血浆sCD36与2型糖尿病非酒精性脂肪肝的关系

Relationship between Plasma s CD36 and Type 2 Diabetes Mellitus Combined with Nonalcoholic Fatty Liver Disease

目的研究血浆可溶性CD36(s CD36)与2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的关系。方法检测正常对照组(A组,39例)、T2DM未合并NAFLD组(B组,39例)和T2DM合并NAFLD组(C组,59例)患者的血浆s CD36水平,计算C组的肝脏脂肪含量(LFC)及NAFLD纤维化评分(NFS),测定上述3组糖脂代谢指标、肝功能指标及炎症指标。方差分析法比较上述指标在3组中的差异;相关分析法分析C组患者上述各项指标与s CD36的相关性;多元逐步回归法分析C组s CD36的影响因素。结果血浆s CD36(μg/L)水平在B组(3.87±1.16)、C组(5.72±1.79)均高于A组(2.57±0.93),且C组高于B组(均P<0.01);相关分析示C组的s CD36水平与体质量指数(BMI)、腰围、内脏脂肪面积、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、游离脂肪酸(FFA)、丙氨酸转氨酶(ALT)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、LFC、NFS呈正相关(均P<0.05),多元逐步回归分析示FFA、LFC、TNF-α、IL-6是s CD36的影响因素。结论血浆s CD36与脂肪肝严重程度、肝脏损伤以及脂肪性肝纤维化有关,可能成为T2DM合并NAFLD的血浆标志物,CD36可能通过炎症机制参与T2DM合并NAFLD的发生发展。

Objective To investigate the relationship between plasma soluble CD36（s CD36） and nonalcoholic fattyliver disease（NAFLD） in patients combined with type 2 diabetes mellitus（T2DM）. Methods Plasma levels of s CD36 weredetermined in normal control group（group A, n=39）, patients of T2 DM without NAFLD group（group B, n=39） and T2 DMwith NAFLD group（group C, n=59）. Liver fat content（LFC） and nonalcoholic fatty liver fibrosis score（NFS） were calculatedin group C. Glucose and lipid metabolic parameters, liver function parameters and inflammatory parameters were also detect-ed in all three groups. Variance analysis was applied to analyze the differences of the above parameters among three groups;Correlation analysis was used to analyze the relationship between s CD36 level and all the above parameters; Multiple stepwise regression analysis was applied to determine the influencing factors of s CD36 level in patients of group C. Results Plasma s CD36（μg/L） levels in group B（3.87±1.16） and group C（5.72±1.79） are higher than that of group A（2.57±0.93）（both P〈0.01）, and it is higher in group C than in group B（each P〈0.05）; Correlation analysis showed that s CD36 levelwas positively correlated with body mass index（BMI）, waist, visceral adipose tissue,fast insulin（FINS）, insulin resistance in-dex（HOMA-IR）, free fatty acid（FFA）, alanine transaminase（ALT）, tumor necrosis factor-α（TNF-α）, interleukin-6（IL-6）,LFC and NFS（P〈0.01 or P〈0.05）; Multiple stepwise regression analysis showed that FFA, LFC, TNF-αand IL-6 were in-fluencing factors of s CD36 level in patients of group C. Conclusion Plasma s CD36 level was related to fatty liver severity,liver injury and fatty liver fibrosis, it might be used as a plasma marker of T2 DM combined with NAFLD. CD36 might con-tribute to the development of T2 DM combined with NAFLD through inflammatory mechanisms.