2型糖尿病并发非酒精性脂肪肝患者生化指标、胰岛功能和周围神经功能的临床研究

Clinical study on biochemical indexes,islet function and peripheral nerve function in type 2 diabetes mellitus patients with non-alcoholic fatty liver

目的研究2型糖尿病并发非酒精性脂肪肝患者生化指标、胰岛功能和周围神经功能。方法将102例非酒精性脂肪肝患者分为血糖正常组(空腹血糖<6.1mmol/L,餐后2h血糖<7.8 mmol/L)30例、糖耐量异常组(空腹血糖6.1～6.9mmol/L,餐后2h血糖7.8～11.0mmol/L)34例、2型糖尿病组(空腹血糖≥7.0 mmol/L,餐后2h血糖≥11.1 mmol/L)38例。观察3组生化指标[同型半胱氨酸、胱抑素C、硫氧还蛋白相互作用蛋白(thioredoxin interaction protein,TXNIP)]、胰岛功能[胰岛素抵抗指数、胰岛β细胞功能、早期相胰岛素分泌指数(△I30/△G30)、李氏β细胞功能指数],并用感觉神经检测系统检测患者2 000、250、5 Hz下左右正中神经、左右腓肠神经的电流感觉阈值。结果 2型糖尿病组、糖耐量异常组同型半胱氨酸、胱抑素C、TXNIP水平高于血糖正常组,2型糖尿病组高于糖耐量异常组(P<0.05)。2型糖尿病组、糖耐量异常组胰岛素抵抗指数高于血糖正常组,胰岛β细胞功能、△I30/△G30、李氏β细胞功能指数低于血糖正常组,2型糖尿病组胰岛素抵抗指数高于糖耐量异常组,胰岛β细胞功能、△I30/△G30、李氏β细胞功能指数低于低于糖耐量异常组(P<0.05)。糖耐量异常组、2型糖尿病组2 000、250、55Hz电流频率刺激下左右正中神经、左右腓肠神经电流感觉阈值均高于血糖正常组,2型糖尿病组高于糖耐量异常组(P<0.05)。250Hz和5Hz电流频率刺激下血糖正常组左右正中神经、左右腓肠神经电流感觉阈值低于2 000Hz,5Hz低于250Hz(P<0.05)。250Hz和5Hz电流频率刺激下糖耐量异常组左右正中神经、左右腓肠神经电流感觉阈值低于2 000Hz,5 Hz左右正中神经低于250 Hz(P<0.05)。250 Hz和5 Hz电流频率刺激下2型糖尿病组右腓肠神经低于2 000Hz,5Hz右正中神经低于2 000Hz(P<0.05)。结论非酒精性脂肪肝患者在糖耐量异常阶段已经发生胰岛功能受损,出现胰岛素抵抗,同时在相同频率下外周神经电流感觉阈值也呈增加趋势,提示血脂、血糖异常可能导致周围神经病变的发生发展,同型半胱氨酸、胱抑素C、TXNIP水平也随疾病进展而逐渐上升,可能参与了疾病的发生发展过程。

Objective To study the biochemical parameters,islet function and peripheral nerve function in type 2 diabetic patients with non-alcoholic fatty liver.Methods A total of 102 patients with non-alcoholic fatty liver disease were divided into four groups：normal blood glucose group（fasting blood glucose 〈6.1 mmol/L and postprandial blood glucose 〈7.8 mmol/L）,impaired glucose tolerance group（fasting blood glucose 6.1-6.9 mmol/2-hour postprandial blood glucose 7.8-11.0 mmol/L）,type 2 diabetic patients（fasting blood glucose ≥7.0 mmol/L,postprandial blood glucose≥11.1 mmol/L 2 h）.The biochemical indexes[homocysteine,cystatin C,thioredoxin interacting protein（TXNIP）],islet function[insulin resistance index,isletβcell function,early phase insulin secretion index（△I30/△G30）,Leeβ-cell function index]were observed.The sensory nerve detection system was used to detect patients at 2,000,250,5 Hz left and right median nerve,left and right sural nerve current sense threshold.Results The levels of homocysteine,cystatin C and TXNIP in patients with type 2 diabetes and impaired glucose tolerance were significantly higher than those with normal glucose levels and those with type 2 diabetes were significantly higher than those with impaired glucose tolerance（P〈0.05）.In type 2 diabetes mellitus group,the insulin resistance index of IGT group was higher than that of normal blood glucose group,the function of isletβcell,△I30/△G30,Leeβcell function index were lower than those of normal glucose group（P〈0.05）.The insulin resistance index of type 2 diabetes mellitus group was higher than those of impaired glucose tolerance group,the function of isletβcell,△I30/△G30,Leeβcell function index were lower than that of glucose tolerance group,the difference was statistically significant（P〈0.05）.The current sensory threshold of left and right median nerve and right and left sural nerve stimulated by different current frequency in type 2 diabetes mellitus patients were higher than those in normal glucose tolerance group and normal glucose group,and those in normal glucose tolerance group were higher than those in normal glucose group（P〈0.05）.In patients with normal blood glucose,the sensory thresholds at 2 000 Hz were higher than 250 Hz and 5 Hz at left median nerve,right median nerve,left sural nerve and right sural nerve at 250 Hz and above 5 Hz,respectively（all P〈0.05）.The sensory threshold of 2 000 Hz of the median nerve and left and right sural nerves in patients with impaired glucose tolerance was higher than 250 Hz and 5 Hz,and the median right and left nerves at 250 Hz and 5 Hz were significantly different（P〈0.05）The sensory threshold of sural nerve at 250 Hz was not significantly different from that at 5 Hz（P〈0.05）.The sensory threshold of 2 000 Hz current in the right median nerve of type 2 diabetes mellitus was higher than 5 Hz,the current sense threshold of 2 000 Hz right sural nerve was higher than250 Hz and 5 Hz,the difference was statistically significant（P〈0.05）There was no significant difference in sensory threshold of electrical stimulation at different frequencies（P〉0.05）.Conclusion Patients with alcoholic fatty liver have impaired pancreatic islet function and insulin resistance in the stage of impaired glucose tolerance,meanwhile,the sensation threshold of peripheral nerve current is also increased under the same frequency,suggesting that abnormal blood lipid and blood glucose may lead to the occurrence of peripheral neuropathy Development,homocysteine,cystatin C,TXNIP levels are also gradually increased with the progress of the disease,which may be involved in the development of the disease process.