老年2型糖尿病患者餐后2小时血糖与空腹血糖差值和非酒精性脂肪性肝病的相关性研究

Correlation of the difference between 2-hour postprandial blood glucose and fasting blood glucose with non-alcoholic fatty liver disease in elderly patients with type 2 diabetes

目的:探讨老年2型糖尿病(T2DM)患者餐后2 h血糖与空腹血糖差值和非酒精性脂肪性肝病(NAFLD)的相关性。方法:回顾性研究,入选2007年1月至2009年6月在上海交通大学附属第六人民医院内分泌代谢科住院、临床资料完整、年龄≥65岁的老年T2DM患者953例。取餐后2 h血糖与空腹血糖差值的绝对值记为血糖差值,根据血糖差值三分位数,将患者分为3组,分别为血糖差值(<4.12 mmol/L)第一分位组317例、血糖差值(4.12~7.69 mmol/L)第二分位组320例和血糖差值(≥7.69 mmol/L)第三分位组316例。收集患者详细临床资料,比较3组患者临床特征及NAFLD的患病率,分析血糖差值与NAFLD的相关性。结果:从血糖差值第一分位组至第三分位组,患者的二甲双胍服用比例(χ^2=9.581,P=0.008)、腰臀比(F=3.663,P=0.026)、24 h尿酸排泄(χ^2=6.241,P=0.044)、谷丙转氨酶(χ^2=22.361,P<0.001)、γ-谷氨酰转肽酶(χ^2=17.681,P<0.001)、餐后2 h血糖(χ^2=579.315,P<0.001)均呈现增高趋势,腰围(F=4.723,P=0.009)、体质指数(F=5.811,P=0.003)、空腹C肽水平(χ^2=9.442,P=0.009)、餐后2 h C肽水平(χ^2=17.599,P<0.001)、糖化血红蛋白(F=30.836,P<0.001)差异有统计学意义,NAFLD患病率也逐渐升高[24.0%(76例)比33.1%(107例)比36.7%(116例)(χ^2=12.712,P<0.01)];经多因素Logistic回归校正其他变量后,血糖差值与老年T2DM患者NAFLD发生相关(OR=1.396,Waldχ^2=0.002,P<0.01)。结论:餐后2 h血糖与空腹血糖差值较大的老年T2DM患者代谢紊乱更严重且NAFLD患病率更高;血糖差值增大是老年T2DM患者发生NAFLD的独立危险因素。

Objective To investigate the association of the difference between 2-hour postprandial blood glucose and fasting blood glucose with non-alcoholic fatty liver disease(NAFLD)in elderly patients with type 2 diabetes(T2DM).Methods A total of 953 patients aged≥65 years with T2DM hospitalized in the Department of Endocrinology and Metabolism,Shanghai Jiaotong University Affiliated Sixth People's Hospital from January 2007 to June 2009,with complete clinical data,were selected in this retrospective study.The absolute value of the difference between 2-hour postprandial blood glucose and fasting blood glucose was recorded as the blood glucose difference.According to the tertiles of the blood glucose difference,patients were divided into three groups including the first tertile(n=317,blood glucose difference<4.12 mmol/L),the second tertile(n=320,blood glucose difference between 4.12-7.69 mmol/L),and the third tertile(n=316,blood glucose difference≥7.69 mmol/L).Detailed clinical data of the patients were collected,and clinical characteristics and the prevalence of NAFLD were compared among the three groups.The correlation between the blood glucose difference and NAFLD was analyzed.Results From the first tertile to the third tertile,there appeared to be increased proportions of patients using metformin(χ^2=9.581,P=0.008),higher waist-to-hip ratios(F=3.663,P=0.026),increased 24 h uric acid excretion(χ^2=6.241,P=0.044),increased alanine aminotransferase levels(χ^2=22.361,P<0.001),increasedγ-glutamyl transpeptidase levels(χ^2=17.681,P<0.001)and increased 2h postprandial blood glucose levels(χ^2=579.315,P<0.001),with significant statistical differences in the waist circumference(F=4.723,P=0.009),body mass index(F=5.811,P=0.003),fasting C-peptide levels(χ^2=9.442,P=0.009),2h postprandial C-peptide levels(χ^2=17.599,P<0.001)and glycosylated hemoglobin A1c(F=30.836,P<0.001)between the three groups and the prevalence of NAFLD also grew steadily(24.0%,n=76 vs.33.1%,n=107 vs.36.7%,n=116,χ^2=12.712,P<0.01).After adjusting for other variables,multivariate logistic regression analysis showed that the blood glucose difference was correlated with NAFLD in elderly patients with T2DM(OR=1.396,Waldχ^2=0.002,P<0.01).Conclusions Elderly T2DM patients with greater blood glucose differences have more severe metabolic disorders and a higher prevalence of NAFLD.An increase in blood glucose differences is an independent risk factor for NAFLD in elderly T2DM patients.