2型糖尿病合并代谢相关脂肪性肝病患者胆汁酸谱水平变化的研究

Changes in bile acid profile in patients with type 2 diabetes mellitus combined with metabolic associated fatty liver disease

目的探讨T2DM合并代谢相关脂肪性肝病(MAFLD)患者胆汁酸(BA)谱水平变化,分析BA谱成分与肝脏脂肪变性指数(HSI)的关系。方法对114例住院T2DM患者进行BA谱检测,根据HIS水平分为单纯T2DM组(T2DM)和T2DM合并MAFLD组(T2DM+MAFLD),比较两组BA谱的差异,分析HSI的影响因素。结果 T2DM+MAFLD组各初级BA及其结合物、总初级BA及总初级BA与总次级BA比例升高,次级BA中脱氧胆酸(DCA)升高,牛磺熊脱氧胆酸(TUDCA)降低(P<0.05)。Spearman相关分析显示,HSI与BMI、WC、丙氨转氨酶呈正相关(P<0.05),与年龄呈负相关(P<0.05)。Logistic回归分析显示,DCA、甘氨胆汁酸(GCA)和TUDCA是HSI的影响因素。结论 T2DM合并MAFLD患者BA谱成分发生变化,以初级BA为主,同时DCA、GCA增加及TUDCA减少与MAFLD发生相关。

Objective To explore the changes in bile acid(BA)profile in patients with type 2 Diabetes mellitus(T2 DM)combined with metabolic associated fatty liver disease(MAFLD),and to evaluate the relationship between BA components and hepatic steatosis index(HSI).Methods The detection of BA profile was performed in 114 hospitalized T2 DM patients. According to HSI,the patients were divided into T2 DM alone(T2 DM group)and T2 DM combined with MAFLD(T2 DM + MAFLD group). The differences in BA profile between groups were compared and the influencing factors of HSI were analyzed.Results There were significant increases in levels of primary BA profile and deoxycholic acid(DCA)in secondary BA,and significant decrease in taurodeoxycholic acid(TUDCA)level in T2 DM + MAFLD group compared with T2 DM group(P<0. 05). Spearman correlation analysis showed that HSI was positively correlated with body mass index(BMI),abdominal circumference(WC),and alanine aminotransferase(ALT),and negatively correlated with age(P<0. 05). Logistic regression analysis showed that DCA,glycocholic acid(GCA)and TUDCA were influencing factors for HIS.Conclusion There are obvious changes in BA profile in patients with T2 DM combined with MAFLD,especially in the primary BA. The increase in DCA and GCA and the decrease in TUDCA associate with the development of MAFLD.