不同体重指数2型糖尿病合并非酒精性脂肪肝临床特征分析

Clinical characters of different body mass index in type 2 diabetes mellitus 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)临床特征及相关危险因素,分析不同体重指数(BMI)T2DM合并NAFLD患者代谢指标及肝酶差异。方法 1 422例T2DM患者的临床资料,按是否合并NAFLD分为不合并NAFLD组(A组,n=595)和合并NAFLD组(B组,n=827),分析比较两组临床特征。采用Logistic回归分析T2DM患者NAFLD的危险因素。同时将T2DM合并NAFLD患者827例按BMI分成体重正常组(n=224)、超重组(n=390)、肥胖组(n=213),分析三组间代谢特点及肝酶差异。结果 A、B两组年龄、病程、空腹血糖(FPG)、糖化白蛋白(GA/ALB)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、尿酸(SUA)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、BMI、收缩压及舒张压分别为(57.6±13.1)岁、8.0年、(9.5±3.5)mmol/L、25.9%、(4.7±1.0)mmol/L、(1.1±0.3)mmol/L、1.3 mmol/L、(296.0±85.0)μmol/L、22.0 U/L、20.0 U/L、(24.1±3.2)kg/m2、(133.0±17.0)mm Hg、(81.0±10.0)mm Hg和(54.3±12.1)岁、6.0年、(10.0±3.1)mmol/L、24.3%、(9.0±1.1)mmol/L、(1.0±0.3)mmol/L、2.1 mmol/L、(323.0±84.0)μmol/L、29.0 U/L、22.0 U/L、(26.1±3.5)kg/m2、(134.0±17.0)mm Hg、(83.0±10.0)mm Hg,比较差异均有统计学意义(P<0.05)。非条件多因素Logistic回归分析显示,校正年龄、性别、吸烟史和糖尿病病程等因素后,TG、HbA1c、BMI、DBP、SUA升高是T2DM合并NAFLD独立危险因素。T2DM合并NAFLD患者,随着BMI增高,年龄、病程、LDL-C、HbA1c、GA/ALB呈下降趋势,男性患者比例、SUA、ALT、AST、GGT和Hb呈增加趋势,差异有统计学意义(P<0.05)。结论在2型糖尿病合并NAFLD的患者中,BMI越低,糖脂代谢紊乱越严重,但其脂肪性肝炎程度较轻。与超重和肥胖者不同,BMI正常的2型糖尿病合并NAFLD患者女性比例偏高。

Objective To investigate clinical characters and risk factors of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2 DM).Methods According to whether the patients had NAFLD,1 422 patients with T2 DM consistent with the standard were divided into non-fatty liver group(group A,n=595)and fatty liver group(group B,n=827).The clinical characters of group A was compared to those of group B.The risk factors about NAFLD were analyzed by Logistic regression.According to body mass index(BMI),827 patients in group B were divided into normal group(n=224),overweight group(n=390)and obesity group(n=213).Metabolic characteristics and differences in liver enzyme levels were analyzed.Results The levels of age,duration of disease,fasting plasma glucose(FPG),glycated albumin,TC,high density lipoprotein cholesterol(HDL-C),serum triglyceride(TG),serum uric acid(SUA),alanine aminotransferase(ALT),aspartate aminotransferase(AST),BMI,systolic blood pressure(SBP)and diastolic blood pressure(DBP)showed statistically significant difference between group A[(57.6±13.1)years old,8.0 years,(9.5±3.5)mmol/L,25.9%,(4.7±1.0)mmol/L,(1.1±0.3)mmol/L,1.3 mmol/L,(296.0±85.0)μmol/L,22.0 U/L,20.0 U/L,(24.1±3.2)kg/m2,(133.0±17.0)mm Hg,(81.0±10.0)mm Hg and group B[(54.3±12.1)years old,6 years,(10.0±3.1)mmol/L,24.3%,(9.0±1.1)mmol/L,(1.0±0.3)mmol/L,2.1 mmol/L,(323.0±84.0)μmol/L,29.0 U/L,22.0 U/L,(26.1±3.5)kg/m2,(134.0±17.0)mm Hg,(83.0±10.0)mm Hg](P<0.05).Logistic regression analysis showed that TG,HbA1 c,BMI,DBP and SUA were the independent risk factors of NAFLD in T2 DM(P<0.05).With the increase of BMI,the age,duration of disease,LDL-C,HbA1 c and GA/ALB showed a downward trend.The proportion of male patients,SUA,ALT,AST,GGT and Hb increased(P<0.05).Conclusions In patients with type 2 diabetes complicated with NAFLD,the lower the BMI,the more severe the disorder of glycolipid metabolism was,but the degree of steatohepatitis was lighter.Unlike overweight and obese people,the proportion of women with type 2 diabetes and NAFLD with normal BMI was higher than men.