2型糖尿病合并非酒精性脂肪肝患者血清维生素D与肝脂肪含量的关系

Relationship between serum vitamin D and liver fat content in patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease

目的:探讨2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者血清维生素D[25-(OH)D3]与肝脂肪含量的关系。方法:137例T2DM合并NAFLD患者,根据患者25-(OH)D3水平将其分为4组,分别为A组(>75 nmol/L,n=40)、B组(>50且≤75 nmol/L,n=36)、C组(>25且≤50 nmol/L,n=31)及D组(≤25 nmol/L,n=30)。观察并比较治疗前后各组患者糖化血红蛋白(HbA1c)、血脂、SUA、肝功能、胰岛素抵抗指数(HOMA-IR)、超敏C反应蛋白(hs-CRP)、受控衰减参数(CAP)及肝脏硬度值(LSM)水平,并采用Spearman法分析25-(OH)D3水平与各临床指标相关性。结果:治疗前,各组患者HbA1c、TG、TC、LDL-C、SUA、ALB、ALT、HOMA-IR及hs-CRP水平相比,从低到高分别为A组、B组、C组及D组,HDL-C水平从低到高分别为D组、C组、B组及A组(P<0.05);治疗后,B组、C组及D组HDL-C水平均较治疗前高,其余指标均较治疗前低(P<0.05);各组患者CAP及SLM水平相比,从低到高依次为A组、B组、C组及D组(P<0.05);患者25-(OH)D3水平与HbA1c、TG、TC、LDL-C、SUA、ALB、ALT、HOMA-IR、hs-CRP、CAP及SLM水平呈负相关(P<0.05),与HDL-C水平呈正相关(P<0.05)。结论:T2DM合并NAFLD患者血清25-(OH)D3水平与肝脏脂肪含量密切相关,当患者缺乏25-(OH)D3时,可能造成患者血糖及血脂等控制不良,将促进患者肝脏脂肪堆积,并促进肝纤维化进展,同时将提高患者发生高尿酸血症风险,而给予25-(OH)D3治疗,将有利于改善患者各项临床指标。

Objective:To investigate the relationship between serum vitamin D [25-(OH)D3] and liver fat content in patients with type 2 diabetes mellitus(T2DM) complicated with nonalcoholic fatty liver disease(NAFLD).Methods:137 patients with T2DM and NAFLD were divided into 4 groups according to their 25-(OH)D3 levels, group A(>75 nmol/L,n=40),group B(>50 and ≤75 nmol/L,n=36),group C(>25 and ≤50 nmol/L,n=31) and group D(≤25 nmol/L,n=30).The glycated hemoglobin(HbA1c),blood lipid, SUA,liver function, insulin resistance index(HOMA-IR),high-sensitivity C-reactive protein(hs-CRP),controlled attenuation parameter(CAP) and liver hardness value(LSM) level were observed and compared in each group before and after treatment.The Spearman method was used to analyze the correlation between the level of 25-(OH)D3 and various clinical indicators.Results:Before treatment, compared with the levels of HbA1c, TG, TC, LDL-C,SUA,ALB,ALT,HOMA-IR and hs-CRP in each group, from low to high, they were group A,group B,group C and group D,respectively.HDL-C levels from low to high were group D,group C,group B and group A(P<0.05).After treatment, the levels of HDL-C in groups B,C and D were higher than those before treatment, and the other indexes were lower than those before treatment(P<0.05).Compared with the levels of CAP and SLM in each group, the order from low to high was group A,group B,group C and group D(P<0.05).The level of 25-(OH)D3 in patients was negatively correlated with the levels of HbA1c, TG, TC, LDL-C,SUA,ALB,ALT,HOMA-IR,hs-CRP,CAP and SLM(P<0.05),and positively correlated with the level of HDL-C(P<0.05).Conclusion:The level of serum 25-(OH)D3 in patients with T2DM combined with NAFLD is closely related to the content of liver fat.When the patient lacks 25-(OH)D3,it may lead to poor control of blood sugar and blood lipids, which will promote the accumulation of liver fat and promote liver fibrosis progresses, and at the same time will increase the risk of hyperuricemia in patients, 25-(OH)D3 treatment is beneficial to improve various clinical indicators of patients.