新确诊2型糖尿病患者85例临床特点及相关危险因素分析

Analysis of clinical characteristics and risk factors in 85 newly diagnosed patients with type 2 diabetes mellitus

目的探讨新确诊2型糖尿病(type 2 diabetes mellitus,T2DM)患者临床特点,并分析该患者群中非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)、高尿酸血症、颈围、颈动脉内中膜厚度(carotid intima-media thicknesCIMT)间的相关性。方法收集并分析85例病程1年以内、新确诊即住院治疗的T2DM患者的临床资料,包括颈围、腰围、腰臀比和体质指数,空腹胰岛素、空腹C-肽、糖化血红蛋白、肝肾功能、血脂分型及尿微量白蛋白水平,肝脏和颈动脉超声等。结果 85例患者中,合并NAFLD、高尿酸血症和CIMT增厚者分别占57.6%(49/85)、16.5%(14/85)和29.4%(25/85)。88.2%(75/85)的患者合并2种及以上代谢异常,T2DM合并NAFLD组、高尿酸血症组及颈围增大组代谢异常数量均多于其他无相应病变组(P<0.05);各组间体质指数、颈围、腰围,丙氨酸转氨酶、三酰甘油水平的差异均有统计学意义(P均<0.05)。多因素非条件logistic回归分析显示,颈围、腰围、体质指数、丙氨酸转氨酶、空腹C-肽及血尿酸是NAFLD及CIMT增厚的共同危险因素。结论 T2DM确诊时绝大多数患者已有多种代谢异常;NAFLD、高尿酸血症、颈围增大及CIMT增厚不仅互为危险因素,而且颈围和血尿酸水平等是NAFLD和CIMT增厚的共同危险因素。

Objective To explore the clinical characteristics and risk factors of newly diagnosed type 2 diabetic mellitus （T2DM） patients and to investigate the correlations among nonalcoholic fatty liver disease （NAFLD）, hyperuricemia, neck circumference （NC） and carotid intima-media thickness （CIMT） in these patients. Methods The 85 patients were all within one year after diagnosis and they were hospitalized immediately after diagnosis. The clinical data including NC, waist circumference （WC）, waist-hip ratio （WHR）, and body mass index （BMI） were collected. The fasting insulin, fasting C-peptide, hemoglobin Ale, liver and renal function, phenotype of lipid and uric microalbumin were determined, and ultrasound examination of the liver and carotid artery was performed. Results The prevalence rates of NAFLD, hyperuricemia and increased CIMT were 57.6%（49/85）, 16. 5%（14/85） and 29. 4% （25/85）, respectively. Up to 88.2~ （75/85） of the patients had two or more metabolic abnormalities. Patients with NAFLD, hyperuricemia and increased NC had significantly more metabolic abnormalities compared with those without the corresponding conditions （P〈0.05）. The BMI, NC, WC, alanine aminotransferase （ALT）, and triglyceride （TG） were significantly different among different groups （all P〈0.05）. Multivariate unconditional logistic regression analysis showed that NC, WC, BMI, ALT, fasting C-peptide, and serum uric acid （SUA） were common risk factors of NAFLD and increased CIMT. Conclusion Most newly diagnosed T2DM are concomitant with a variety of metabolic abnormalities. NAFLD, hyperuricemia, increased NC and CIMT are risk factors to each other. NC and SUA are also the common risk factors of NAFLD and increased CIMT.