2型糖尿病非酒精性脂肪肝与尿白蛋白排泄率和肾小球滤过率的关系

Relations of nonalcoholic fatty liver disease with urinary albumin excretion rate and glomerular filtration rate in patients with type 2 diabetes mellitus

目的:探讨2型糖尿病(T2DM)患者非酒精性脂肪肝(NAFLD)与尿白蛋白排泄率(UAER)和肾小球滤过率(eGFR)的关系,并分析UAER的相关影响因素。方法:224例T2DM患者根据是否合并NAFLD分为2组,观察组131例合并NAFLD,对照组93例不合并NAFLD,比较2组患者年龄、糖尿病病程、高血压患病率、收缩压、舒张压、体质量指数、糖化血红蛋白、空腹C肽、空腹胰岛素、胰岛素抵抗、肝功能、肾功能、血脂、血糖、果糖胺、eGFR、UAER之间的差异,然后将有显著性差异的因素作为自变量,将UAER作为因变量进行多元Logistic回归分析。结果:观察组的BMI、谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、三酰甘油、低密度脂蛋白、胱抑素C高于对照组(P<0.05),而年龄、病程、高密度脂蛋白低于对照组(P<0.05);糖尿病肾病早期阶段,合并NAFLD患者eGFR高于对照组(P<0.05);T2DM合并NAFLD的患者发生蛋白尿的可能性大,高体质量指数、高空腹血糖、NAFLD是T2DM患者UAER增加的独立危险因素。结论:NAFLD是T2DM患者UAER增加的独立危险因素,早期T2DM肾病合并NAFLD患者有较高的eGFR水平,因此早期诊断和干预NAFLD有可能会预防糖尿病肾病的发生发展。

Objective： To investigate the relations between nonalcoholic fat liver disease （NAFLD） and urinary albumin excretion rate （UAER） and glomerular filtration rate（eGFR） in patients with type 2 diabetes mellitus （T2DM）, and to analyze the influencing factors of UAER. Methods： 224 patients were divided into observation group （complicated with NAFLD, 131 cases） and control group （without NAFLD, 93 cases） . The age, duration of diabetes, morbidity of hypertension, SBP, DBP, BMI, HbA1 c, fasting C peptide, fasting insulin and insulin resistance （HOMA-IR） , liver function, renal function, blood lipids, blood glucose, fructosamine（FMN） , eGFR and UAER were compared between the two groups. Then Logistic regression analysis was performed with taking the factors with statistically significant differences as independent variables, and the UAER as dependent variable. Results： The BMI, ALT, AST, GGT, TG, LDL and Cystatin C of the observation group were significantly higher than those of the control group（ P 〈 0. 05 ） ; the age, duration of diabetes and HDL were significantly lower than those of the control group （ P 〈 0. 05 ） ; the eGFR of patients complicated with NAFLD was significantly higher than that of the control group during the early stage of diabetic nephropathy （P 〈 0. 05 ）; T2DM patients complicated with NAFLD had a higher probability of proteinuria;high BMI, high fasting glucose and NAFLD were independent risk factors for increased UAER in T2DM patients. Conclusion： NAFLD is an independent risk factor for increased UAER in T2DM patients. The early diagnosis and intervention of NAFLD may prevent the occurrence and development of diabetic nephropathy in T2DM patients.