2型糖尿病患者非酒精性脂肪性肝病与动脉粥样硬化及危险因素的关系

目的观察2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者的肝脏超声分级与动脉粥样硬化及危险因素的关系。方法我科4个月内住院的142例2型糖尿病患者经彩色超声检查后分为三组：A组56例为不伴非酒精性脂肪性肝病,B组46例伴轻度非酒精性脂肪性肝病,C组40例伴中、重度非酒精性脂肪性肝病,分别测定三组患者的平均颈动脉IMT、胰岛素抵抗指数（HOMA—IR）、糖化血红蛋白（HbAIc）、血脂、体重指数（BMI）,并进行比较。结果三组患者ALT、BMI及HOMA—IR的均值间差别均有显著性意义（P〈0．05）;与不伴非酒精性脂肪性肝病患者相比,非酒精性脂肪性肝病患者颈动脉内膜中层厚度增加更明显（各组P〈0．05）,颈动脉内膜的厚度与NAFLD的分级增加呈正相关。而三组患者TG、TC、LDL—C、HDL—C和HbA1C同差别无显著性差异（P〉0．05）。结论2型糖尿病（T2DM）合并非酒精性脂肪性肝病患者胰岛素抵抗增强,颈动脉内膜中层厚度（IMT）增加,发生动脉粥样硬化的风险增加。

Relations between atherosclerosis and nonalcoholic fatty liver disease in Type 2 diabetes subjects

Objective To evaluate whether NAFLD is associated with atherosclerosis and its risk factors in type 2 diabetic subjects. Methods Total 142 T2DM patients were examined by color Doppler sonography, and they were divided into group A （56 subjects without NAFLD）, group B （46 subjects with mild NAFLD）, group C （40 subjects with moderate-severe NAFLD）. Carotid IMT were measured by ultrosonography in all subjects, their HbAlc, plasma lipids and insulin resistance index （HOMA-IR） were also measured and analyzed. Results There were significant differences in ALT, BMI and HOMA-IR in three groups （P 〈0.05）. The difference in carotid IMT between the control group with- out NAFLD,the mild group and the moderate-severe group was significant （P 〈 0.05）. Moreover, carotid IMT was positively associated with degree of hepatic steatosis. However, there was no significant difference in TG,TC,LDL-C,HDL-C and HbAlc in the three groups （P〈0.05）. Conclusions Increased Carotid IMT and IR is observed among T2DM subjects with NAFLD, and the risk of developing atherosclerosis is increased.