老年2型糖尿病胰岛素抵抗与非酒精性脂肪肝相关分析

Association between insulin resistance and nonalcoholic fatty liver disease in aged patients with type-2 diabetes mellitus

目的 探讨老年2型糖尿病（T2DM）合并非酒精性脂肪肝（NAFLD）患者与肥胖、血脂紊乱及胰岛素抵抗（IR）的关系。方法 115例老年T2DM患者根据B超检查结果，分为糖尿病（DM）合并NAFLD组（DFL组）与DM无脂肪肝组（T2DM组），并收集同期的无DMNAFLD（NASH组）患者50例作为对照。运用稳态模型评估法（homeostasis model assessment，HOMA）及其他相关指标，评价IR。结果 （1）115例T2DM患者合并脂肪肝的发生率为56％；（2）DFL组的危险因素：体质量指数（BMI）、舒张压（DBP）、血尿酸（UA）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FINS）、空腹C肽（FC）、餐后胰岛素（PINS）、载脂蛋白B（ApoB）、HOMA-IR均有显著升高（P〈0．05～0．01），载脂蛋白Al（ApoAl）、脂蛋白（a）[Lp（a）]、HOMA-胰岛素β细胞分泌指数（IS）、胰岛素敏感指数（ISI）则有显著降低（P〈0．05～0．01），其中最主要的危险因素是BMI、TG和PINS。（3）DFL组与T2DM组比较，性别、年龄、血糖、病程无显著差异；DFL组与NASH组比较，血清丙氨酸氨基转移酶水平有显著差异（P〈0．05～0．01），HOMA-IR无显著差异。结论 （1）T2DM合并NAFLD患者存在明显的肥胖、血脂紊乱及IR，尤以TG、BMI和ISI为主要因素，高TG血症反映了IR的程度；（2）虽然性别、年龄、血糖、病程对NASH患者影响显著，但在DM患者中它们的影响不大；（3）老年T2DM患者控制体质量、血糖、血脂，减少IR，对于预防和减少T2DM并发脂肪肝具有重要的意义。

Objective To investigate the relationship of obesity, dyslipidaemia, insulin resistanee（IR） with nonalcoholie fatty liver disease in aged patients with type 2 diabetes mellitus. Methods One hundred and fifteen patients with type 2 diabetes were divided into two groups （DFL group and T2DM group） according to whether the patients presented with fatty liver or not. Fifty eases of nondiabetie nonalcoholic fatty liver disease were collected in the same period as NASH group. Homeostasis model assessment （HOMA） was applied to estimating IR. Results （ 1 ） The prevalenee of fatty liver in type 2 diabetie patients was 56%. （2） Risk faetors related to DFL ineluding BMI,DBP,UA,TG,LDL-C,FINS,FC, PINS ,ApoB and HOMA-IR were siguifieantly higher, and ApoA1, Lp（a） ,HOMA-IS and ISI were obviously lower in DFL group eompared to T2DM and NASH group. BMI, TG and PINS were the most important risk factors. （3） There were no siguifieant differenees between DFL and DM groups in age, sex, fast blood glucose （ FBG）, duration of diabetes. There were siguifieant differences between DFL and NASH groups in serum enzyme activity of the liver. Conclusions Reducing body weight, regulating hyperlipidemia, eontrolling blood pressure and improving IR ean reduee the prevalenee of fatty liver. Hypertrlglyeeridemia eould refleet the degree of IR.