2型糖尿病合并非酒精性脂肪肝与糖尿病慢性并发症的相关性

Correlation between type 2 diabetes mellitus with non-alcoholic fatty liver disease and diabetes complications

目的研究2型糖尿病（T2DM）合并非酒精性脂肪肝（NAFLD）患者的临床特点，并探讨与糖尿病慢性并发症的关系。方法将255例T2DM患者按是否合并NAFLD分为合并NAFLD组（125例）和无NAFLD组（130例），收集两组患者的性别、年龄、身高、体重、病史等一般资料，血压、空腹血糖（FPG）、空腹胰岛素（FINS）、糖化血红蛋白（HbA1C）、肝功能、肾功能、血脂等检测指标数据，同时计算体质指数（BMI）和胰岛素抵抗指数（HOMA—IR），并进行相关分析。结果与无NAFLD组相比，合并NAFLD组年龄较小、糖尿病病程短、高密度脂蛋白胆固醇（HDL—C）水平低，差异均有统计学意义（P〈O．05）；BMI、FINS、餐后2h胰岛素、HbA。血尿酸（SUA）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、尿素氮（BUN）、甘油三酯（TG）、HOMA—IR均升高，大血管病变率增加，差异均有统计学意义（P〈0．05）。两组患者微血管病变和周围神经病变患病率差异无统计学意义（P〉O．05）。logistic回归分析显示，NAFLD是糖尿病患者发生大血管病变的危险因素（OR=2．603，95％CI：1．434～4．727）。结论T2DM合并NAFLD的患者易发生糖尿病大血管病变，应对该类患者及早进行干预治疗，预防或减少大血管病变发生的可能。

Objective To study the clinical features of type 2 diabetes mellitus （T2DM） patients with non-alcoholic fatty liver disease （NAFLD） and to explore the relationship between the clinical features and diabetes complications. Methods 255 T2DM patients were divided into DM＋NAFLD group （125 cases） and DM group （130 cases）. General information of gender, age, height, weight, medical history were collected. Blood pressure, fasting plasma glucose （FPG）, and 2-hour postprandial blood glucose （2 h PG）, glycosylated hemoglobin （HbAlc）, liver function, kidney function, blood lipids were measured. Body mass index （BMI） and homeostasis model assessment of insulin resistance （HOMA-IR） were calculated. Results As compared with DM group, the age was younger, DM duration was shorter and high-density lipoprotein cholesterol （HDL-C） level was lower in DM＋NAFLD group, there were significant differences （P〈O.05）; the levels of BM1, FINS, 2 h PG, HbAxc, serum uric acid （SUA）, alanine aminotransferase （ALT）, glutamyl transferase （GGT）, blood urea nitrogen （BUN）, triglycerides （TG）, HOMA-IR and the macrovascular disease rate increased significantly （P〈0.05）. There were no differences of microvascular disease rate and peripheral neuropathy rate between tow groups. The logistic regression analysis showed that NAFLD was a risk factor for diabetic macrovascular disease （OR= 2.603, 95%CI： 1.434-4.727）. Conclusion T2DM patients with NAFLD easily suffered from macrovascular disease and should be treated early to prevent from the macrovascular disease.