新诊断2型糖尿病患者代谢指标与非酒精性脂肪性肝病的相关性

Association between metabolic imbalance and nonalcoholic fatty liver disease in newly diagnosed type 2 metabolism

目的探讨新诊断2型糖尿病（T2DM）患者代谢指标与非酒精性脂肪性肝病（NAFLD）的相关性。方法采用回顾性分析方法，纳入117例北京地坛医院内分泌科住院的新诊断2型糖尿病（T2DM）患者，根据有无NAFLD分为T2DM组57例和T2DM合并NAFLD组60例；所有患者均检测体质量指数（BMI）、腰围（WC）、肝肾功、血脂、糖化血红蛋白（HbAlc）、空腹血糖、空腹胰岛素及C肽等指标，并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）。结果T2DM患者NAFLD发生率为51％（即T2DM合并NAFLD患者60例），与2型糖尿病组比较，合并非NAFLD的T2DM组代谢指标明显增高[血甘油三酯（2．58±1．8）mmol／L与（1．22±0．4）mmol／L、空腹血糖（11．5±6．1）mmol／L与（9．2±4．3）mmol／L、血尿酸（465．3±65）umol／L与（325．3±72）umol／L；P值分别为0．03，0．03，0．02]；胰岛素抵抗更严重[（4．9±2．8）与（3．8±2．7）；P=0．03]；胰岛B细胞功能减退更明显[（49．2±27）与（29．5±18）；P=0．02]；肥胖症、高血压以及糖尿病酮症、糖尿病视网膜病变（DR）、糖尿病周围神经病变（DPN）的发生率也明显增高（P值均〈0．05）。Logistic回归分析显示，吸烟（OR=1．405，95％CI：1．262-1．567）、男性（OR=1．037，95％CI：1．015-1．063）、体质量指数（（OR=1．113，95％CI：1．278～2．531）、腰围（OR=1．624，95％CI：1．162～1．761）、甘油三脂（OR=1．823，95％CI：1．282-2．563）对NAFLD的发生均有显著影响（P均〈0．05）。结论合并NAFLD的新诊断T2DM患者有严重的代谢紊乱，且胰岛素抵抗更严重，胰岛β细胞功能减退更明显；NAFLD易发生于肥胖，特别是吸烟的T2DM男性患者。

Objective To explore the correlation of metabolic disorder of newly diagnosed type 2 metabolism（T2DM） and nonalcoholic fatty liver disease （NAFLD） . Methods A total of 117 patients with newly diagnosed T2DM in Beijing Ditan Hospital Affiliated to Capital Medical University from June 2014 to June 2015 were enrolled. Patients were divided into two groups：T2DM with NAFLD of 57 cases and T2DM without NAFLD of 60 cases. Body mass index （ BMI ） , waist circumference （ WC ） , liver and kidney function, serum lipid,glycosylated hemoglobin Alc （HbAlc） , fasting glucose, fasting insulin and C-peptide （FCP） were detected. The insulin resistance and β-cell function were assessed by homeostasis model assessment insulin resistance （HOMA-IR） and HOMA-β. Results The incidence of NAFLD in T2DM patients was 51% （ that was, 60 cases of T2DM patients with NAFLD） , compared with 2TDM group, the metabolic index of T2DM without NAFLD was significantly increased（ blood triglyceridc（TG） ： （ 2. 58± 1.8 ） mmol/1 vs. （ 1.22±0. 4） mmol/l, fasting blood glucose： （ 11.5 ±6. 1 ） mmol/1 vs. （ 9. 2 ±4. 3 ） mmol/l, serum uric acid ： （ 465. 3 ± 65 ） umol/1 vs. （325.3±72） umol/l;P = 0. 03,0. 03,0. 02） ; HOMA-IR was more serious （ （4. 9 ± 2. 8 ） vs. （ 3.8 ± 2. 7） ;P = 0. 03 ） ; insulin B-cell function was compensatory more obvious （ （ 49. 2 ± 27 ） vs. （ 29.5 ± 18 ） ; P =- 0. 02） ; prevalence rate of obesity, hypertension and diabetic ketoacidosis （DKD） , diabetic retinopathy （DR） , diabetic peripheral neuropathy（DPN） were significantly increased（P〈0.05） . Logistic regression analysis showed that, smoking（ OR= 1. 405,95% CI： 1. 262-1. 567）, male （ OR = 1. 037,95% CI： 1. 015-1. 063 ）, BMI （ OR = 1.113, 95%CI： 1. 278 - 2. 531 ）, WC （ OR = 1. 624, 95% CI： 1. 162- 1. 761 ） and TG （ OR = 1. 823,95% CI： 1. 282-2. 563） were risk factors of NAFLD （P 〈 0. 05 ） . Conclusion T2DM patients with NAFLD have severer insulin resistance than those without NAFLD. The β-cell function of those patients is compensatory increased. NAFLD prevalence rate significantly increase in patients with obesity, especially in male diabetic patients who smoking.