2型糖尿病患者合并非酒精性脂肪性肝病危险因素分析

Risk factors for non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

收集我院2007年1月至2008年4月内分泌科住院的2型糖尿病患者400例，男女各200例，经B超诊断为非酒精性脂肪性肝病（NAFLD）267例，无脂肪肝133例，比较两组问体重指数、腰臀比、空腹血糖、血脂、肝肾功能、超敏c反应蛋白（hsCRP）、尿微量白蛋白／肌酐（Alb／Cr）等指标，分析各因素与NAFLD的相关性。结果显示，男性NAFLD患者的年龄小于女性。NAFLD组体重指数（t=11．361，P=0．000）、腰围（t=9．771，P=0．000）、臀围（t=10．469，P=0．000）、甘油三酯（t=7．352，P=0．000）、hsCRP（t=2．242，P=0．026）均高于非NAFLD组，高密度脂蛋白显著低于非NAFLD组（t=-3．489，P=0．000）；中心性肥胖组hsCRP显著高于非中心性肥胖组（t=0．266，P=0．045）。体重指数、甘油三酯与NAFLD独立正相关；男性患者腰围与NAFLD的发病独立相关，女性患者臀围与NAFLD的发病独立相关。提示2型糖尿病患者中NAFLD的发病与性别、中心性肥胖、血脂等代谢综合征相关因素密切相关。

Two hundred male and 200 female patients with type 2 diabetes mellitus admitted from January 2007 to April 2008 were enrolled in the study. Of them, 267 were diagnosed as non-alcoholic fatty liver disease （NAFLD） by altrasonography. The measurements included：body mass index （BMI）, waist-tohip ratio （ WHR）, fasting blood glucose （FBG） , ALT, AST, total bilirubin （ TBIL）, cholesterol （ CHO ）, triglyceride（ TG）, high density lipoprotein cholesterol （ HDL-C ） , low density lipoprotein cholesterol （ LDL- C） , serum creatinine （Cr） , supersensitive C-reactive protein （ hsCRP ） and urine albumin/creatinine. The relationship of above factors with NAFLD was determined. Our data showed that male NAFLD patients were in general younger than female. The BMI （ t = 11,361, P = 0. 000 ） , waist circumference （ t = 9. 771, P = 0. 000） , hip circumference （t = 10. 469, P =0. 000） ,TG（t =7. 352, P =0. 000） and hsCRP （t =2. 242, P = 0. 026） of NAFLD patients were significantly higher than those without NAFLD. The hsCRP of patients with central obesity was also significantly higher than those without central obesity （ t = 0. 266, P = 0. 045 ）, BMI and TG were positively correlated with NAFLD. Waist circumference was an independent factor of NAFLD in male patients, same as hip circumference with NAFLD in female patients. In conclusion, gender, central obesity and dyslipidcmia may be risk factors for NAFLD in patients with type 2 diabetes mellitus.