老年2型糖尿病证型与肝脏脂肪浸润相关性研究

目的:研究老年2型糖尿病不同证型与肝脏脂肪浸润的相关性及预后。方法:选取确诊的老年2型糖尿病患者共64例,参照相关诊断分为痰瘀阻络型(31例)、脾肾两虚型(33例),取同期住院的非糖尿病患者41例作为对照组。记录其年龄、性别、血生化等一般资料,评估体重指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)、肝脾CT之比、非酒精性脂肪性肝病肝纤维化评分(NFS),并测量肝纤维化四项、踝肱指数(ABI),行上腹部CT。结果:1与对照组比较,糖尿病脾肾两虚型和痰瘀阻络型HOMA-IR值明显升高;脾肾两虚型HDL值、LN值、肝脾CT比值明显降低、超敏C反应蛋白及NFS值明显升高,差异具有统计学意义(P<0.05);2与痰瘀阻络型比较,脾肾两虚型HA、肝脾CT值之比明显降低、HOMA-IR、NFS值明显升高,差异具有统计学意义(P<0.05)。结论:老年2型糖尿病患者易出现肝脏脂肪浸润,其中脾肾两虚型患者易进展出现肝脏纤维化,预后较差。

Correlation Study between Syndromes and Liver Fatty Infiltration in Elderly Patients with Type 2 Diabetes

Objective:To investigate the relevance between syndromes and liver fatty infiltration in elderly patients with type 2 diabetes and its prognosis. Methods:Total 64 elderly patients with type 2 diabetes were selected and diagnosed as phlegm and blood stasis obstructing collateral type(31 patients) and spleen and kidney deficiency type(34 patients). In addition,41 non- diabetic patients at the same period were selected as the control group. The age,sex,blood biochemical and other general information of all the patients were recorded,body mass index(BMI),waist to hip ratio(WHR),insulin resistance index(HOMA- IR),liver and spleen CT ratio and nonalcoholic fatty liver fibrosis score(NFS) were evaluated,liver fiber examination and ankle brachial index(ABI) were measured and abdominal CT was undergone. Results : 1 Compared with the control group,HOMA- IR values increased significantly in the spleen and kidney deficiency type and phlegm and blood stasis obstructing collateral type. HDL value,value of LN,liver and spleen CT ratio decreased significantly in spleen and kidney deficiency type,high- sensitivity Creactive protein and NFS value increased significantly with statistical significance(P< 0.05). 2Compared with the phlegm and blood stasis obstructing collateral type,HA,liver and spleen CT value ratio decreased significantly,HOMA- IR,NFS values increased significantly in the spleen and kidney deficiency type with statistical significance(P< 0.05). Conclusion:Elderly patients with type 2 diabetes were prone to fatty infiltration of the liver,the patients of spleen and kidney deficiency type were more likely to progress into liver fibrosis with unfavorable prognosis.