2型糖尿病患者瞬时弹性成像检测肝脏脂肪变及纤维化程度与空腹C肽的关系

The relationship between fasting C-peptide levels and hepatic steatosis and liver stiffness measurement detected by transient elastography in patients with type 2 diabetes mellitus

目的探讨使用瞬时弹性成像技术检测2型糖尿病患者肝脏脂肪变及纤维化程度与血清C肽的关系。方法收集56例2型糖尿病患者临床资料,包括吸烟史、年龄、血压、身高、体质量、腰围、臀围、空腹血糖(FBG)、空腹C肽(F-CP)、餐后30 min血糖(30M-PBG)、餐后30 minC肽(30M-CP)、餐后2 h血糖(2H-PBG)、餐后2 h C肽(2H-CP)、糖化血红蛋白、糖化白蛋白、肾功能、肝功能及血脂等,完成瞬时弹性成像技术检测受控衰减参数(CAP)和肝脏硬度测量值(LSM)。按CAP分组:CAP <238 dB/m组为肝脏脂肪正常组(n=20),CAP≥238 dB/m为高肝脏脂肪变组(n=36)。比较两组间各指标差异,分析C肽水平分别与CAP及LSM的关系。结果肝脏脂肪正常组和高肝脏脂肪变组腰围、臀围、体质量指数、腰臀比、谷丙转氨酶、三酰甘油、脂蛋白a、脂蛋白a/b、F-CP、30M-CP及2H-CP差别有统计学意义(P <0.05)。与肝脏脂肪正常组相比,高肝脏脂肪变组有较高的F-CP、30M-CP、2H-CP水平及较高的胰岛素抵抗指数(P <0.05或P <0.01)。分析结果表明,CAP与F-CP、30M-CP及2H-CP等均呈正相关(P <0.05),在校正性别、糖尿病病程、年龄、身高、体质量、腰围及臀围后,CAP仍与F-CP呈正相关(P <0.05),而LSM分别与F-CP及30M-CP也呈正相关,但校正上述因素后,却无相关性。逻辑回归分析结果显示,F-CP水平升高为CAP升高的独立危险因素(P <0.05)。结论 2型糖尿病患者F-CP与CAP关系密切,F-CP可能是2型糖尿病患者肝脏脂肪变的独立危险因素,但与肝脏纤维化程度无关。

Objective To investigate the relationship between serum C-peptide levels and hepatic steatosis and liver stiffness measurement detected by transient elastography in patients with type 2 diabetes mellitus.Methods The study includes 56 patients with type 2 diabetes mellitus.The clinical data and laboratory examinations,including history of smoking,age,blood pressure,height,weight,waist circumference,hip circumference,fasting blood glucose(FBG),fasting C peptide(F-CP),30 min postprandial blood glucose(30 M-PBG)and C peptide(30 M-CP),2 h postprandial blood glucose(2 H-PBG)and 2 h postprandial C peptide(2 H-CP),glycated hemoglobin,glycated albumin,renal function,liver function,and blood lipid were collected or analyzed.Ultrasound-based transient elastography was performed in all subjects.Controlled attenuation parameter(CAP)and liver stiffness measurement(LSM)were obtained by FibroScan.According to CAP values,patients with type 2 diabetes were divided into two groups,including the normal group(CAP<238 dB/m,n=20)and high steatosis group(CAP≥238 dB/m,n=36).The clinical parameter was compared between two groups,and the relationship between serum C-peptide and CAP and LSM was analyzed.Results There were significant difference in weight,waist circumference,hip circumference,body mass index,waist hip ratio,glutamic-pyruvic transaminase,triglyceride,lipoprotein a,lipoprotein a/b,F-CP,30 M-CP,and 2 H-CP between two groups(P<0.05).Compared with the normal group,patients with hepatic steatosis had higher F-CP,30 M-CP,and 2 H-CP levels,and more severe insulin resistance(P<0.05 or P<0.01).CAP was positively correlated with F-CP,30 M-CP,and 2 H-CP(P<0.05).After adjusting for gender,diabetes duration,age,height,weight,waist circumference and hip circumference,there was still a positive correlation between F-CP and CAP(P<0.05).LSM was also positively correlated with F-CP and 30 M-CP.But after controlling the same confounding factors,there was no correlation between F-CP and LSM.The logistic regression analysis showed that the increased F-CP level was an independent risk factor for CAP(P<0.05).Conclusion F-CP is closely related to CAP in type 2 diabetes mellitus.F-CP may be an independent risk factor for hepatic steatosis in type 2 diabetes mellitus,but it was not a risk factor for the degree of liver fibrosis.