2型糖尿病患者发生脂肪肝的独立危险因素分析

目的 分析2型糖尿病患者发生脂肪肝的独立危险因素。方法 2型糖尿病伴脂肪肝患者163例,2型糖尿病非脂肪肝患者63例怍为对照组。对两组的相关变量进行logistic回归分析,并比较两组临床和肝功能等指标。结果 2型糖尿病脂肪肝组,肥胖和高脂血症患者的比例明显高于对照组。体重指数优势比(OR)为4.392与2型糖尿病脂肪肝呈正相关,胰岛素敏感性指数OR为0.000、规则使用胰岛素治疗OR为0.058与2型糖尿病脂肪肝呈负相关。2型糖尿病脂肪肝组天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、AST/ALT<1和γ-谷氨酰转移酶(GGT)的异常率分别为16.0％、25.2％、52.8％和31.9％,对照组分别为3.2％、6.4％、36.5％和11.1％,x~2值分别为6.833、10.075、4.807和10.181,P值均<0.05。结论 肥胖和胰岛素抵抗的2型糖尿病患者是脂肪肝的独立危险因素。2型糖尿病脂肪肝患者易发生血脂紊乱和肝功能损害。

Associated risk factors of fatty liver in the patients with type 2 diabetes mellitus

Objective To analyze the associated risk factors, clinical characteristics and laboratory abnormalities of type 2 diabetes patients with fatty liver. Methods The data of type 2 diabetes cases with fatty liver were collected in our hospital from 1998. 1 to 2002. 5. Sixty three cases of type 2 diabetes without fatty liver were selected randomly as control during the same period. The associated variables were analyzed by using logistic regression model. The clinical data and liver function were compared between two groups. Results The proportion of obesity and hyperlipidemia was higher in type 2 diabetes patients with fatty liver than without fatty liver. Body mass index(BMI) (OR: 4.392) was positive correlation to fatty liver in the patients with type 2 diabetes. In contrast, insulin sensitivity index (ISI) (OR: 0.000) and regular insulin treatment (OR: 0.058) were negative correlation to it. The abnormal frequencies of aspartate aminotransferase (AST, 16.0%), alanine aminotransferase (ALT, 25.2%), the ratio of AST/ALT less than 1(52.8%) and gamma-glutamyltransferase (GGT, 31.9%) of type 2 diabetes patients with fatty liver were significantly higher than those without fatty liver(3.2%, 6.4%, 36.5% and 11.1% respectively, P<0.05). Conclusions Obesity and insulin resistance might increase the risk of fatty liver in the patients with type 2 diabetes. Patients of type 2 diabetes with fatty liver show higher serum lipid level and more obvious damages of liver function than those without fatty liver.