T2DM患者外周血氧化应激变化及其与合并NAFLD的关系研究

Study on the changes of oxidative stress in peripheral blood of patients with T2DM and its relationship with NAFLD

目的检测2型糖尿病(T2DM)患者外周血氧化应激变化,并分析其与合并非酒精性脂肪性肝病(NAFLD)的关系。方法选取本单位2016年1月至2017年12月收治的133例T2DM患者,随访5年,统计NAFLD发生率。根据是否发生NAFLD记为发生组(n=98)和未发生组(n=35),比较2组患者一般资料和外周血超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)、硫氧还蛋白互作蛋白(TXNIP)水平;采用Logistic回归分析探讨T2DM患者并发NAFLD的危险因素;绘制受试者工作特征(ROC)曲线分析外周血SOD、MDA、GSH-PX、TXNIP水平单独与联合对T2DM患者并发NAFLD的预测价值。结果T2DM患者中NAFLD发生率为73.68%(98/133);NAFLD发生患者外周血MDA、TXNIP水平均高于NAFLD未发生患者(P<0.05),SOD、GSH-PX水平低于NAFLD未发生患者(P<0.05);病程>5年,未进行胰岛素降糖,空腹血糖,外周血SOD、MDA、GSH-PX、TXNIP水平均是T2DM并发NAFLD的影响因素(OR=3.062、3.725、4.350、0.649、4.328、0.551、4.697,P<0.05);外周血SOD、MDA、GSH-PX、TXNIP水平联合预测T2DM并发NAFLD的灵敏度均高于单独预测(P<0.01),AUC均高于单独预测(P<0.05),特异度均与单独预测差异无统计学意义(P>0.05)。结论外周血氧化应激水平升高可增加T2DM并发NAFLD的风险,外周血SOD、MDA、GSH-PX、TXNIP水平联合预测并发NAFLD的效能高。

Objective To detect the changes of oxidative stress in peripheral blood of patients with type 2 diabetes mellitus(T2DM),and analyze their relationships with nonalcoholic fatty liver disease(NAFLD).Methods A total of 133 T2DM patients admitted to our unit from January 2016 to December 2017 were selected and followed up for 5 years to analyze the incidence of NAFLD.The occurrence of NAFLD was classified as the occurrence group(n=98)and the non-occurrence group(n=35).The general data and the levels of superoxide dismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-PX)and thioredoxin interacting protein(TXNIP)in peripheral blood of the two groups were compared.Logistic regression analysis was used to explore the risk factors of NAFLD in T2DM patients.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of peripheral blood SOD,MDA,GSH-PX and TXNIP levels alone and in combination in T2DM patients with NAFLD.Results The incidence of NAFLD in T2DM patients was 73.68%(98/133).The levels of MDA and TXNIP in peripheral blood of patients with NAFLD were higher than those of patients without NAFLD(P<0.05),and the levels of SOD and GSH-PX were lower than those of patients without NAFLD(P<0.05).The disease duration>5 years,no insulin hypoglycemia was performed,fasting blood glucose,the levels of SOD,MDA,GSH-PX and TXNIP in peripheral blood were the influencing factors of T2DM complicated with NAFLD(OR=3.062,3.725,4.350,0.649,4.328,0.551,4.697,P<0.05).The sensitivity of SOD,MDA,GSH-PX and TXNIP combined in predicting T2DM complicated with NAFLD was higher than that of single prediction(P<0.01),and the AUC was higher than that of single prediction(P<0.05).There was no significant difference in specificity between the two groups(P>0.05).Conclusion Elevated levels of peripheral blood oxidative stress can increase the risk of T2DM complicated with NAFLD.The combination of peripheral blood SOD,MDA,GSH-PX and TXNIP levels has a high efficacy in predicting NAFLD complicated with T2DM.