NAFLD合并T2DM患者糖化血红蛋白和甲状腺激素水平的变化及其临床意义

Changes of blood glycosylated hemoglobin and thyroid hormone levels in patients with NAFLD complicated by T2DM

目的探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者糖化血红蛋白(HbA1C)和甲状腺激素水平的变化及其临床意义。方法2017年4月~2019年3月我院内分泌科就诊的T2DM患者50例和NAFLD合并T2DM患者55例,检测人体学指标,采用电化学发光法检测空腹胰岛素(FINS)水平,采用胶体金法检测血糖化血红蛋白(HbA1C)水平,采用化学发光免疫分析法测定血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)和促甲状腺激素(TSH)水平。结果NAFLD合并T2DM患者体质指数(BMI)为(28.4±2.7)kg/m 2,显著大于T2DM患者[(24.0±2.4)kg/m 2,P<0.05],NAFLD合并T2DM患者腰围为(94.5±8.5)cm,显著大于T2DM患者[(84.0±7.6)cm,P<0.05],NAFLD合并T2DM患者臀围为(97.1±8.0)cm,显著大于T2DM患者[(89.7±7.2)cm,P<0.05];NAFLD合并T2DM患者血清谷丙转氨酶(ALT)水平为(79.5±7.6)U/L,显著高于T2DM患者[(42.3±4.3)U/L,P<0.05],NAFLD合并T2DM患者血清谷草转氨酶(AST)水平为(59.7±6.1)U/L,显著高于T2DM患者[(41.2±3.9)U/L,P<0.05],NAFLD合并T2DM患者血清谷氨酰转肽酶(GGT)水平为(105.8±9.4)U/L,显著高于T2DM患者[(60.9±6.5)U/L,P<0.05];NAFLD合并T2DM患者血甘油三酯(TG)水平为(4.2±1.7)mmol/L,显著高于T2DM患者[(2.4±0.9)mmol/L,P<0.05],NAFLD合并T2DM患者空腹血胰岛素(FINS)水平为(12.0±2.5)mU/L,显著大于T2DM患者[(9.1±1.8)mU/L,P<0.05];NAFLD合并T2DM患者血清TSH水平为(3.4±1.2)mU/L,显著大于T2DM患者[(1.9±0.8)mU/L,P<0.05],而两组FT3和FT4水平无显著性差异(P>0.05)。结论NAFLD合并T2DM患者BMI、肝功能指标、TG、FINS和TSH水平均显著增大或升高,与T2DM患者有明显的不同,在临床诊治过程中应当有所甄别,深入研究NAFLD患者发病机制对诊治将大有裨益。

Objective The aim of this study was to investigate the changes of blood glycosylated hemoglobin(HbA1C)and thyroid hormone levels in patients with nonalcoholic fatty liver disease(NAFLD)complicated by type 2 diabetes mellitus(T2DM).Methods 50 patients with T2DM and 55 patients with NAFLD complicated byT2DM were recruited in the Department of Endocrinology in our hospital between April 2017 and March 2019,and all patients underwent somatology,serum liver and kidney function tests,blood lipids,HbA1C,fasting insulin(FINS),free triiodothyronine(FT3),free tetraiodothyronine(FT4)and thyroid stimulating hormone(TSH)were assayed.Results The body mass index(BMI)in patients with NAFLD complicated byT2DM was(28.4±2.7)kg/m 2,significantly higher than[(24.0±2.4)kg/m 2,P<0.05]in patients with T2DM,the waist circumference in patients with NAFLD and T2DM was(94.5±8.5)cm,significantly higher than(84.0_7.6)cm,P<0.05)in patients with T2DM,and the hip circumference in patients with NAFLD complicated by T2DM was(97.1±8.0)cm,significantly higher than(89.7±7.2)cm,P<0.05)in T2DM patients;serum level of alanine aminotransferasein patients with NAFLD complicated by T2DM was(79.5±7.6)u/L,significantly higher than[(42.3±4.3)μ/L,P<0.05]in patients with T2DM,serum aspartate aminotransferase level in patients with NAFLD complicated by T2DM was(59.7±6.1)u/L,significantly higher than[(41.2±3.9)u/L,P<0.05]in patients with T2DM,and serum level of glutamyltranspeptidasein patients with NAFLD complicated byT2DM was(105.8±9.4)u/L,significantly higher than[(60.9±6.5)u/L,P<0.05]in patients with T2DM;blood triglyceride levelin patients with NAFLD complicated by T2DM was(4.2±1.7)mmol/L,significantly higher than[(2.4±0.9)mmol/L,P<0.05]in patients with T2DM,and blood level of fasting insulinin patients with NAFLD complicated by T2DM was(12.0±2.5)mU/L,significantly higher than[(9.1±1.8)mU/L,P<0.05]in patients with T2DM;serum level of thyroid stimulating hormone level in patients with NAFLD complicated byT2DM was(3.4±1.2)mU/L,significantly higher than[(1.9±0.8)mU/L,P<0.05]in patients with T2DM,while serum FT3 and FT4 levels in the two groups were not significantly different(P>0.05).Conclusion The BMI,serum liver function index,TG,FINS and TSH in patients with NAFLD complicated by T2DMchange greatly,significantly different as compared to in patients with T2DM,and clinicians should take these differences into consideration in clinical practice for early diagnosis and management.