2型糖尿病腹型肥胖患者肝内脂肪沉积的危险因素研究

The Risk Factors for Intrahepatic Lipid Accumulation in Type 2 Diabetic Patients with Central Obesity

目的:探讨2型糖尿病腹型肥胖患者肝内脂肪沉积的危险因素。方法:以未用过口服降糖药的腹型肥胖2型糖尿病患者为研究对象,通过1H-MRS法评估肝内脂肪含量(IHCL),比较IHCL水平不同组的脂肪量及分布、代谢改变和循环中脂肪因子、细胞因子的水平。结果:以IHCL值的下四分位数为切点分成少量脂肪浸润组与明显脂肪浸润组时,两组间体重、体质量指数(BMI)、腰围、腰臀比这些简单体脂指标无显著差别。而L3断面的CT扫描显示腹腔内脂肪占总横断面脂肪百分比差别具统计学意义(45.27±17.01比56.72±8.77,P=0.02)。明显脂肪浸润组的血清脂联素水平显著低于少量脂肪浸润组(19.49±12.08比12.36±5.03,P=0.022),而血清瘦素、肿瘤坏死因子α水平在两组间差别无统计学意义。校正性别和年龄后,IHCL与腹腔内脂肪占横断面总体脂百分比(r=0.58,P<0.05),肝脏体积(r=0.46,P<0.05),血脂联素水平(r=0.43,P<0.05)及HOMA-IR(r=0.62,P<0.05)相关。结论:腹型肥胖2型糖尿病患者的IHCL与腹腔内脂肪占横断面总体脂百分比、肝脏体积、血脂联素水平及HOMA-IR相关。

Objective：To study the risk factors for intrahepatic lipid accumulation in type 2 diabetic patients with central obesity. Methods：l H magnetic resonance spectroscopy was used to assess intrahepatic lipid content in drug naive type 2 diabetic patients with central obesity. Body adiposity and its distribution, metabolic feature and the serum adipocytokines were compared in subjects with different degree of intrahepatic lipid content. Results： There was no difference of simple parameters such as body weight, body mass indes （BMI）, waist circumstance, waist hip ratio （WHR） between the little-intrahepatic lipid group and marked intrahepatic lipid group , while significant difference was seen about intraabdominal fat markedly lower than those of little- intrahepatic lipid group （P = 0. 022）, but both groups had similar level of serum leptin and TNF-α. After adjusted for sex and age, analysis IHCL was closely related to intraabdominal fat area%, （r = 0.58）, liver volume（ r = 0.46）, serum adiponectin （r=0.43） and HOMA-IR （r= 0.62）, all P〈0.05. Conclusion：IHCL was closely related to intraabdominal fat area%, liver volume, serum adiponectin and HOMA-IR in type 2 diabetic patients with central obesity.