2型糖尿病合并代谢相关脂肪性肝病患者的脂肪酸代谢谱研究

Fatty acids in type 2 diabetes patients with metabolic-dysfunction-associated fatty liver disease

目的探讨2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)患者的脂肪酸代谢谱特征。方法为回顾性研究,选取2018年10月至2019年12月就诊于大连医科大学附属第二医院内分泌科的患者作为研究对象。测量研究对象的身高、体重并计算体重指数(BMI),检测其空腹血糖(FPG)、空腹血胰岛素(FINS)并计算稳态模型评估胰岛素抵抗指数(HOMA-IR),检测其胰岛素样生长因子1(IGF-1)、甘油三酯(TG)、棕榈油酸、二十碳五烯酸、二十二碳六烯酸、花生四烯酸、亚油酸、总omega-3、总omega-6。依据肝脏超声检查及瞬时弹性成像技术检测结果将研究对象分为A组(单纯T2DM组)、B组(T2DM合并脂肪肝组)、C组(T2DM合并肝纤维化组)。采用单因素方差分析、Kruskal-Wallis H检验、χ^(2)检验进行组间比较,采用Spearman相关性分析法分析脂肪酸与各指标的相关性,采用二元logistic回归分析T2DM合并MAFLD的影响因素。结果共纳入T2DM患者426例。其中,A组165例,B组170例,C组91例。与A组比较,B、C 2组的BMI、HOMA-IR、TG、FINS、棕榈油酸均升高,IGF-1、二十碳五烯酸、二十二碳六烯酸、花生四烯酸、亚油酸、总omega-3、总omega-6均降低(P<0.05);与B组比较,C组的BMI、HOMA-IR均升高,IGF-1、亚油酸、总omega-6均降低(P<0.05)。Spearman相关性分析结果显示,棕榈油酸与BMI呈正相关(r=0.174,P<0.001),亚油酸(r=-0.121,P=0.012)、总omega-6(r=-0.108,P=0.026)与BMI均呈负相关;二十碳五烯酸与HOMA-IR呈负相关(r=-0.109,P=0.025)。二元logistic回归分析结果显示,BMI、TG、FINS、HOMA-IR、IGF-1为T2DM合并MAFLD的影响因素。结论T2DM合并MAFLD患者的omega-3和omega-6脂肪酸水平降低,其中,omega-3系列中以二十碳五烯酸和二十二碳六烯酸、omega-6系列中以亚油酸和花生四烯酸为代表。

Objective To investigate the fatty acid metabolism profile characteristics of patients with type 2 diabetes mellitus(T2DM)and metabolic associated fatty liver disease(MAFLD).Methods This was a retrospective study.All patients who visited the Department of Endocrinology of the Second Affiliated Hospital of Dalian Medical University from October 2018 to December 2019 were enrolled.Height and weight of the subjects were measured and body mass index(BMI)were calculated,fasting plasma glucose(FPG),fasting insulin(FINS)were measured,and homeostasis model assessment of insulin resistance(HOMA-IR)were calculated and their insulin-like growth factor 1(IGF-1),triglyceride(TG),palmitoleic acid,eicosapentaenoic acid,docosahexaenoic acid,arachidonic acid,linoleic acid,total omega-3,total omega-6 were measured.According to the results of liver ultrasound and transient elastography technology,the participants were divided into group A(T2DM alone),group B(T2DM combined with fatty liver group)and group C(T2DM combined with liver fibrosis group).One-way analysis of variance(ANOVA),Kruskal-Wallis H test andχ^(2) test were used to compare between groups,Spearman correlation analysis was used to analyze the correlation between fatty acids and various indices,and binary logistic regression was used to analyze the factors influencing T2DM combined with MAFLD.Results A total of 426 patients with T2DM were enrolled.There were 165 cases in group A,170 in group B,and 91 in group C.Compared with group A,BMI,HOMA-IR,TG,FINS and palmitoleic acid were all increased,and IGF-1,eicosapentaenoic acid,docosahexaenoic acid,arachidonic acid,linoleic acid,total omega-3 and total omega-6 were decreased in groups B and C(P<0.05).Compared with group B,BMI and HOMA-IR were increased in group C,and IGF-1,linoleic acid and total omega-6 were decreased(P<0.05).The results of Spearman correlation analysis showed that palmitoleic acid(r=0.174,P<0.001)was positively correlated with BMI,linoleic acid(r=-0.121,P=0.012),total omega-6(r=-0.108,P=0.026)and BMI were negatively correlated.Eicosapentaenoic acid(r=-0.109,P=0.025)was negatively correlated with HOMA-IR.The results of binary logistic regression analysis showed that BMI,TG,FINS,HOMA-IR,and IGF-1 were the influencing factors of T2DM combined with MAFLD.Conclusions Patients with T2DM and MAFLD had lower levels of omega-3 and omega-6 fatty acids,with eicosapentaenoic acid and docosahexaenoic acid representing the omega-3 series and linoleic acid and arachidonic acid representing the omega-6 series.