2型糖尿病合并非酒精性脂肪性肝病患者血浆脂肪细胞特异性脂肪酸结合蛋白水平的分析

Analysis of the Serum Level of Adipocyte-specific Fatty Acid-binding Protein in Type 2 Diabetic Patients Complicated with Non-alcoholic Fatty Liver Disease

目的研究2型糖尿病(type 2diabetes mellitus,T2DM)合并非酒精性脂肪性肝病(non-alcoholic fattyliver disease,NAFLD)患者血浆脂肪细胞特异性脂肪酸结合蛋白(adipocyte-specific fatty acid-binding protein,A-FABP)的水平及其相关因素。方法 2009年10月～2010年10月选取T2DM合并NAFLD组(A组)60例,未合并NAFLD组56例(B组)为研究对象。测定体质量指数(body mass index,BMI),检测血脂、糖化血红蛋白(hemoglobinA1c,HbA1c)等生化指标。放射免疫法测定空腹胰岛素(fasting insulin,FINS),空腹C肽水平(fasting C-peptide,FCP),计算胰岛素抵抗指数(homeostasis model of assessment-insulin resistance,HOMA-IR)、胰岛素敏感指数(insulin sensitivity index,ISI),测定A-FABP、C反应蛋白(C-reaction protein,CRP)及肿瘤坏死因子-α(tumor necrosisfactor-α,TNF-α)。结果与B组患者相比,A组患者其血浆A-FABP水平、BMI、腰围、腰臀比、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、CRP、TNF-α、FCP、FINS、总胆固醇、甘油三酯、Ln(HOMA-IR)升高,Ln(ISI)降低,差异有统计学意义(P<0.05);两组HbA1c差异无统计学意义(P>0.05)。A-FABP水平变化与TNF-α、HOMA-IR、CRP呈正相关,与ISI呈负相关。结论 T2DM伴NAFLD中,A-FABP升高与胰岛素抵抗是并存的,且存在明显相关关系,二者在疾病的发生发展中均可能具有重要的作用。

Objective To analyze the serum level of adipocyte-specific fatty acid-binding protein（A-FABP） in patients with type 2 diabetes mellitus（T2DM） complicated with non-alcoholic fatty liver disease（NAFLD）,and its related factors.Methods From October 2009 to October 2010,112 patients with T2DM were categorized into two groups： the group with NAFLD（group A） with 60 patients,and the group without NAFLD（group B） with 56 patients.Body mass index（BMI）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,and hemoglobin A1c（HbA1c） were detected.Radioimmunoassay was carried out to measure fasting insulin（FINS） and fasting C-peptide（FCP）,and homeostasis model of assessment-insulin resistance（HOMA-IR） and insulin sensitivity index（ISI） were calculated.At the same time,A-FABP,C-reaction protein（CRP） and tumor necrosis factor-α（TNF-α） were also detected.Results Compared with patients in group B,plasma levels of A-FABP,BMI,waistline,waist to hip ratio,ALT,AST,TG,TC,HDL-C,LDL-C,CRP,FCP,FINS,and HOMA-IR for patients in group A were all higher,while ISI was lower;and the differences in the above-mentioned parameters were statistically significant（P0.05）.The levels of HbA1c in the two groups were not significantly different（P0.05）.The change of A-FABP level was positively correlated with TNF-α,HOMA-IR and CRP,while it was negatively correlated with ISI.Conclusions In patients with T2DM with NAFLD,there is an obvious correlation between the coexisting A-FABP rise and insulin resistance.Both of them played critical roles in the onset and developing of the disease.