2型糖尿病和非酒精性脂肪肝与脂肪细胞因子的相关性

Relationship of type 2 diabetes mellitus and nonalcoholic fatty liver disease with adipocytokines

目的研究2型糖尿病和非酒精性脂肪肝（NAFLD）与脂肪细胞因子的相关性。方法240例受试者分为正常对照组47例（A组）、非酒精性脂肪肝组53例（B组）、2型糖尿病组79例（C组）、2型糖尿病伴非酒精性脂肪肝组61例（D组），进行肝功、血脂、血糖、胰岛素水平、血尿酸、脂联素（APN）、肿瘤坏死因子（TNF-d）的测定以及腹部B超检查。结果B组体质量、体质量指数、腰围、血脂、胰岛素水平、胰岛素抵抗指数（HOMA．IR）、肝酶、血尿酸显著高于A组（P〈0．01）；B细胞功能评估显著低于A组（P〈0．01）；其空腹胰岛素水平、胆固醇、甘油三酯、血尿酸水平、丙氨酸转氨酶（ALT）、y-谷氨酰转移酶（GGT）高于C组（P〈0．01）。D组体质量、腰围、空腹胰岛素水平、甘油三酯、HOMA．IR、ALT、GGT显著高于C组（P〈0．01），其血压、HOMA．IR显著高于B组（P〈0．01）。B组，C组，D组与A组相比APN明显下降（P〈0．01），TNF-a明显升高（P〈0．01），D组与B组，C组相比ANP下降（P〈0．01），TNF-a上升（P〈0．01）。Logistic回归分析发现，甘油三酯、TNF．d为NAFLD的独立危险因素。Spearman相关分析显示，ANP与HOMA．IR、甘油三酯、腰围、TNF-a呈负相关，TNF-a与空腹胰岛素及HOMA．IR呈正相关，与ANP呈负相关。结论脂肪细胞因子参与2型糖尿病、NAFLD病理生理过程，恢复脂肪细胞因子的水平是非常有意义的。

Objective To investigate the association of type 2 diabetes mellitus （T2DM） and nonalcoholic fatty liver disease （NAFLD） with adipocytokines. Methods One hundred subjects from our medical examination center were included in the study. The control group comprised 47 subjects（group A） and the NAFLD group comprised 53 subjects （group B）. One hundred and forty inpatients with T2DM were divided into two groups according to the abdominal ultrasound. Seventy-nine patients had T2DM（group C） and 61 patients had T2DM and NAFLD （group D）. All the participants were subjected to measurement of liver function, lipids, blood glucose, insulin, C reactive protein （CRP）, uric acid, adiponecin（APN） and tumor necrosis factor-a （TNF-a）. Results The body mass, body mass index （BMI）, waist circumference, levels of lipids, insulin, HOMA-IR, transaminase and uric acid in group B were significantly higher than those in group A（P 〈 0.01）. β-cell function was significantly lower in group B than in group A（P 〈 0.01）. The levels of fasting insulin, cholesterol, triglycerides（TG）, uric acid, alanine aminotransferase （ALT） and y-glutamyltransferase （GGT） in group B were significantly higher than those in group C（P 〈 0.01）. The body mass, waist circumference, levels of fasting insulin, TG, HOMA-IR, ALT and GGT in group D were significantly higher than those in group C（P 〈 0.01）. The blood pressure and levels of HOMA-IR in group D were higher than those in group B（P 〈 0.01）. The APN levels in group B, C and D were significantly lower （P 〈 0.01）, and TNF-a levels were significantly higher than those in group A（P 〈 0.01）. The APN levels of group D were lower （P 〈 0.01）, and TNF-a levels were higher than those in group B and C （P 〈 0.01）. The logistic regression analysis showed that TG and TNF-a were independent risk factors for NAFLD. The APN was negatively associated with HOMA-IR, TG, waist circumference, TNF-a. And TNF-a was positively associated with fasting insulin, HOMA-IR, negatively associated with APN. Conclusions The adipocytokines probably play a role in the pathophysiology of T2DM and NAFLD, and the restoration of the adipocytokines has some clinical significance.