2型糖尿病并非酒精性脂肪性肝病患者血清游离脂肪酸和细胞角蛋白18的表达

Increased expression of blood serum free fatty acids and cytokeratin 18 in patients with type 2 diabetes with non alcoholic fatty liver disease

目的:探讨2型糖尿病(T2DM)并非酒精性脂肪性肝病(NAFLD)患者血清游离脂肪酸(FFA)和细胞角蛋白18(CK18)的表达及其影响。方法:T2DM患者40例,T2DM并NAFLD患者40例,健康对照组20例。体格检查,测定静脉血空腹血糖(FPG)、胆固醇(TC)、甘油三酯(TG)、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、糖化血红蛋白(HbA1c)、胰岛素(FINS)以及血清FFA和CK18,并行肝脏B超检查。结果:①T2DM组的体质指数(BMI)、FPG、FINS、A1C水平和胰岛素抵抗指数(HOMA-IR)显著高于正常对照组,差异有统计学意义;TC、TG、ALT、AST、GGT水平差异无统计学意义。T2DM并NAFLD患者的BMI、FPG、FINS、TC、TG、ALT、AST、GGT水平和HOMA-IR均显著高于T2DM患者,差异有统计学意义(P<0.001);②T2DM组与正常对照组相比,FFA水平明显增高,差异有统计学意义,CK18水平差异无统计学意义。而T2DM并NAFLD组FFA和CK18水平均高于正常对照组和T2DM组,差异有统计学意义(P<0.001)。结论:与T2DM相比,T2DM并NAFLD患者胰岛素抵抗、代谢紊乱更加显著,肝细胞的凋亡增加,对于进一步研究T2DM并NAFLD的发病机制具有重要的意义。

Objective：To explore the expression of blood serum free fatty acid（FFA）and cytokeratin 18（CK18）and their impact on patients with type 2 diabetes mellitus with non alcoholic fatty liver disease（NAFLD）.Methods：Forty patients with type 2 diabetes,40 cases with type 2 diabetes with alcoholic fatty liver disease,20 cases of healthy controls were enrolled.Fasting blood glucose（FPG）,cholesterol（TC）,triglyceride（TG）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,γ-glutamyl（GGT）,glycated hemoglobin（HbA1c）,insulin（FINS）,FFAa and CK18 were detected,and liver B-ultrasound was performed.Results：① BMI,FPG,FINS,A1C levels and HOMA-IR were significantly higher in group of type 2 diabetes than that of the normal control group;CH,TG,ALT,AST,GGT levels were not significantly different.BMI,FPG,FINS,CH,TG,ALT,AST,GGT levels and HOMA-IR were significantly higher in group of type 2 diabetes with NAFLD than that of type 2 diabetes group（P 〈0.001）;② Compared with normal control group,FFA levels were significantly increased in group of type 2 diabetes,but CK18 levels were not significantly different.In group of type 2 diabetes with NAFLD,CK18 and FFA levels were higher than normal control group as well as type 2 diabetes group（P 〈 0.001）.Conclusion：Compared with type 2 diabetes patients,insulin resistance,metabolic disorders were more significant and apoptosis of liver cells increased in patients with type 2 diabetes with NAFLD.Further study on pathogenesis of type 2 diabetes with NAFLD should be performed.