T2DM患者合并非酒精性脂肪肝与胰岛β细胞功能和胰岛素抵抗的关系

Relationship between Non-alcoholic Fatty Liver and Islet Beta-cell Function and Insulin Resistance in Patients with T2DM

目的分析T2DM患者合并非酒精性脂肪肝与胰岛β细胞功能和胰岛素抵抗的关系。方法选取确诊为T2DM并符合纳入标准的181例患者,根据B超检测有无脂肪肝影像将糖尿病患者分为非酒精性脂肪肝病变组(NAFLD)和无非酒精性脂肪肝病变组(无NAFLD),分别统计2组患者的BMI、血脂(TG、TC、HDL、LDL)、ALT、AST、Cr、CHE、尿素和UA的测定等临床资料,行胰岛素释放试验、C肽释放试验、OGTT葡萄糖耐量试验,计算胰岛素抵抗指数(HOMA-IR)、胰岛细胞敏感指数(HOMA-β)。比较各组不同指标之间的差异,分析2型糖尿病患者合并非酒精性脂肪肝与胰岛β细胞功能和胰岛素抵抗的关系。结果 NAFLD组HOMA-β指数明显下降(P<0.01),甘油三酯、尿素、肌酐均明显升高(P<0.05),HOMA-IR值升高(P<0.05);(3)Logistic回归分析结果显示,年龄、BMI、TG、ALT、CHE为糖尿病非酒精性脂肪肝病变的危险因素(P<0.05)。结论与NAFLD组相比,2型糖尿病并非酒精性脂肪肝组胰岛β细胞功能受损较严重,并存在一定脂代谢紊乱和胰岛素抵抗。

Objective To analyze the relationship between non-alcoholic fatty liver and islet beta-cellfunction and insulin resistance in T2DM patients.Methods We selected 181 patients who were diagnosed asT2DM and met the inclusion criteria. According to B-mode ultrasound imaging of fatty liver, diabetic patients weredivided into nonalcoholic fatty liver disease group （NAFLD） and non-alcoholic fatty liver disease group （noNAFLD ） . The clinical data of BMI,blood lipids（TG,TC,HDL,LDL ）,ALT,AST,Cr,CHE,urea,andUA were determined separately in the two groups,Insulin release test, C-peptide release test,OGTT glucosetolerance test,calculation of insulin resistance index（HOMA-IR）,islet cell sensitivity index（HOMA-β） .Thedifferences between different groups of indicators were compared to analyze the relationship between non-alcoholic fatty liver and islet beta-cell function and insulin resistance in patients with type 2 diabetes.ResultsHOMA-βindex decreased significantly in NAFLD group （ P〈0.01）, Triglyceride, urea, creatinine weresignificantly increased （ P〈 0.05）,HOMA-IR increased （0.01P〈 P〈 0.05） .Conclusion Compared with theNAFLD group, type 2 diabetes is not severely impaired in islet beta-cell function in alcoholic fatty liver disease,andthere is a certain lipid metabolism disorder and insulin resistance.