2型糖尿病合并非酒精性脂肪性肝病患者血清白脂素和脂联素水平的变化及意义

Changes and significance of serum asprosin and adiponectin levels in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease

目的观察2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清中白脂素及脂联素水平变化,探讨白脂素及脂联素在T2DM合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)中的作用。方法收集2020年4月至2020年10月就诊于山西医科大学第二医院内分泌科的T2DM患者86例,分为两组:单纯T2DM组40例(男26例,女14例),T2DM合并NAFLD组46例(男28例,女18例),另选健康体检人群20名(男12名,女8名)作为对照组。测定受试者空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,FIN)、C肽、糖化血红蛋白A1c型(glycosylated hemoglobin A1c,HbA1c)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)等一般生化指标,ELISA法测定血清白脂素及脂联素水平。结果与对照组比较,T2DM组患者FPG、收缩压、HbA1c、血清白脂素水平显著升高,HLD-C、血清脂联素水平显著降低(P<0.05)。与单纯T2DM组比较,T2DM合并NAFLD组患者年龄、FPG、BMI、LDL-C、收缩压、FIN、HOMA-IR、C肽、血清白脂素水平显著升高,病程更长,血清脂联素水平显著降低(P<0.05)。Spearman相关性分析结果显示,T2DM组血清白脂素水平与年龄、收缩压、FPG、HOMA-IR、病程呈显著正相关(P<0.05),与血清脂联素水平呈显著负相关(P<0.05);血清脂联素水平与C肽、血清白脂素呈显著负相关(P<0.05);T2DM合并NAFLD组血清白脂素水平与病程呈显著正相关(P<0.05),与血清脂联素呈显著负相关(P<0.05);血清脂联素水平与血清白脂素呈显著负相关(P<0.05)。Logistic回归分析结果显示,LDL-C、HOMA-IR、血清白脂素是发生T2DM合并NAFLD的独立危险因素。结论T2DM合并NAFLD患者血清白脂素水平升高,血清脂联素水平降低;血清白脂素与血清脂联素及HOMA-IR相关;LDL-C、HOMA-IR、血清白脂素是发生T2DM合并NAFLD的独立危险因素。

Objective To observe the changes of serum asprosin and adiponectin levels in patients with type 2 diabetes mellitus(T2 DM),and to investigate the role of asprosin and adiponectin in T2 DM patients with non-alcoholic fatty liver disease(NAFLD).Methods A total of 86 patients with T2 DM who were admitted to the Department of Endocrinology,the Second Hospital of Shanxi Medical University from Apr.2020 to Oct.2020 were divided into two groups:40 patients in the simple T2 DM group(26 males,14 females)and 46 patients in the T2 DM combined NAFLD group(28 males,18 females).Another 20 healthy subjects(12 males,8 females)were selected as the control group.Fasting plasma glucose(FPG),fasting insulin(FIN),C-peptide,glycosylated hemoglobin A1 c(HbA1 c),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and other general biochemical indexes were measured.ELISA was used to determine serum asprosin and adiponectin levels.Results Compared with control group,the levels of FPG,systolic blood pressure,HbA1 c and serum asprosin in T2 DM group were significantly increased,while the levels of HLD-C and serum adiponectin were significantly decreased(P<0.05).Compared with simple T2 DM group,age,FPG,BMI,LDL-C,systolic blood pressure,FIN,HOMA-IR,C-peptide,serum asprosin level in T2 DM combined NAFLD group were significantly increased,the disease course was longer,while serum adiponectin level was significantly decreased(P<0.05).Spearman correlation analysis showed that serum asprosin level in T2 DM group was significantly positively correlated with age,systolic blood pressure,FPG,HOMA-IR and course of disease(P<0.05),and significantly negatively correlated with adiponectin level(P<0.05).The level of serum adiponectin was significantly negatively correlated with C-peptide and serum asprosin(P<0.05).In the T2 DM combined NAFLD group,there was a significant positive correlation between serum asprosin level and course of disease(P<0.05),and a significant negative correlation between serum asprosin level and adiponectin level(P<0.05).There was a significant negative correlation between serum adiponectin level and serum asprosin(P<0.05).Logistic regression analysis showed that LDL-C,HOMA-IR and serum asprosin were independent risk factors for T2 DM complicated with NAFLD.Conclusion The level of serum asprosin is increased and the level of serum adiponectin is decreased in T2 DM patients with NAFLD.Serum asprosin is correlated with serum adiponectin and HOMA-IR.LDL-C,HOMA-IR and serum asprosin levels are independent risk factors for T2 DM complicated with NAFLD.