非酒精性脂肪性肝病对糖尿病患者胰岛功能的影响

The impact of non-alcoholic fatty liver disease on islet function in type 2 diabetes

目的 评价非酒精性脂肪性肝病（NAFLD）对于糖尿病患者胰岛功能的影响.方法 采用回顾性分析方法,纳入213例天津医科大学代谢病医院2013年1-12月住院的2型糖尿病（T2DM）患者,根据有无NAFLD分为T2DM合并NAFLD组和单纯T2DM组;所有患者均检测ALT、AST、γ-谷氨酰转肽酶（γ-GT）、血脂、糖化血红蛋白（HbA1c）、果糖胺、空腹血糖、空腹胰岛素及糖负荷后2h血糖、胰岛素;采用稳态模型评估法计算胰岛素抵抗指数（HOMA-IR）和胰岛β细胞功能指数（HOMA-β）用于评价胰岛素抵抗和胰岛β细胞功能.结果 T2DM患者NAFLD发生率为51％（即T2DM合并NAFLD患者108例）;T2DM合并NAFLD组和单纯T2DM组血糖水平、HbA1c和果糖胺水平差异无统计学意义（P＞0.05）,T2DM合并NAFLD组HOMA-IR和HOMA-β明显高于单纯T2DM组[分别为4.76（2.83,7.21）比2.79（1.76,4.37）,P＜0.05和49.18（37.78,85.09）比29.50（18.09,45.54）,P＜0.05];T2DM合并NAFLD组中,肝功能正常组HOMA-IR、HOMA-β明显高于肝功能异常组[分别为6.28（2.87,8.17）比2.95（2.07,3.66）和59.18（37.78,85.09）比30.59（28.56,34.49）,P值均＜0.05].结论 T2DM患者合并NAFLD时,肝功能正常阶段,胰岛素抵抗较明显,胰岛β细胞功能代偿性升高;若肝功能发生异常,胰岛β细胞功能减退较明显.

Objective To analyze the influence of hepatosteatosis on pancreatic β-cell function in type 2 diabetes mellitus （T2DM）.Methods A total of 213 subjects with T2DM from Metabolic Disease Hospital,Tianjin Medical University from January 2013 to December 2013 were included in the study.Non-alcoholic fatty liver disease （NAFLD） was diagnosed with abdominal ultrasonography.Patients were divided into two groups：T2DM with NAFLD and T2DM without NAFLD.ALT,AST,γ-glutamyltransferase,serum lipid,glycosylated hemoglobin A1 c （HbA1c）,fructosamine,fasting glucose,insulin and 2 hours plasma glucose,insulin after 75g glucoseload were detected.The insulin resistance and β-cell function were assessed by HOMA-IR and HOMA-β.Results Among the 213 T2DM subjects,51% （108 cases） were with NAFLD.The HOMA-IR [4.76 （2.83,7.21） vs 2.79 （1.76,4.37）,P 〈 0.05] and HOMA-β [49.18 （37.78,85.09） vs 29.50 （18.09,45.54）,P 〈 0.05] were significantly higher in T2DM with NAFLD than those in T2DM alone.Within subjects with T2DM and NAFLD,the HOMA-IR [6.28 （2.87,8.17） vs 2.95 （2.07,3.66） P 〈 0.05] and HOMA-β [59.18 （37.78,85.09） vs 30.59 （28.56,34.49）,P 〈 0.05] levels were higher in subjects with normal liver function than those with abnormal liver function.Conclusions T2DM patients with NAFLD have severer insulin resistance than those without NAFLD.The β-cell function of those patients was compensatory increased,which was decreased in subjects with abnormal liver function.