Ⅰ型原胶原氨基端前肽在2型糖尿病合并非酒精性脂肪肝病中的作用

The role of procollagen type Ⅰ proamino-terminal peptide in type 2 diabetes mellitus with non-alcoholic fatty liver disease

目的研究在2型糖尿病(T2DM)合并非酒精性脂肪肝病(NAFLD)患者体内血清Ⅰ型原胶原氨基端前肽(PINP)及25-羟维生素D〔25(OH)D〕的变化及其作用。方法选取T2DM患者84例,分为(T2DM)组42例、T2DM合并NAFLD组42例及健康对照组(NC组)45例,单纯NAFLD组40例。检测各组空腹血糖(FPG)、肝功能、血脂、糖化血红蛋白(HbA1c)、空腹胰岛素(FIns)、D〔25-(OH)D〕及血清PINP水平;计算胰岛素抵抗指数(HOMA-IR)。结果各组性别、年龄无显著差异(P>0.05);25-(OH)D水平在T2DM组及T2DM合并NAFLD组显著降低(P<0.05)。T2DM+NAFLD组PINP显著降低(P<0.05)。PINP与高密度脂蛋白胆固醇(HDL-C)、25-(OH)D呈显著正相关(r=0.247、0.253,P均<0.05),与体重指数(BMI)、腰臀比(WHR)、HbA1c、FPG、FIns、HOMA-IR、三酰甘油(TG)、总胆固醇(TC)呈显著负相关(r=-0.164、-0.296、-0.421、-0.394、-0.162、-0.413、-0.334、-0.231,P均<0.05)。多元线性逐步回归分析:FPG、HbA1c、TG、TC是PINP水平的独立影响因素。二分类Logistic回归分析显示:PINP、25-(OH)D是T2DM合并NAFLD的保护因素。结论血清PINP与T2DM合并NAFLD糖脂代谢密切相关,对其发生发展起保护作用。

Objective To investigate the changes and impact of serum typeⅠprocollagen amino terminal propeptide(PINP)and 25-hydroxyvitamin D〔25(OH)D〕levels in diabetes mellitus(DM)combined with nonalcoholic fatty liver disease(NAFLD).Methods A total of 84 patients with DM were enrolled,including 42 patients in DM group and 42 patients in DM+NAFLD group,40 cases in NAFLD group and 45 healthy subjects as normal controls(NC group).The levels of fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),fasting insulin(FIns),liver function,blood lipids,25-hydroxyvitamin D〔25-(OH)D〕were tested and PINP were tested,HOMA-IR was calculated.Results There were no significant differences in gender and age among groups(P>0.05).Compared with that of NC group,the level of 25-(OH)D was significantly lower in DM and DM+NAFLD groups(P<0.05).The level of PINP in DM+NAFLD group was significantly lower than that in NC,NAFLD and DM groups(P<0.05).The level of PINP was significantly positively correlated with HDL-C and 25-(OH)D(r=0.247,0.253;P<0.05 respectively),and significantly negative with BMI,WHR,HbA1c,FPG,HOMA-IR,TG,TC(r=-0.164,-0.296,-0.421,-0.394,-0.413,-0.334,-0.231;all P<0.05 respectively).Multiple linear stepwise regression analysis showed that FPG,HbA1c,TG and TC were independent factors influencing PINP levels.PINP and 25-(OH)D were protective factors for diabetes with NAFLD in Two-class logistic regression analysis.Conclusions Serum level of PINP is closely related to glycolipid metabolism,which has a protective effect on the development of DM combined with NAFLD.