2型糖尿病伴非酒精性脂肪肝患者胰岛素抵抗与游离脂肪酸关系研究

目的：了解2型糖尿病伴非酒精性脂肪肝（NAFLD）患者胰岛素抵抗（IR）与游离脂肪酸（FFA）的关系。方法：2型糖尿病伴非酒精性脂肪肝患者39例、单纯2型糖尿病患者42例、单纯非酒精性脂肪肝患者40例、健康人群42例为研究对象。检测所有对象的FFA、胰岛素敏感性指数（ISI）以及总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）等指标。结果：2型糖尿病伴非酒精性脂肪肝组的FFA、ISI、TC、TG和LDL-C分别为（697．58±45．12）μmol／L，-4．99±0．12，（6．72±1．26）、（3．14±0．98）、（3．56±0．99）mmol／L；FFA、TC、TG、LDL-C等各项指标均以2型糖尿病伴非酒精性脂肪肝组高于其余各组（均P〈0．05）；ISI则以2型糖尿病伴非酒精性脂肪肝组低于其余各组（均P〈0．05）；将2型糖尿病伴非酒精性脂肪肝组的FFA与ISI、血脂3项指标作相关性分析。结果显示，FFA与ISI呈负相关（r=-0．773，P〈0．05），与TC、TG、LDL-C呈正相关（分别为r=-0．791，0．816，0．873，均P〈0．05）。结论：在2型糖尿病伴非酒精性脂肪肝中，FFA升高与IR是并存的，并且存在明显相关关系，二者在疾病的发生发展中均具有重要的作用。

Relationship between insulin resistance and free fatty acids in patients of type two diabetes mellitus with non-alcoholic fatty liver disease(NAFLD)

Objective： To explore the relaionship between insulin resistance（IR） and free fatty acids（FFA） in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease （NAFLD）.Methods：The patients of type 2 diabetes mellitus with NAFLD （39 cases）,type 2 diabetes alone （42 cases）, NAFLD alone （40 eases） were selected as case groups,while the healthy individuals（42 cases） were selected as control group.FFA,insulin-sensitivity index（ISI）,total cholesterol（TC）,low density lipoprotein-cholesterol （LDL-C） were tested for each subject.Results：The levels of FFA,ISI,TC,TG and LDL-C of type two diabetes mellitus CHD were （697.58±45.12）μmol/L,-4.99±0.12,（6.72±1.26） mmol/L,（3.14±0.98）mmol/L,（3.56±0.99） mmol/L,respectively.The levels of FFA,TC,TG,LDL-C of the type two diabetes mellitus companied with CHD group were higher than those of other three groups （P〈0.05）.However,ISI level of former group was lower than that of other three group （all P〈0.05）.According to the type 2 diabetes mellitus with NAFLD group,there existed negative correlation between FFA and ISI（r=-0.773,P〈0.05）,while there existed positive correlation between FFA and TC,TG,LSL-C（r=-0.791,0.816,0.873, all P〈0.05）.Conclusion：In patients of type 2 diabetes mellitus with NAFLD,there existed clear correlation between higher FFA and more IR.Both factors play a very important role in the development of the disease.