2型糖尿病患者肝脏硬度与功能的相关性研究

Association between Liver Stiffness and Liver Function in Patients with Type 2 Diabetes Mellitus

目的探讨2型糖尿病(T2DM)患者肝脏硬度与肝脏功能及血流动力学的相关性。方法收集2020年4月~2020年12月在笔者医院内分泌科住院的T2DM患者共74例,根据肝功能情况分为肝功能正常组(A组)46例及肝功能异常组(B组)28例。另选同期健康对照组(C组)50例。收集各组肝功能血清学指标,同时应用声脉冲辐射力成像(ARFI)技术和彩色多普勒检测各组肝脏组织剪切波速度(SWV)、门静脉及肝固有动脉血流动力学参数,比较各组指标差异并分析相关性。结果B组患者谷氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)高于A组及C组(P<0.05);A组与B组患者的直接胆红素(DBIL)均高于C组(P<0.05);3组间间接胆红素(IBIL)两两比较,差异有统计学意义(P<0.05),B组高于A组,A组高于C组。肝脏SWV比较,B组高于A组及C组(P=0.00)。相关性分析显示,肝脏SWV值与ALT、AST、GGT、TBIL、DBIL、IBIL均呈正相关(P<0.05)。结论T2DM患者的肝脏硬度与肝脏功能相关性较高,与血流动力学无相关性,SWV可作为评价T2DM患者肝脏损害的有益补充。

Objective To explore the correlation between liver stiffness,liver function and hemodynamics in patients with type 2 diabetes mellitus(T2DM).Methods A total of 74 patients with T2DM who were hospitalized in the Department of Endocrinology of our hospital from April 2020 to December 2020 were enrolled,and were divided into two groups:normal liver function group(group A)46 cases;liver function abnormal group(group B)28 cases.Another 50 healthy cases during the same period were selected as control group(group C).The liver function in each group were collected and recorded.Meanwhile,the acoustic radiation force impulse imaging(ARFI)combined with color Doppler were used to measure the liver shear wave velocity(SWV),hemodynamic parameters related to portal vein and hepatic proper arterial.Above indicators were compared among groups and the correlation was analyzed.Results Alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(GGT)and total bilirubin(TBIL)in group B were higher than those in group A and C(P<0.05).The direct bilirubin(DBIL)of patients in group A and B were higher than that of group C(P<0.05).For indirect bilirubin(IBIL),there was a significant difference in pairwise comparison(P<0.05),group B was higher than group A,and group A was higher than group C.The liver SWV in group B was higher than that in group A and group C(P=0.00).Correlation analysis showed that the liver SWV was positively correlated with ALT,AST,GGT,TBIL,DBIL,IBIL(P<0.05).Conclusion There is a high correlation between liver stiffness and liver function in patients with T2DM,but no correlation with hemodynamics.SWV can be used as a useful supplement for evaluating liver damage in patients with T2DM.