住院2型糖尿病患者肝脏疾病谱调查及非酒精性脂肪性肝病相关危险因素分析

Liver disease spectrum in hospitalized type 2 diabetes and related risk factors analysis of non-alcoholic fatty liver disease

目的应用肝酶、肝脏超声和肝脏质子核磁共振波谱（。HMRS）3种方法探讨住院2型糖尿病（T2DM）患者肝病构成谱及非酒精性脂肪性肝病（NAFLD）的危险因素。方法采集2009年9月至2011年10月复旦大学附属中山医院内分泌代谢科1069例住院T2DM患者的病史资料、生化指标、肝脏超声检查结果和肝脏1HMRS检查结果进行分析。结果（1）T2DM人群肝酶升高检出率28．7％（307／1069），其中39．4％（121／307）由NAFLD引起。排除酒精、肝炎病毒等其他因素后，T2DM人群中肝酶升高检出率26．9％（185／688）；（2）T2DM者超声诊断脂肪肝的检出率为56．7％（500／882），其中72．6％（363／500）由NAFLD引起，NAFLD的检出率达58．0％（363／626）；（3）T2DM者肝脏。HMRS诊断脂肪肝的检出率为72．8％（227／312），其中69．6％（158／227）为NAFLD；（4）T2DM患者中NAFLD的检出率肝脏。HMRS〉肝脏超声〉肝酶检测。以肝脏。HMRS为金标准，联合肝酶和肝脏超声诊断较单纯肝酶或肝脏超声诊断灵敏度增高，丙氨酸转氨酶（ALT）诊断NAFLD的最佳临界值男性为19．7U／L[受试者工作特征曲线曲线下面积（ROC。c）=0．689，P〈0．01]，女性17．0U／L（ROCacc=0．727，P〈0．01）；（5）Logistic逐步回归分析，性别、体质指数、血红蛋白、空腹C肽、尿酸均与NAFLD独立正相关（OR=3．803，1．195，1．037，2．896，1．011，均P〈0．05）。糖尿病病程与NAFLD独立负相关（OR=0．948，P〈0．05）。结论T2DM患者中脂肪肝检出率高，构成以NAFLD为主，且肝酶异常检出率高，提示合并T2DM的NAFLD患者更易发牛非酒精性脂肪性肝炎。

Objective To explore the liver disease spectrum in patients with type 2 diabetes （T2DM） and the risk factors of non-alcoholic fatty liver disease （NAFLD）. Methods From September 2009 to October 2011, 1069 hospitalized patients with T2DM in Department of Endocrinology and Metabolism were involved in the study. The history informations, results of laboratory examination, hepatic ultrasound and hepatic proton magnetic resonance spectnm （1H MRS ） of all patients were collected to analysis. Results （1）The detectable rate of raised liver enzymes in T2DM patients was 28.7% （307/ 1069）, composed mainly of NAFLD （39. 4%, 121/307）. After excluding the factors such as alcoholic abuse, viral hepatitis, the detect rate of raised liver enzymes in T2DM patients was 26. 9% （ 185/688 ）. （2） The detectable rate of fatty liver by ultrasound in T2DM patients was 56. 7% （500/882）, composed mainly of NAFLD （ 72. 6%, 363/500 ）, and the detectable rate of NAFLD was 58.0% （ 363/626 ）. （ 3 ） The detectable rate of fatty liver by hepatic 1H MRS was 72. 8% （227/312）, composed mainly of NAFLD （69. 6% ,158/227）. The detectable rate of NAFLD was 69.6% （158/227）. （4） Of the three methods for diagnosing NAFLD, 1H MRS had the highest detectable rate, followed by ultrasound, and the hepaticenzymes was the lowest. Set the hepatic ~ H MRS as gold diagnosing standrd of NAFLD, the combination of hepatic enzymes and ultrasound increase the sensitivity. The optional cut-off points of ALT were 19. 7 U/L （male, ROCAuc = 0. 689, P 〈 0. 01 ） and 17. 0 U/L （ female, ROCAuc = 0. 727, P 〈 0. 01 ）. （5） Logistic stepwise regression analysis showed sex, BMI, hemoglobin, fasting C-peptide and uric acid （OR-3. 803, 1. 195,1. 037,2. 896,1.011, all P 〈 0. 05 ） were positively correlated with NAFLD, and diabetes duration （ OR = 0. 948,P 〈 0. 05） was positively correlated with NAFLD independently. Conclusions The detectable rate of fatty liver was high in T2DM which was composed mainly of NAFLD. High abnormal liver enzymes detectable rate indicated that NAFLD with T2DM are prone to NASH.