新发2型糖尿病合并非酒精性脂肪性肝病与胰岛素抵抗的关系

目的研究新发2型糖尿病（type 2 diabetes mellitus,T2DM）合并非酒精性脂肪性肝病（nonalcoholic fattyliver disease,NAFLD）与胰岛素抵抗（insulin resistance,IR）的关系并明确其可能的危险因素。方法选择2010年11月～2011年4月我院就诊的新发T2DM患者共218例。根据有无NAFLD将患者分为两组,其中NALFD组140例,无NALFD组78例。收集患者体质量指数（body mass index,BMI）、空腹血糖、空腹C肽水平、糖化血红蛋白（glycosylated hemoglobin,HbA1c）、高密度脂蛋白胆固醇（high density lipoprotein cholesterin,HDL-C）、低密度脂蛋白胆固醇（low density lipoprotein,LDL-C）、三酰甘油（Triglycerides,TG）、谷草转氨酶（aspartate aminotrans-ferase,AST）、谷丙转氨酶（alanine aminotransferase,ALT）、γ-谷氨酰胺转肽酶（γ-glutamyl transferase,GGT）、总胆红素（total bilirubin,TBIL）和直接胆红素（direct bilirubin,DBIL）并计算稳态模型（homeostasis model,HOMA）,明确上述指标与IR之间的相互关系及T2DM合并NAFLD可能的危险因素。结果与无NALFD组患者比较,NALFD组患者BMI、HbA1c、AST、ALT、GGT、TG、LDL-C及HOMA2-IR等指标高于无NALFD组,差异有统计学意义（P〈0.05）;NALFD组患者HDL-C水平低于无NALFD组,差异有统计学意义（P〈0.05）。BMI、GGT、TG、HDL-C、LDL-C、HOMA2-IR为T2DM合并NAFLD的独立危险因素,差异有统计学意义（P〈0.05）。结论 IR与NAFLD关系密切并相互影响,治疗NAFLD要积极治疗IR,以改善预后。

Relationship between nonalcoholic fatty liver disease and insulin resistance in patients with onset type 2 diabetes mellitus

Objective To investigate the relationship between onset type 2 diabetes mellitus（DM） with nonalcoholic fatty liver disease（NAFLD） and insulin resistance（IR）,and to find out risk factors for NAFLD in patients with DM.Methods 218 DM patients from November 2010 to April 2011 in our hospital were enrolled and divided into two groups according to the complication of NAFLD with 140 cases in NALFD group and 78 cases in non-NALFD group.Body mass index（BMI）,fasting glucose and C peptide,glycosylated hemoglobin（HbA1c）,high density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,triglyceride（TG）,aspartate aminotransferase（AST）,alanine aminotransferase（ALT）,gamma-glutamyl transferase（GGT）,total bilirubin and direct bilirubin were collected and HOMA-IR were also calculated.The relationship between above indexs and IR,the risk factors for NAFLD in patients with DM were cleared.Results BMI,HbA1c,AST,ALT,GGT,TG,LDL-C,HOMA2-IR in NALFD group were higher than those in non-NALFD group,the differences were statistically significant（P 0.05）;the level of HDL-C was lower in NALFD group than those in non-NALFD group,the difference was statistically significant（P 0.05）.BMI,GGT,TG,HDL-C,LDL-C,HOMA2-IR were the risk factors of NAFLD in DM patients,the differences were statistically significant（P 0.05）.Conclusion IR maybe an independent factor to act on the process of NADLS.The NAFLD patients must to treat the IR to improve the prognosis.