2型糖尿病合并高甘油三酯血症-腰围表型与非酒精性脂肪性肝病的相关性研究

Association of Nonalcoholic Fatty Liver Disease with Hypertriglyceridaemic Wasit Phenotype Complicated with Type 2 Diabetes Mellitus

目的探讨2型糖尿病（T2DM）合并高甘油三酯血症-腰围表型（HTWC）与非酒精性脂肪性肝病（NAFLD）之间的关系。方法选取T2DM患者804例,以血三酰甘油≥1.7 mmol/L、腰围男性≥90 cm或女性≥85 cm为切点,分为三酰甘油和腰围正常组、单纯高甘油三酯血症组、单纯腹型肥胖组、HTWC组。记录4组患者的一般临床资料,计算体质指数（BMI）、稳态模型评估的胰岛素抵抗指数（HOMA-IR）和非酒精性脂肪肝纤维化指数（NAFLDFS）。结果 HTWC组患者平均BMI、收缩压、舒张压、HOMA-IR、丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶、血尿酸、NAFLDFS及NAFLD发病率均明显高于非HTWC组（均P〈0.01）。Logistic回归分析显示,除BMI、γ-谷氨酰转移酶、血尿酸外,HTWC也是T2DM患者合并NAFLD的危险因素（OR=1.986,95%CI：1.006~3.921）。结论 HTWC是T2DM合并NAFLD的危险因素,重视对HTWC表型者的早期筛查和诊断,使患者尽早获得干预,控制代谢紊乱,有助于减少NAFLD的发生和延缓疾病的进展。

Objective To investigate the association of nonalcoholic fatty liver disease with hypertriglyceridaemicwasit phenotype complicated with type 2 diabetes mellitus. Methods Base on whether plasma triglycerides concentration ≥1.7 mmol/L or not, waist circumference ≥90 cm or not in men or ≥85 cm or not in women, patients with type 2 diabe-tes mellitus（n=804） were divided into four groups： normal waist circumference with normal triglycerides, normal waist cir-cumference with hypertriglyceridemia, abdominal obesity with normal triglycerides and hypertriglyceridemic-waist pheno-type（HTWC）. The four groups＇ clinical data were recorded. Body mass index（BMI）, homeostasis model assessment insulinresistance（HOMA-IR） and nonalcoholic fatty liver disease fibrosis score（NAFLDFS） were calculated and the results werecompared among four groups. Results BMI, waist circumference, systolic blood pressure, diastolic blood pressure, HOMA-IR, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, serum uric acid,NAFLDFS and the inci-dence of NAFLD were all higher in the HTWC group compared to non-HTWC group（P〈0.01）. Logistic regression analysisrevealed that besides BMI,γ-glutamyltransferase and serum uric acid,HTWC was also a risk factor for NAFLD in patientswith type 2 diabetes mellitus（OR=1.986,95%CI：1.006-3.921）. Conclusion HTWC is a risk factor for NAFLD in patientswith type 2 diabetes mellitus. Screening and diagnosis of HTWC is helpful for reducing the occurrence of NAFLD and canslow its progress through controlling and interfering metabolic disturbance.