成人隐匿性自身免疫性糖尿病患者非酒精性脂肪肝与代谢综合征的关系

The relationship between non-alcoholic fatty liver disease and metabolic syndrome in patients with latent autoimmune diabetes in adults

目的探讨成人隐匿性自身免疫性糖尿病（LADA）患者非酒精性脂肪肝（NAFLD）与代谢综合征的关系。方法选取2007年1月至2009年6月在上海交通大学附属第六人民医院内分泌代谢科住院的LADA患者共223例，剔除饮酒及临床资料不全的患者，最终有142例患者纳入本研究。依据超声结果将患者分为LADA伴NAFLD组（37例）及LADA不伴NAFLD组（105例）。收集临床资料，包括糖尿病病程、吸烟史、用药史、身高、体重、血压、血脂、血糖、C肽及肝肾功能等指标，比较两组间代谢综合征的患病率及代谢综合征组分，并分析NAFLD与代谢综合征间的关系。结果与LADA不伴NAFLD组相比，LADA伴NAFLD组患者年龄更大，校正年龄及性别后，LADA伴NAFLD组患者高血压患病率更高。体质指数[（26.5±3.7）kg/m2比（21.9±3.1）kg/m2]、腰臀比（0.92±0.06比0.86±0.07）、低密度脂蛋白胆固醇[（3.26±0.72）mmol/L比（2.70±0.87）mmol/L]及空腹C肽、餐后2 h C肽、收缩压、舒张压、丙氨酸转氨酶、三酰甘油、C反应蛋白在LADA伴NAFLD组更高（均P〈0.05）。但高密度脂蛋白胆固醇[（1.17±0.43）mmol/L比（1.35±0.40）mmol/L]及糖化血红蛋白[（8.83±2.14）%比（10.02±2.79）%]在LADA伴NAFLD组更低（均P〈0.05）。LADA伴NAFLD组患者代谢综合征患病率明显高于不伴NAFLD组（97.3%比47.6%，P〈0.001），且LADA伴NAFLD组含4个（32.4%比16.2%，P〈0.001）和5个（43.2%比5.7%，P〈0.001）代谢综合征组分的患者比例明显高于LADA不伴NAFLD组。校正多种混杂因素后，多因素logistic回归分析显示NAFLD是LADA患者发生代谢综合征的独立相关因素（P〈0.001）。结论LADA伴NAFLD患者有更加严重的代谢紊乱及更高的代谢综合征患病率，NAFLD是LADA患者发生代谢综合征的独立相关因素。

ObjectiveTo investigate the relationship between non-alcoholic fatty liver disease （NAFLD） and metabolic syndrome （MetS） in patients with latent autoimmune diabetes in adults （LADA）.MethodsA total of 223 hospitalized patients were recruited between January 2007 and June 2009 in Department of Endocrinology and Metabolism of the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University. Finally, 142 patients with complete clinical data and without history of drinking were included in this study. According to the Chinese Medical Association′s Guidelines of NAFLD, based on the result of ultrasound, all subjects were divided into two groups including patients with LADA and NAFLD （n=37） and patients with LADA but without NAFLD （n=105）. Clinical data including diabetes duration, history of smoking and medications, height, weight, blood pressure, blood lipids, blood glucose, C-peptide, and liver and kidney function were collected. The prevalence and components of MetS were compared between two groups. The association between MetS and NAFLD was also explored.ResultsAfter adjusting for age and sex, compared with the subjects without NAFLD, the subjects with NAFLD were older and had higher percentage of hypertension, and had higher body mass index[（26.5±3.7） kg/m2 vs （21.9±3.1） kg/m2], waist-hip ratio（0.92±0.06 vs 0.86±0.07）, low density lipoprotein cholesterol[（3.26±0.72） mmol/L vs （2.70±0.87） mmol/L], C-reactive protein, fasting C-peptide, 2 h postprandial C-peptide, systolic blood pressure, diastolic blood pressure, alanine aminotransferase and triglyceride （all P〈0.05）. But they had lower high-density lipoprotein cholesterol[（1.17±0.43） mmol/L vs （1.35±0.40） mmol/L]and HbA1c[（8.83±2.14） % vs （10.02±2.79）%]（both P〈0.05）. In addition, after adjusting for age and sex, compared with the patients with LADA but without NAFLD, the prevalence of MetS in the patients with LADA and NAFLD was obviously higher （97.3% vs 47.6%, P〈0.001）, and the proportion of the patients with four （32.4% vs 16.2%, P〈0.001） and five （43.2% vs 5.7%, P〈0.001） components of MetS in the patients with LADA and NAFLD was also significantly increased than that in the patients with LADA but without NAFLD. Binary regression analysis showed that NAFLD was an independent factor associated with MetS in the patients with LADA after correcting other confounding factors （P〈0.001）.ConclusionsCompared with the patients with LADA but without NAFLD, the prevalence of MetS was obviously higher, and had more serious metabolic disorder in the patients with LADA and NAFLD. The presence of NAFLD was an independent factor associated with MetS in the patients with LADA.