初发2型糖尿病合并非酒精性脂肪肝与胰高血糖素和C肽的关系

目的：探讨初发2型糖尿病（Type 2 diabetes mellitus，T2DM）合并非酒精性脂肪肝病（non-alcoholic fatty liver disease，NAFLD）患者早期降糖治疗对血胰高血糖素、C肽的影响。方法：选取93例初发T2DM患者，依据肝B超结果分为T2DM组（n=46）和T2DM合并NAFLD组（n=47）。两组均采用胰岛素联合口服降糖药物治疗1周，于治疗前、后分别行馒头餐试验，检测各测定时间点血清胰高血糖素、C肽及血糖的水平。结果：与两组治疗前相比较，T2DM 合并NAFLD患者三酰甘油（P〈0.05）、体质量指数（P〈0.01）高于单纯2型糖尿病组；两组空腹及餐后胰高血糖素差异无统计学意义（P〉0.05）。与治疗前比较，T2DM 合并NAFLD组空腹及餐后胰高血糖素均有所下降，差异无统计学意义（均P〉0.05）；T2DM组于餐后30，60，180 min的血胰高血糖素较治疗前下降显著，差异有统计学意义（均P〈0.05）；两组治疗后餐后各测定时间点C肽较治疗前均显著升高，差异有统计学意义（均P〈0.01）。结论：T2DM患者早期降糖治疗可降低血胰高血糖素水平，T2DM合并NAFLD患者存在脂代谢紊乱及α细胞胰岛素抵抗。

Relationship of glucagon and C peptide with Type 2 diabetes combined with nonalcoholic fatty liver disease

Objective： To explore the effects of early hypoglycemic therapy on serum glucagon and C peptide in patients combined with Type 2 diabetes （T2DM） and non-alcoholic fatty liver disease （NAFLD）. Methods： A total of 93 newly diagnosed patients with T2DM were divided into two groups： a T2DM group （n=46） and a T2DM combined with NAFLD group （n=47）. These patients received insulin together with oral glucose-lowering drugs for one week, then underwent the steamed bread meal test before and after the treatment separately. The levels of serum glucagon, C peptide and blood glucose were measured both before and after the treatment. Results： Compared with the data in the 2 groups before the treatment, the triglyceride （P〈0.05） and body mass index （P〈0.01） in the T2DM combined with NAFLD group were higher than those in T2DM group; there was no significant statistical differences in the fasting and the postprandial glucagon between the 2 groups （P〉0.05）. Compared with the data before the treatment, the fasting and the postprandial glucagon tended to decrease in the T2MD combined with NAFLD group, but this decrease did not reach statistical significance （P〉0.05）; after the treatment, the glucagon in the T2MD group obviously decreased at the time point of 30, 60, and 180 min （P〈0.05）; After the treatment, the C peptide level of the 2 groups increased obviously, and the difference had statistical significance at each time point of the postprandial （all P〈0.01）. Conclusion： The early hypoglycemic therapy in T2MD patients can reduce the level of blood glucagon. There are alpha cell insulin resistance and disorder of lipid metabolism in the patients with T2MD combined with NAFLD.