摘要
目的探讨2型糖尿病(T2DM)合并不同程度非酒精性脂肪性肝病(NAFLD)与血脂异常、肥胖和胰岛素抵抗的关系及其发病的危险因素。方法对268例2型糖尿病患者,根据肝脏B超结果分为无脂肪肝组、轻度脂肪肝组、中重度脂肪肝组。记录患者身高、体重、腰围、臀围,进行空腹血糖(FBG)、糖化血红蛋白(GHbA1c)、血总胆醇(TC)、高密度脂蛋白胆固醇(HDL—C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、丙氨酸氨基转移酶(ALT)、空腹胰岛素(FINS)测定,计算体重指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA—IR)。通过非条件Logistic回归进行NAFLD的危险因素分析。结果无脂肪肝组、轻度脂肪肝组、中重度脂肪肝组BMI分别为(24.25±5.37)、(25.98±4.63)、(27.69±4.35)kg/m^2,WC分别为(83.36±8.27)、(88.36±7.96)、(92.36±9.35)cm,WHR分别为1.01±0.32、1.12±0.27、1.19±0.34,FINS分别为(18.47±7.13)、(23.01±9.89)、(29.26±11.94)μU/L,HOMA—IR分别为4.25±2.37、7.37±3.20、9.48±4.13,TC分别为(4.92±1.25)、(5.43±1.30)、(5.60±1.04)mmol/L;LDL—C分另4为(2.91±0.90)、(3.32±0.83)、(3.57±0.73)mmo]/L,TG分别为(2.02±1.03)、(2.68±1.47)、(3.49±1.86)mmol/L,ALT分别为(26.35±14.48)、(30.68±13.54)、(37.58±16.79)U/L。与无脂肪肝组相比,轻度脂肪肝组及中重度脂肪肝组BMI、WC、WHR、FINS、HOMA—IR、TC、LDL—C、TG、ALT均较高(P均〈0.05)。中重度脂肪肝与轻度脂肪肝组相比,BMI、WC、WHR、FINS、HOMA—IR、TG、ALT明显升高(P均〈0.05)。TG、WHR、HOMA—IR是NAFLD的危险因素(OR值分别为2.394、3.273、5.256,P均〈0.05)。结论T2DM合并NAFLD患者存在明显的血脂紊乱、超重、中心性肥胖及胰岛素抵抗,TG、WHR、HOMA—IR是NAFLD发病的危险因素。
Objective To investigate the relationship between dyslipidemia, obesity, insulin resistance (IR) and various degrees of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM) ,and the risk factors of NAFLD. Methods Two hundred and sixty-eight patients were divided into three groups (non -NAFLD group, mild NAFLD group, moderate and severe NAFLD group) by liver ultrasonography. Body height (H),weight (W), waist circumference (WC), hip circumference (H) were measured. The levels of fasting blood glucose ( FBG), glycosylated hemoglobin AI c ( GHbA1C ), serum total cholesterol ( TC ), serum high density lipoprotein ( HDL-C ), serum low density lipoprotein ( LDL-C ), serum triglyeeride ( TG), alanine aminotransferase (ALT) and fasting serum insulin(FINS) were measured. Body mass index (BMI) ,the waist to hip ratio(WHR) and insulin resistance index(HOMA-IR) were calculated. Unconditional logistic regression model was used to test for the risk factors of NAFLD. Results BMI,WC,WHR,FINS,HOMA-IR,TC,LDL-C,TG and ALT in NAFLD group were significantly higher than those in non- NAFLD group (P 〈 0.05). The levels of BMI,WC,WHR,FINS,HOMA-IR, TG and ALT increased significantly in moderate and severe NAFLD group compared with mild NAFLD group (P 〈 0.05 ). TG,WHR and HOMA-IR were the risk factors of NAFLD (P 〈 0.05, OR = 2. 394,3. 273,5. 256) . Conclusions NAFLD in patients with T2DM had remarkable dyslipidemia, overweight, central obesity and insulin resistance. TG,WHR and HOMA-IR were risk factors of NAFLD.
出处
《中国综合临床》
2010年第1期27-29,共3页
Clinical Medicine of China