2型糖尿病患者血皮质醇与非酒精性脂肪性肝病的相关性研究

Relationship between serum cortisol and non-alcoholic fatty liver disease in type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者血皮质醇与非酒精性脂肪性肝病(NAFLD)的关系.方法回顾性分析2018年9月~2019年6月于我科住院治疗的614例T2DM患者的临床资料,根据肝脏瞬时弹性成像结果将患者分为T2DM组(328例)及T2DM合并NAFLD组(286例),比较并分析患者的一般资料及实验室相关指标.结果T2DM合并NAFLD组患者的BMI、血压、胰岛素抵抗指数(HOMA-IR)、午夜0时皮质醇[F(0)]、ALT、AST、γ-谷氨酰转肽酶(γ-GT)及甘油三酯(TG)均明显高于T2DM组(P<0.05),而高密度脂蛋白胆固醇(HDL-C)、载脂蛋白(apo)A及糖尿病病程均明显低于T2DM组(P<0.01).Logistic回归分析结果显示,F(0)是T2DM合并NAFLD的独立危险因素(OR=1.006,P<0.001).F(0)最高三分位组(T3组)NAFLD患病率明显高于其余两组(P<0.05).F(0)联合BMI、ALT预测T2DM患者发生NAFLD的受试者工作特征(ROC)曲线下面积为0.758(95%CI 0.72~0.95).结论T2DM患者血F(0)与NAFLD密切相关,血F(0)升高是NAFLD的独立危险因素.

Objective To study the association between serum cortisol and nonalcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 614 T2DM inpatients in our department from September 2018 to June 2019 were selected and their clinical data were retrospectively analyzed.They were divided into T2DM+NAFLD group(n=286)and T2DM group(n=328)based on the measurement with liver transient elastography.Data of demographics tind laboratory measurements were compared and analyzed.Results Compared to the patients in T2DM group,subjects of T2DM+NAFIJD group had markedly higher BMI,blood pressure,insulin resistance index(HOMA-IR),midnight cortisol[F(0)],ALT,AST,γ-glutamyl transpeptadase(γ-GT),triglyceride(TG)levels(P V0.05),and lower high density lipoprotein cholesterol(HDL-C),apolipoprotein(apo)A and diabetes duration(P<0.01).Logistic regression analysis revealed that F(0)was an independent risk factor for NAFLD(OR=1.006,P<0.001).The prevalence of NAFLD in the highest F(0)tertile group(group T3)was significantly higher than those of other two groups(P<0.05).Area under receiver operating characteristic(ROC)curve of F(0)combined with BMI and ALT predicting NAFLD in patients with T2DM was 0.758(95%CI 0.72-0.95).Conclusion In T2DM patients,serum F(0)is inseparably associated with NAFLD.Increased serum F(0)is an independent risk factor for NAFLD.