2型糖尿病患者脂肪肝患病率调查及危险因素分析

Study on prevalence and risk factors of fatty liver of patients with type 2 diabetes

目的探讨2型糖尿病患者非酒精性脂肪肝(NAFL)的患病率及主要危险因素。方法1335例住院2型糖尿病患者根据 B 超检查结果分为 NAFL 组和对照组,并进行体脂参数、血压、血糖、血脂谱、C 肽、C 反应蛋白(CRP)等检查。代谢综合征(MS)采用中华医学会糖尿病分会的诊断标准。结果 (1)住院2型糖尿病患者 NAFL 的患病率为42.1%,50岁前男性 NAFL 患病率高于女性,50岁以后则低于女性(P<0.05～0.01)。(2)NAFL 组超重/肥胖、血脂紊乱、高血压及 MS 的患病率分别为59.4%、66.4%、57.7%、71.7%,显著高于对照组(P<0.01);同时随着代谢异常数目的增加,NAFL 患病风险逐渐增加(趋势 P<0.01),其中4种代谢异常者较单纯糖尿病患者,其 NAFL 患病风险增加幅度为:男性11.1倍、女性10.6倍。(3)NAFL 组体重指数、舒张压、空腹血糖、糖化血红蛋白、总胆固醇、甘油三酯、CRP、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶、血尿酸及 C 肽水平均高于对照组,而高密度脂蛋白胆固醇、AST/ALT 则低于对照组(P<0.05～0.01);多元回归分析显示甘油三酯、体重指数、CRP、餐后30 min C 肽水平以及空腹血糖与 NAFL 独立正相关。(4)2型糖尿病患者中伴 CRP 水平升高(男性 CRP≥2.11 mg/L、女性 CRP≥2.22 mg/L)的比例为:男性29.1%、女性33.8%;与不伴 CRP 水平升高者相比,NAFL 患病率显著升高(54.4%比35.3%,62.0%比38.4%,均 P<0.01)。结论 (1)住院2型糖尿病患者约2/5合并 NAFL,后者与MS 关系密切。(2)除了肥胖、糖、脂代谢紊乱及餐后 C 肽水平升高外,CRP 水平升高与 NAFL 的发病也密切相关。

Objective To study the prevalence and risk factors of nonalcoholic fatty liver （NAFL） of patients with type 2 diabetes. Methods A total of 1335 patients with type 2 diabetes were divided into NAFL group and control group according to type B ultrasonic tomography results. Results （1）The prevalence of NAFL in type 2 diabetic patients was 42. 1%. Among the patients younger than 50 years old, the prevalence of NAFL in males was higher than that in females. However, among the patients older than 50 years old, the case was just the opposite, higher in females. （2）The prevalenees of overweight/obesity, dyslipidemia, hypertension, and metabolic syndrome （MS） of NAFL group were 59.4%, 66.4%, 57.7% and 71.7% respectively, all significantly higher than those of control group （P 〈0. 01 ）. The risk for NAFL paralled with the increment of number of components of MS. Those patients with four components of MS had higher risk of NAFL than those patients with isolated type 2 diabetes （ OR = 11.1 and 10. 6, both P 〈 0. 001 ）. （3）The body mass index, diastolic blood pressure, fasting plasma glucose, hemoglobin A1 c, total cholesterol, triglyceride, C-reactive protein （CRP）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST） , gamma-glutamyltransferase, the level of serum uric acid and C-peptide of NAFL group were all higher than those of control group （P 〈 0.05 - 0. 01 ）. The level of serum high density lipoproteincholesterol and the AST/ALT rate were lower than those of control group （ P 〈 0. 05 - 0. 01 ）.Triglyceride, body mass index, CRP, the level of postprandial C-peptide at 30 min and fasting plasma glucose were the risk facters of NAFL （4） The incidence of type 2 diabetic patients with increased CRP levels were 29. 1% in male and 33.8% in female, patients with increased CRP levels had higher incidence of NAFL（54.4% vs 35.3% in male,62.0% vs 38.4% in female,both P 〈0.01）. Conclusions （1） About 2/5 of in-patients with type 2 diabetes had NAFL, and NAFL was closely associated with MS. （2） The increased level of CRP, as well as obesity, hyperglycemia, dyslipidemia and the increased level of postprandial C-peptide might increase the risk of NAFL in the patients with type 2 diabetes.