2型糖尿病病人合并非酒精性脂肪性肝病的危险因素分析

Analysis of the risk factors for NAFLD in patients with T2DM

目的:通过人体体成分分析、人体测量、胰岛功能检测及生化检查等多项综合营养评价手段对2型糖尿病(T2DM)病人合并非酒精性脂肪性肝病(NAFLD)的危险因素进行分析。方法:分析2017年1月至2018年10月江苏省常州市第一人民医院临床营养科进行营养评估的T2DM住院病人临床资料,按照有无合并NAFLD分为病例组(n=210)和对照组(n=157),同时进行年龄与身体质量指数(BMI)匹配,观察两组病人人体体成分分析、人体测量、胰岛功能检查及血生化指标。结果:经过年龄与BMI匹配的两组病人进行对比,T2DM合并NAFLD病人的空腹C肽、胰岛功能指数(Homa-IR)、胰岛素抵抗指数(Homa-islet)、血尿酸、ALT、AST、总胆红素、总蛋白水平及血白蛋白水平均显著增高(P<0.05)。在T2DM病人空腹C肽、相位角均是合并NAFLD的危险因素。而对男女病人中分别进行logistics回归:空腹C肽、总蛋白、相位角是男性T2DM病人合并NAFLD的危险因素;而空腹C肽及餐后2小时血糖(2hPG)则是女性T2DM病人合并NAFLD的危险因素。结论:在T2DM病人中,空腹C肽的升高是T2DM病人合并NAFLD的危险因素。与女性T2DM病人相比,人体体成分分析对于男性T2DM病人合并NAFLD的诊断以及监测意义可能更为重要。

Objective:The risk factors of non-alcoholic fatty liver disease(NAFLD)in type 2 diabetes mellitus(T2DM)patients were analyzed by the comprehensive nutritional assessments,including body composition analysis,anthropometry,islet function monitoring and blood biochemical examination.Methods:A total of 360 patients with T2DM were enrolled in the Clinical Nutrition Department of Changzhou First People's Hospital,between January 2017 and October 2018.The patients were divided into two groups:NAFLD group(n=210)and control group(n=150),according to the presence or absence of NAFLD.The body composition,anthropometry,islet function and blood biochemical indicators of the patients in both groups were examined.The multivariable logistic regression analysis was used to evaluate risk factors of NAFLD in the patients.Results:Fasting C-peptide,islet function index(Homa-IR),insulin resistance index(Homa-islet),and the serum levels of uric acid,ALT,AST,total bilirubin,total protein and albumin were markedly elevated in NAFLD group,comparing with those of the controls.Also,the level of serum albumin was significantly increased in NAFLD group.The logistic regression analysis showed that the risk factors of NAFLD in T2DM patients were fasting C-peptide and phase angle.In the male patients with T2DM,the risk factors of NAFLD included fasting C-peptide,totalprotein,and phase angle,and in the female patients,the risk factors were fasting C-peptide and 2-hour postprandial blood glucose levels.Conclusion:In patients with T2DM,elevated fasting C-peptide is a risk factor for NAFLD in patients with T2DM,both male and female.In male T2DM patients,body composition analysis may be more important for the diagnosis and monitoring of NAFLD.