2型糖尿病合并脂肪肝患者胰岛素抵抗和血脂水平分析

非酒精性脂肪肝（NAFLD）与酒精性肝病（ALD）相似，也可进展为肝硬化，甚至发展为肝细胞癌、肝功能衰竭，且与动脉粥样硬化性心脑血管事件关系密切。2型糖尿病（T2DM）是NAFLD最常见的原因之一。本文对T2DM合并脂肪肝患者胰岛素指标和血脂水平进行分析，为临床防治T2DM合并脂肪肝提供参考。     

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。     

2型糖尿病胰岛素抵抗、血脂紊乱与脂肪肝关系的研究

目的 探讨2型糖尿病（T2DM）胰岛素抵抗（IR）、血脂紊乱与脂肪肝的关系.方法 对T2DM并脂肪肝患者进行血脂水平、空腹血糖（FBG）及血浆胰岛素（FINS）的测定,计算胰岛素抵抗指数（IRI）、体重指数（BMI）,并与T2DM无脂肪肝患者作对照.结果 T2DM并脂肪肝组与无脂肪肝组相比较,BMI、甘油三酯（TG）、低密度脂蛋白（LDL）、FINS、IRI均升高（p<0.05）.结论 T2DM并脂肪肝患者存在明显脂代谢紊乱、胰岛素抵抗及超重.对T2DM尽可能防止高胰岛素血症,控制血糖,维持正常脂质代谢,减轻IR,对预防和减少T2DM脂肪肝的发生具有重要意义.     

利拉鲁肽应用于2型糖尿病合并非酒精性脂肪肝患者的疗效及安全性分析

目的 观察利拉鲁肽治疗2型糖尿病合并非酒精性脂肪肝患者的疗效和安全性.方法 随机选择40例符合诊断标准的2型糖尿病合并NAFLD患者,口服二甲双胍,每天2次,每次1g,疗程12周,同时给予利拉鲁肽,初始剂量0.6mg,1次/d,睡前皮下注射,疗程12周.第2周调整剂量为1.2 mg/d,第3周调整为1.8 mg/d,若不能耐受则维持0.6 mg/d,症状缓解再按上述原则加量.若为非初诊治疗的患者,在纳入前停服其他药物(二甲双胍除外).比较治疗前后体重、体质指数(BMI)、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c),以及肝功指标:谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT),脂代谢及其他指标:总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C),血尿酸(UA),同时观察用药期间有无不良反应.结果 患者体重、BMI、FPG、2hPG、HbA1c均较治疗前下降(P ＜0.05);ALT、AST、GGT及SUA均较治疗前下降(P＜0.05);治疗后血脂水平(低密度脂蛋白、甘油三酯、总胆固醇)较治疗前降低,差异有统计学意义(P＜0.05).治疗过程中无低血糖及其他严重的不良反应.结论 利拉鲁肽治疗2型糖尿病合并NAFLD患者,可有效安全降糖,改善肝功能,同时调脂并降低体重.     

2型糖尿病胰岛素抵抗、血脂紊乱与脂肪肝关系的研究

目的：探讨2型糖尿病（T2DM）胰岛素抵抗（IR）、血脂紊乱与脂肪肝的关系。方法：对T2DM并脂肪肝患者进行血脂水平、空腹血糖（FBG）及血浆胰岛素（FINS）的测定,计算胰岛素抵抗指数（IRI）、体重指数（BMI）,与与T2DM无脂肪肝患者作对照。结果T2DM并脂肪肝组与无脂肪肝组织比较。BMI、甘油三酯（TG）、低密度脂蛋白（LDL）、FINS、IRI均升高（P＜0．05）。结论T2DM并脂肪肝患者存在明显脂代谢乱、胰岛素抵抗及超重,对T2DM尽可能防止高脂岛素血症,控制血糖、维持正常脂质代谢,减轻IR,对预防和减少T2DM脂肪肝的发生具有重要意义。     

2型糖尿病合并非酒精性脂肪肝的危险因素研究

探讨2型糖尿病合并非酒精性脂肪肝的危险因素。方法 选择2017年1月~12月在我院住院的T2DM患者138例,根据是否合并NAFLD分为两组,合并NAFLD的86例患者设为观察组,52例单纯T2DM设为对照组。比较两组一般临床资料及生化指标,采用回归分析判定其中的独立相关的主要危险因素和（或）保护性因素。结果 两组患者BMI、收缩压、糖化血红蛋白、甘油三酯、高密度脂蛋白、低密度脂蛋白、尿酸、同型半胱氨酸、胰岛素抵抗指数等指标比较,差异有统计学意义（P≤0.05）;将上述有差异指标进行二元Logistic回归分析发现,BMI、TG、SUA、HbA1c、HOMA-IR与T2DM合并NAFLD呈正相关（OR＞1,P＜0.05）,HDL-C与T2DM合并NAFLD呈负相关（OR＜1,P≤0.05）。结论 T2DM合并NAFLD相当常见,BMI、HOMA-IR、HbA1c、TG、SUA是其危险因素,HDL-C 是其保护因素。胰岛素抵抗在并发NAFLD的T2DM者中更加明显。     

抵抗素与2型糖尿病患者胰岛素抵抗的关系

研究血清抵抗素与2型糖尿病(DM)患者胰岛素抵抗(IR)的关系。应用EIA测定72例2型DM患者(非肥胖2型DM组33例,肥胖2型DM组39例)及34名健康者(对照组)的空腹血清抵抗素水平。对照组、肥胖2型DM组及非肥胖2型DM组血清抵抗素水平分别为11.0±6.5μg/L、30.2±9.5μg/L及19.1±8.3μg/L,肥胖2型DM组和非肥胖2型DM组血清抵抗素水平均显著高于对照组(P均<0.001),肥胖2型DM组血清抵抗素水平显著高于非肥胖2型DM组(P<0.001),血清抵抗素水平与2型DM患者HOMAIR指数和程度呈显著正相关(P<0.001)。     

2型糖尿病胰岛素抵抗与阿尔茨海默病

2型糖尿病(type 2 diabetes mellitus,T2DM)是一种复杂而异质的代谢紊乱,可导致不同程度的胰岛素抵抗和B细胞功能障碍.胰岛素抵抗与认知功能障碍之间存在明确的联系,而认知功能障的终点为阿尔茨海默病(Alzheimer's disease,AD).因此,AD和T2DM之间的关键交叉点可能是胰岛素抵...     

2型糖尿病患者血尿酸水平与胰岛素抵抗的相关性分析

目的:回顾性分析2型糖尿病(T2DM)人群高尿酸(UA)血症患者血UA水平与胰岛素抵抗(IR)之间的关系。方法:收集2016-01—2018-05共1 273例住院T2DM患者病历资料,根据血UA水平分为正常UA组(NHG组,n=698)和高UA血症组(HG组,n=575),比较两组一般资料和血UA水平等指标的差异,分析高UA血症患者血UA水平等与稳态模型评估的胰岛抵抗指数(HOMA-IR)的相关性。结果:1 273例患者中高UA血症575例(占45.2%),与NHG组相比,HG组HOMA-IR、血UA、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、尿素氮(BUN)、肌酐(Cr)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、体重指数(BMI)和吸烟史均显著升高(P<0.05),高密度脂蛋白胆固醇(HDL-C)明显降低(P<0.05);而且UA、FBG、HbA1c、FINS、BUN、Cr、TC、LDL-C、BMI和吸烟史均与HOMA-IR水平呈明显正相关(P<0.05),与HDL-C呈负相关(P<0.05)。但经过增加变量BMI、LDL-C、HbA1c、FBG、FINS的多元Logistic回归分析显示,血UA与HOMA-IR并无明显相关性(P>0.05)。结论:高UA血症与IR呈正相关,但可能并不是IR的独立危险因素。     

脂肪肝与胰岛素抗性的关系

目的探讨脂肪肝与胰岛素抗性的关系。方法对30例诊断为脂肪肝患者作回顾性分析。结果多数患者合并胰岛素抗性综合征(高血压、肥胖症、糖尿病、高脂血症),18例接受口服葡萄糖耐量试验(OGTT)中,1例确诊为Ⅱ型糖尿病,17例患者中3例空腹血糖减损(IFG),1例糖耐量减退(IGT)及13例糖耐量正常(NGT)具有较正常人为高的血浆胰岛素(INS)浓度,胰岛素抗性脂数为8.91±1.52%。结论脂肪肝与胰岛素抗性所致的代谢紊乱关系紧密,呈正相关系。     

非酒精性脂肪性肝病在代谢综合征相关的2型糖尿病发病中的作用

目的: 探讨非酒精性脂肪性肝病(NAFLD)在代谢综合征(MS)相关Ⅱ型糖尿病中的作用。方法: 将64只大鼠随机分为8组,分别是3月正常对照组(3NC)、3月高糖高脂组(3H)、6月正常对照组(6NC)、6月高糖高脂组(6H)、9月正常对照组(9NC)、9月高糖高脂组(9H)、12月正常对照组(12NC)和12月高糖高脂组(12H)。测定血浆丙氨酸氨基转移酶(ALT)、游离脂肪酸(FFA)、内毒素(LPS)、肿瘤坏死因子α(TNFα)、C反应蛋白(CRP)、巨噬细胞趋化蛋白-1(MCP-1)、空腹血糖(FPG)、空腹胰岛素(FINS),并计算胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HOMA-β)。取肝组织和胰腺组织切片行苏木素-伊红(HE)染色和苏丹Ⅳ染色;内脏脂肪组织行苏木素-伊红(HE)染色。以TUNEL法检测胰岛内细胞凋亡水平。结果: 与正常对照组相比,各阶段高糖高脂组大鼠血清ALT、FFA、LPS、TNFα、CRP、MCP-1、FPG、FINS和HOMA-IR水平都明显升高;而HOMA-β在第6个月出现代偿性增强后进行性衰退。高糖高脂组第3-12月胰岛凋亡细胞数量逐渐增加。结论: NAFLD(特别是脂肪肝与脂肪性肝炎)可以诱发MS相关的2型糖尿病。     

Weight reduction improves markers of hepatic function and insulin resistance in type-2 diabetic patients with non-alcoholic fatty liver

Objective

The incidence of non-alcoholic fatty liver disease (NAFLD) is increasing dramatically affecting up to 30% of the population worldwide. At present, treatment options are limited and pharmacological management of NAFLD has had disappointing results. Some of the best available evidence to improve NAFLD concerns lifestyle modification.

Objective

To detect the degree of weight reduction needed to improve the markers of hepatic function and insulin resistance in type-2 diabetics with NAFLD.

Methods

One hundred type-2 diabetic male patients with NAFLD were included into this study and divided into two equal groups. Group (A) received aerobic exercise training in addition to diet regimen. Group (B) received no treatment intervention.

Results

There was a 26.99%, 40.8%, 33.81%, 32.73%, 37.8% and 15 % reduction in mean values of Alkaline Phosphatase (ALP), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma - Glutamyltransferase (GGT) and Homeostasis Model Assessment-Insulin Resistance-index (HOMA-IR) and BMI respectively in group (A) at the end of the study. While there were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment.

Conclusion

About 15 % reduction in BMI is effective to improve the liver condition and insulin resistance in type-2 diabetics with NAFLD.     

Prognostic value of high sensitivity C-reaction protein in non-insulin dependent diabetes mellitus patients with non-alcoholic fatty liver disease

Background and purpose: High sensitivity C-reaction protein (hsCRP) has been used as a significant predictive factor of cardiovascular events in patients with non-insulin dependent diabetes mellitus (NIDDM). However, existing reports in regards to the significance of hsCRP in predicting the progression of hepatic complications in NIDDM patients are too sparse to deliver clear results. This study is aimed at investigating the prognostic value of hsCRP in NIDDM patients with non-alcoholic fatty liver disease (NAFLD). Methods: 1128 NIDDM patients with a definite diagnosis of NAFLD were enrolled and followed for one year. The baseline body mass index (BMI), waist-hip circumference ratio (WHR), serum aspartate aminotransferase (AST), presence of hypertension, alanine aminotransferase (ALT), serum hsCRP, total cholesterol (Tch), fasting blood glucose (FBG), triglycerine (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and hepatitis B surface antigen (HBsAg) were recorded to analyze the significance of hsCRP in predicting the short-term progression from NAFLD to non-alcoholic steatohepatitis (NASH). Results: One year after baseline, 32% of the NAFLD patients suffered progression to NASH and the percentages of NASH were respectively 8.2%, 12.5%, 33.8% and 72.6% in 4 groups with quartered baseline serum level of hsCRP; there was significant difference among the 4 groups in percentage of NASH (P<0.001). With sex, age, WHR, BMI, hypertension, TG, TCH, HDL-C, LDL-C, FBG and HBsAg included, the calibrated regression model gave the OR values of 1.000, 1.669, 6.635 and 32.131 in in 4 quartered baseline serum levels of hsCRP. Conclusion: High serum level of hsCRP is an independent risk factor of short-term progression to NASH in patients with NIDDM and NAFLD. Those NIDDM patients with NAFLD that present with high serum level of hsCRP should be subjected to regular monitoring, lifestyle intervention and medication.     

Predictivity of fatty liver index for non-alcoholic fatty liver disease in lean females with polycystic ovary syndrome

BackgroundFatty liver index (FLI) is a simple tool used to predict non-alcoholic fatty liver disease (NAFLD). The role of FLI in polycystic ovary syndrome (PCOS) for the prediction of NAFLD has not been elucidated.MethodsThis case-control study was from January 2014 to January 2016. Anthropometric measurements, biochemical testing, and abdominal ultrasonography were performed in 83 premenopausal otherwise healthy women with PCOS and 58 controls. NAFLD was diagnosed by ultrasound. The predictivity of FLI for NAFLD in lean and overweight/obese females with PCOS was analyzed.ResultsThe γ-glutamyl transferase levels were significantly higher in the females with PCOS than in the controls (p = 0.001). In women with PCOS, FLI was significantly higher in females with NAFLD comparing to those without NAFLD (47.1 ± 33.6 vs. 16.9 ± 21.6; p = 0.001). For the PCOS group, Body Mass Index had the strongest relationship with FLI (p < 0.05, r = 0.908). FLI < 30 was calculated for all the lean females. The lean females with PCOS had a significantly higher rate of NAFLD (27.5% vs. 8.8%; p = 0.041) than lean controls.ConclusionAn FLI < 30 was not sufficient to rule out NAFLD in the lean PCOS patients.     

Central obesity,type 2 diabetes and insulin: exploring a pathway full of thorns

The prevalence of type 2 diabetes (T2D) is rapidly increasing. This is strongly related to the contemporary lifestyle changes that have resulted in increased rates of overweight individuals and obesity. Central (intra-abdominal) obesity is observed in the majority of patients with T2D. It is associated with insulin resistance, mainly at the level of skeletal muscle, adipose tissue and liver. The discovery of macrophage infiltration in the abdominal adipose tissue and the unbalanced production of adipocyte cytokines (adipokines) was an essential step towards novel research perspectives for a better understanding of the molecular mechanisms governing the development of insulin resistance. Furthermore, in an obese state, the increased cellular uptake of non-esterified fatty acids is exacerbated without any subsequent β-oxidation. This in turn contributes to the accumulation of intermediate lipid metabolites that cause defects in the insulin signaling pathway. This paper examines the possible cellular mechanisms that connect central obesity with defects in the insulin pathway. It discusses the discrepancies observed from studies organized in cell cultures, animal models and humans. Finally, it emphasizes the need for therapeutic strategies in order to achieve weight reduction in overweight and obese patients with T2D.     

Characteristics of type 2 diabetes in terms of insulin resistance in Korea

The aim of this study was to assess the implications of insulin resistance on the clinical and biochemical profiles of Korean type 2 diabetic patients. 122 patients with type 2 diabetes underwent a short insulin tolerance test to assess insulin resistance. Subjects were classified in tertiles according to ISI (insulin sensitivity index), and the tertile I (the insulin- resistant group) and tertile III (the insulin-sensitive group) clinical and biochemical parameters were compared. Age, waist circumference (WC), systolic blood pressure (SBP), HbA1c, body fat content, and fasting plasma glucose were significantly higher in tertile I than tertile III (all p < 0.05). The frequency of hypertension and family history of cerebrovascular disease (CVD) were greater in tertile I than III (p < 0.05). To evaluate the factors affecting ISI, multiple regression was performed, and age, WC, SBP, HbA1c, and body fat content were found to be independently related to insulin resistance (p < 0.05). Old age, hypertension, central obesity, and poor glycemic control were identified as clinical parameters of insulin resistance in Korean type 2 diabetic patients.     

锌alpha2糖蛋白与非酒精性脂肪性肝病

随着肥胖与代谢综合征在全球的流行,非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）已成为严重威胁人类健康的公共卫生问题。脂肪在肝脏过度蓄积是NAFLD的主要特点。了解调节肝脏三酰甘油（triglyceride, TG）合成所涉及的过程是预防和治疗NAFLD新视角。锌alpha2糖蛋白(Zinc alpha2 glycoprotein, ZAG)是一种能强烈促进脂肪分解、减少脂肪蓄积的新型脂肪细胞因子。ZAG可能在维持肝脏脂质代谢平衡中发挥重要作用。     

Non-alcoholic fatty liver disease: an emerging pathological spectrum

The spectrum of pathological lesions observed in non-alcoholic fatty liver disease (NAFLD) is wide and strongly resembles that of alcohol-induced liver disease. It ranges from fatty liver to steatohepatitis, progressive fibrosis and cirrhosis. Hepatocellular carcinoma is a possible complication of NAFLD, but whether it is related to frequently associated metabolic disorders (e.g., overweight, diabetes) or to underlying cirrhosis is unclear. This disease is the result of a multi-factorial process in which insulin resistance seems to play a major role in the initial accumulation of fat in the liver, whereas multiple causes of mitochondrial dysfunction and oxidative stress can induce the secondary occurrence of necroinflammatory lesions and fibrosis. Genetic factors might explain why only some patients with simple steatosis will develop steatohepatitis and fibrosis. Due to the increasing prevalence of obesity in Western countries, NAFLD will possibly be a public health problem and the liver disease of the future.