2型糖尿病并非酒精性脂肪性肝病患者炎症反应及氧化应激水平与动脉硬化的关系

The correlation of inflammation and oxidative stress with atherosclerosis in patients of type 2 diabetes mellitus with nonalcoholic fatty liver disease

目的了解2型糖尿病合并非酒精性脂肪性肝病患者体内炎症反应、氧化应激水平及其与颈动脉内膜中层厚度（IMT）的相关性。方法选取2型糖尿病患者158例，按照是否合并非酒精性脂肪性肝病分为合并脂肪肝组（76例）和单纯糖尿病组（82例）。检测体重指数（BMI）、血压、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、血脂、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、白细胞介素（IL）-6、高敏C反应蛋白（hs—CRP）、8-异前列腺素F2d（8-iso—PGF20t）及颈动脉内膜中层厚度。结果合并脂肪肝组患者BMI、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）、丙氨酸氨基转移酶（ALT）、IL-6、8-iso—PGF2α、hs—CRP、胰岛素抵抗指数（HOMA—IR）及IMT水平高于单纯糖尿病组，而HDL—C则低于单纯糖尿病组（P〈0．05）。IMT与IL-6、8-iso—PGF2α、hs—CRP、HOMA—IR、LDL-C呈正相关（P〈0．01）。多元逐步回归分析显示，IL-6、8-iso-PGF2α、hs—CRP是颈动脉IMT的主要危险因素。结论非酒精性脂肪性肝病加重2型糖尿病患者炎症反应和氧化应激，炎症反应和氧化应激可能是动脉硬化的主要危险因素。

Objective To investigate the correlation of inflammation and oxidative stress with carotid artery intima-media thickness（IMT） in type-2 diabetes mellitus（type-2 DM） patients with nonalcoholic fatty liver disease（NAFLD）. Methods 185 patients with type-2 DM were divided into two groups, DM with NAFLD group（n =76） and DM without NAFLD group（n =82）. The levels of BMI,blood pressure ,fasting plasma glucose （FPG）, HbAlc ,fasting insulin（ FINS）, serum lipids, aminopherase, serum interleukin-6 （IL-6）, hs-CRP,8-iso-PGF2ct and carotid artery IMT were measured in all subjects. Results The levels of BMI, TG, TC, LDL-c, ALT, IL-6,8-iso-PGF2α, hs-CRP, insulin resistance index （ HOMA-IR ） and IMT in DM with NAFLD group were significantly higher than those in DM without NAFLD group（P 〈 . 05 ）, whereas the level of HDL-C was otherwise（ P 〈 0.05 ）. The carotid artery IMT was positively relat- ed with IL-6,8-iso-PGF2α, hs-CRP, HOMA-IR and LDL-C （ P 〈 0. 05 ）. A tstepwise muhiple linear regres- sion analysis showed that IL-6,8-iso-PGF2α and hs-CRP were major risk factors of carotid artery IMT. Conclusion NAFLD can increase the degree of inflammation and oxidative stress in patients with type-2 DM,which were major risk factors for atherosclerosis.