2型糖尿病患者合并非酒精性脂肪肝与胰岛素抵抗的相关性

目的研究2型糖尿病合并非酒精性脂肪肝（NAFLD）患者的代谢特征、胰岛功能及胰岛素抵抗水平,并探讨其主要危险因素。方法根据肝脏B超结果,将113例2型糖尿病患者分为NAFLD组和非NAFLD组,比较两组之间的体质指数（BMI）、血脂、血糖、胰岛素、C肽、肝酶、尿酸、胰岛素抵抗、胰岛β细胞功能等指标,并采用Logistic回归分析2型糖尿病患者合并NAFLD的独立危险因素。结果 NAFLD组BMI、甘油三酯（TG）、空腹血糖（FBG）、餐后2h血糖（2hPG）、空腹胰岛素（FIns）和C肽（FCP）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、胰岛素抵抗指数（HOMA-IR）较非NAFLD组均显著升高,而年龄、高密度脂蛋白（HDL）则显著降低。Logistic回归显示年龄、BMI、TG、HOMA-IR与2型糖尿病患者合并NAFLD独立相关（OR=0.95,P=0.024;OR=1.24,P=0.024;OR=2.81,P=0.025;OR=11.96,P=0.001）,其中HOMA-IR是主要的危险因素。结论 2型糖尿病合并非酒精性脂肪肝患者存在更严重的肥胖倾向和代谢紊乱,而胰岛素抵抗是其主要危险因素。

Non-alcoholic fatty liver disease in patients with type 2 diabetes is closely associated with insulin resistance

Objective To investigate the metabolic characteristics,β-cell function and insulin resistance in type-2 diabetic individuals with non-alcoholic fatty liver disease（NAFLD）,and to reveal the main factors associated with NAFLD.Methods According to the results of ultrasonography detection of liver,a total of 113 type-2 diabetic subjects were divided into NAFLD group and non-NAFLD group.The differences of BMI,blood lipid,blood glucose,insulin,C-peptide,liver enzymes,uric acid,insulin resistance and islet β-cell function between the two groups were compared.Logistic regression analysis was used to analyze the factors independently associated with the presence of NAFLD.Results Compared with the diabetic patients without NAFLD,the patients with NAFLD hada higher level of BMI,triglyceride（TG）,fasting blood glucose（FBG）,2-hour blood glucose（2hPG）,fasting insulin（FIns）,fasting C peptide（FCP）,alanine transaminase（ALT）,aspartate aminotransferase（AST） and insulin resistance index（HOMA-IR）.However,the high density lipoprotein（HDL） was low.Logistic regression analysis showed that age,BMI,TG,HOMA-IR were independently associated with the presence of NAFLD in diabetic patients（OR=0.95,P=0.024;OR=1.24,P=0.024;OR=2.81,P=0.025;OR=11.96,P=0.001）,while HOMA-IR was the major risk factor.Conclusion Type-2 diabetic patients with NAFLD usually had serious obesity and metabolic disorder.Insulin resistance is the major risk factor.