaian 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院消化科,淮安223300 [2]南京医科大学附属淮安第一医院内分泌科,淮安223300 [3]南京医科大学附属淮安第一医院老年科,淮安223300 [4]南京医科大学附属淮安第一医院全科医学科,淮安223300

出　　处：《中华内分泌代谢杂志》2023年第8期676-682,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金资助项目(82000475);江苏省老年健康科研面上项目(LKM2022069)。

摘　　要：目的研究2型糖尿病(type 2 diabetes mellitus,T2DM)患者非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)及进展纤维化与骨质疏松(osteoporosis,OP)的关系。方法通过横断面研究方法,收集2019年9月至2020年9月于南京医科大学附属淮安第一医院内分泌及老年医学科住院的T2DM患者391例。根据肝脏B超分为T2DM合并NAFLD和T2DM未合并NAFLD组。根据肝纤维化指数分为肝脏纤维化低分险组及肝脏纤维化中高风险组。收集患者一般临床特征和病史、实验室及双能X线骨密度检查结果。多因素logistic回归评估T2DM患者NAFLD及进展肝纤维化与OP的关系,最后根据年龄、性别、体重指数和糖尿病病程进行交互作用和分层分析。结果多因素logistic回归显示T2DM患者罹患OP风险及骨密度下降与NAFLD发生无统计学意义上差异(所有P>0.05)。调整年龄、性别、体重指数和糖尿病病程后,肝脏纤维化中高风险组T2DM患者髋部骨密度(β为-0.044,95%CI-0.087~-0.001,P=0.046)和腰椎L1-L4骨密度(β为-0.044,95%CI-0.087~-0.002,P=0.044)均显著减低,罹患OP的风险显著增加(OR为2.428,95%CI 1.124~5.244,P=0.024)。最后亚组分析显示,肝脏纤维化中高风险组的T2DM超重患者罹患OP风险显著增加(OR为4.240,95%CI 1.637~10.987,交互作用P=0.018)。结论T2DM患者骨密度下降和罹患OP风险与NAFLD发生差异无统计学意义,但NAFLD相关进展肝性纤维化是T2DM超重患者骨密度下降和罹患OP的独立危险因素。Objective To study the association of non-alcoholic fatty liver disease(NAFLD)and advanced liver fibrosis with osteoporosis in patients with type 2 diabetes mellitus(T2DM).Methods Data was collected from 391 in-patients with type 2 diabetes mellitus(T2DM)from September 2019 to September 2020 at the Department of Endocrinology and Geriatric Medicine,Affiliated Huai′an First Hospital of Nanjing Medical University in this cross-sectional study.Participants were divided into T2DM with coexistent NAFLD(TCN)and with no NAFLD(TON)group via liver B-mode ultrasound.Also,the patients were divided into low and middle-high risk group via fibrosis index based on 4 factors index(FIB-4).Participant characteristics,laboratory results,and dual energy x-ray absorptiometry were obtained and analyzed.Multivariable logistic regression models were used to evaluate the association of NAFLD and advanced liver fibrosis with osteoporosis in T2DM.Interaction and stratified analyses were conducted according to age,sex,body mass index(BMI)and duration of diabetes(DD).Results There was no significant difference in risk of osteoporosis and bone mineral density(BMD)loss between TCN and TON group(all P>0.05).After adjusting for age,sex,BMI,and DD,total hip BMD(β=-0.044,95%CI-0.087--0.001,P=0.046)and lumbar L1-L4BMD(β=-0.044,95%CI-0.087--0.002,P=0.044)were significantly reduced,and the risk of osteoporosis was significantly increased(OR=2.428,95%CI 1.124-5.244,P=0.024)in FIB-4 middle-high risk group compared with low risk group.The subgroup analysis showed that overweight patients with T2DM had a significantly increased risk of osteoporosis(OR=4.240,95%CI 1.637-10.987,interaction P=0.018)in FIB-4 middle-high risk group compared with low risk group.Conclusion There was no significant difference in risk of osteoporosis and BMD loss between TCN and TON group.However,among T2DM patients who were overweight,NAFLD-related progressive liver fibrosis emerged as an independent risk factor for both BMD decline and the development of osteoporosis.

关 键 词：非酒精性脂肪肝 肝脏纤维化 糖尿病 2型 骨密度 骨质疏松症 

分 类 号：R587.1[医药卫生—内分泌] R575.2[医药卫生—内科学] R580[医药卫生—临床医学]