BMI正常2型糖尿病合并非酒精性脂肪肝病影响因素分析

Analysis on influencing factors of type 2 diabetes mellitus with non-alcoholic fatty liver disease and normal body mass index

目的非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)与胰岛素抵抗和糖尿病有关,NAFLD的存在预示着糖尿病的发展。本研究旨在探讨体质量指数(body mass index,BMI)正常的2型糖尿病患者发生NAFLD的影响因素,并分析其与胰岛功能及脂代谢的关系。方法选取2016-10-01-2017-10-30于潍坊市人民医院内分泌科住院的BMI正常的2型糖尿病患者120例,其中53例单纯糖尿病患者作为对照组,67例合并NAFLD患者作为研究组。比较两组一般临床特征及胰岛功能。结果对照组与研究组收缩压分别为(117.91±15.03)和(127.77±29.18)mm Hg,差异有统计学意义,t=1.662,P=0.040。三酰甘油(triacylglycerol,TG)分别为(1.32±0.51)和(2.67±1.63)mmol/L,差异有统计学意义,t=-4.936,P<0.001,胰岛素β细胞功能指数(homeostasis model assessment ofβcell,HOMA-β)分别为1.30±0.49和2.53±0.29,差异有统计学意义,t=-1.811,P=0.030;C肽分泌指数(homeostasis model assessmentof C-peptide index,HOMA-C)分别为0.38±0.12和0.44±0.89,差异有统计学意义,t=-2.350,P=0.020。血尿酸(blood uric acid,UA)、谷氨酰转肽酶(glutamine transpeptidase,GGT)、胰岛素曲线下面积(area under the insulin curve,AUCi)和C肽曲线下面积(area under the C-peptide curve,AUCc)水平等也均明显升高,差异均有统计学意义,均P<0.05。Logistic回归分析显示,血TG(OR=2.132,95%CI为1.369～3.322,P=0.001)、高血压(OR=1.084,95%CI为1.044～1.126,P=0.001)、GGT(OR=1.067,95%CI为1.031～1.103,P<0.001)、低水平的高密度脂蛋白胆固醇(OR=0.470,95%CI为0.230～0.962,P=0.039)、HOMA-C(OR=1.116,95%CI为1.045～1.396,P=0.003)是BMI正常的2型糖尿病患者发生NAFLD的独立危险因素。结论 BMI正常的糖尿病患者中,合并NAFLD可导致血脂异常、血压升高和正常范围内使转氨酶升高,同时也导致胰岛素分泌量增多、胰岛素抵抗程度加重;BMI正常且合并NAFLD的患者肝酶升高,尽管多为正常范围内,但仍需引起重视。血脂异常、高血压和高胰岛素血症、胰岛素抵抗为BMI正常的2型糖尿病患者发生NAFLD的危险因素。

OBJECTIVE Non-alcoholic fatty liver disease(NAFLD)is associated with insulin resistance and diabetes.The presence of NAFLD predicts the development of diabetes.The aim of this study is to investigate the influencing factors of NAFLD in type 2 diabetic patients with normal body mass index(BMI)and to analyze its relationship with islet function and lipid metabolism.METHODS A total of 120 cases with type 2 diabetes mellitus admitted to our department were enrolled from October 2016 to October 2017.Among them,53 patients with simple diabetes were selected as the control group,and 67 patients with NAFLD were included as the study group.The general clinical features and islet function were compared between the two groups.RESULTS Comparing the two groups,the systolic blood pressure of control group and study group were 117.91±15.03 and 127.77±29.18,respectively,t=1.662,P=0.040,and triglyceride(TG)respectively were(1.32±0.51)and(2.67±1.63)mmol/L,t=-4.936,P<O.001.Homeostasis model assessment ofβcell(HOMA-β)were 1.30±0.49 in control group and 2.53±0.29 in study group,t=-1.811,P=0.030,and homeostasis model assessment of C-peptide(HOMA-C)were 0.38±0.12 and 0.44±0.89,respectively,t=-2.350,P=0.020.Compared with those in the control group,the blood uric acid(UA),glutamine transpeptidase(GGT),area under the insulin curve(AUCi),area under the C-peptide curve(AUCc)in study group all increased,and the differences were statistically significant,all P<0.05.Logistic regression analysis showed that blood TG(OR=2.132,95%CI:1.369-3.322,P=0.001),hypertension(OR=1.084,95%CI:1.044-1.126,P=0.001),GGT(OR=1.067,95%CI:1.031-1.103,P<0.001),low-level high-density lipoprotein cholesterol(OR=0.470,95%CI:0.230-0.962,P=0.039),and HOMA-C(OR=1.116,95%CI:1.045-1.396,P=0.003)were independent risk factors for NAFLD in type 2 diabetic patients with normal BMI.CONCLUSIONS In patients with normal BMI,NAFLD can lead to abnormal dyslipidemia,elevated blood pressure,elevated transaminase in the normal range,and increased insulin secretion and insulin resistance.The liver enzymes in patients with normal BMI and NAFLD are elevated.Although it is mostly within the normal range,it still needs attention.Dyslipidemia,hypertension,hyperinsulinemia,and insulin resistance are risk factors for NAFLD in type 2 diabetic patients with normal BMI.