2型糖尿病并发非酒精性脂肪肝患者的临床特征及影响因素分析

目的分析并发非酒精性脂肪肝(NAFLD)的2型糖尿病(T2DM)患者的临床特征,探讨T2DM患者发生NAFLD的影响因素。方法选取T2DM患者167例,收集患者性别、年龄、糖尿病病程、身高、体质量等一般资料,采集空腹血糖(FPG)、TG、TC、LDL-C、HDL-C、糖化血红蛋白(HbA1c)、ALT、AST、空腹胰岛素、空腹-C肽(FCP)等实验室检查指标。于空腹状态下行腹部肝脏多普勒超声检查,根据检查结果诊断是否存在NAFLD。比较有、无并发NAFLD的T2DM患者的一般资料、实验室检查指标;比较不同HbA1c、TG、TC、BMI水平分层的T2DM患者的NAFLD发生率;分析T2DM患者并发NAFLD的相关危险因素。结果根据B超检查结果,分为单纯T2DM患者86例、T2DM并发NAFLD患者81例。T2DM并发NAFLD患者的HbA1c、TG、TC、BMI、ALT、FCP均高于单纯T2DM患者,糖尿病病程小于单纯T2DM患者(P均<0.05)。HbA1c>8.9%、TG>1.7 mmol/L、BMI>23.43 kg/m²的T2DM患者并发NAFLD的发生率较高(P均<0.05)。以是否并发NAFLD为因变量,临床指标为自变量进行logistic回归分析示,FCP(OR=0.737,P=0.009)、BMI(OR=0.786,P=0.003)、HbA1c(OR=0.996,P<0.001)是导致T2DM患者并发NAFLD的独立危险因素。结论血糖控制不佳、血脂水平较高、病程短的T2DM患者更易出现NAFLD。FCP、BMI、HbA1c是导致T2DM患者发生NAFLD的独立危险因素。建议对BMI超过23.43 kg/m²、高脂血症的T2DM人群进行肝脏彩超筛查,及时预防NAFLD发生。

Analyze the clinical characteristics and influencing factors of patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease

Objective To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)com?plicated with nonalcoholic fatty liver disease(NAFLD)and to explore the influencing factors of NAFLD in T2DM patients.Methods A total of 167 patients with T2DM were selected.The general data such as gender,age,course of diabetes,height and weight were collected.The laboratory indexes such as fasting blood glucose(FPG),triglyceride(TG),cholester?ol(TC),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C),glycosylated hemoglobin(HbA1c),alanine aminotransferase(ALT)and fasting C peptide(FCP)were collected.In the fasting state of abdominal liver Doppler ultra?sound examination,according to the results of diagnosis whether there is NAFLD.The general data and laboratory indexes of T2DM patients with and without NAFLD were compared;the incidence of NAFLD in T2DM patients with different levels of HbA1c,TG,TC and BMI was compared;the related risk factors of NAFLD in T2DM patients were analyzed.Results Ac?cording to the results of B-ultrasound examination,86 patients with simple T2DM and 81 patients with T2DM combined with NAFLD were divided.HbA1c,TG,TC,BMI,ALT and FCP of T2DM patients with NAFLD were higher than those of T2DM patients alone,and the duration of diabetes was shorter than that of T2DM patients alone(all P<0.05).The incidence of NAFLD was higher in T2DM patients with HbA1c>8.9%,TG>1.7 mmol/L and BMI>23.43 kg/m²(all P<0.05).Logistic regression analysis showed that:FCP(OR=0.737,P=0.009),BMI(OR=0.786,P=0.003),HbA1c(OR=0.996,P<0.001)were independent risk factors for NAFLD in T2DM patients.Conclusion Patients with poor blood glucose con?trol,low blood lipid level and short course of disease are more likely to have NAFLD.FCP,BMI and HbA1c are independent risk factors for NAFLD.It is suggested that T2DM patients with BMI over 23.43 kg/m² and hyperlipidemia,should be screened by color Doppler ultrasound to prevent NAFLD in time.