非酒精性脂肪肝和2型糖尿病与颈动脉病变的关系

目的探讨非酒精性脂肪肝(NAFLD)和2型糖尿病(T2DM)与颈动脉病变的关系。方法按是否有T2DM和NAFLD分为4组:对照组、NAFLD组、T2DM组、T2DM合并NAFLD组,观察各组临床及生化特征、颈动脉内-中膜厚度(IMT)以及超声分型,并对出现的颈动脉斑块形态、特点和颈动脉斑块积分进行分析。结果 T2DM合并NAFLD组的HOMA胰岛素抵抗指数高于其他三组;单纯T2DM组和NAFLD组HOMA-IR、TC、TG、LDL-C和BMI高于对照组,HDL-C低于对照组。T2DM合并NAFLD组IMT与其他三组比较,差异显著(P<0.05);T2DM组、NAFLD组IMT也大于对照组(P<0.05)。颈动脉硬化超声分型各组之间构成比的比较有差异。T2DM合并NAFLD组不稳定斑块形成高于T2DM组、NAFLD组,颈动脉斑块积分也较T2DM组、NAFLD组增多。结论NAFLD、T2DM与胰岛素抵抗、血脂异常、肥胖密切相关,易引起动脉粥样硬化,T2DM合并NAFLD与动脉粥样硬化斑块不稳定性和斑块发生程度之间有一定关联。     

Relationship between non-alcoholic fatty liver disease and pulmonary function

Background: It has been observed that non‐alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease and insulin resistance. Pulmonary function is also known to be related with cardiovascular disease and metabolic syndrome. Aims: The objective of this study was to investigate the association between NAFLD and pulmonary function. Methods: We performed a cross‐sectional study to examine the association of NAFLD based on abdominal sonographic findings and pulmonary function in 2119 Korean men between the ages of 30 and 75. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁) were compared according to the presence of NAFLD. Univariate and multivariate logistic regression analyses were conducted to evaluate the relationship of NAFLD with FVC and FEV₁ as pulmonary function tests. Results: The subjects with NAFLD had lower FVC and FEV₁ than their non‐steatotic counterparts, and FVC and FEV₁ gradually decreased according to the grade of hepatic steatosis. After adjusting for age, body mass index, smoking status, blood pressure, fasting plasma glucose, total cholesterol, hypertension, diabetes, triglyceride and high‐density lipoprotein cholesterol, the FVC and FEV₁ were found to be inversely associated with the presence of NAFLD. Conclusion: NAFLD was independently associated with reduced pulmonary function, and the severity of NAFLD was inversely correlated with pulmonary function.     

2型糖尿病合并非酒精性脂肪肝与骨密度的关系

目的探讨2型糖尿病(T2DM)患者合并非酒精性脂肪肝(NAFLD)与骨密度(BMD)的相关性。方法筛选T2DM患者119例,依据B超结果分为2组:T2DM组(62例),T2DM合并NAFLD组(57例)。测定正位腰椎2-4(L2-4)、左侧股骨颈、Ward's三角、大粗隆及左前臂骨密度,行肝脏彩超及血糖、血脂、空腹C肽、肝肾功能、尿微量白蛋白检测,测量身高、体重等。结果 T2DM合并NAFLD组患者体重指数、三酰甘油、总胆固醇、空腹C肽、谷氨酰转酞酶、尿酸、尿微量蛋白均高于T2DM组,差异有统计学意义(均P0.05);左股骨颈、Ward's三角和左前臂骨密度值低于T2DM组,差异有统计学意义(均P0.05)。T2DM合并NAFLD与年龄、病程、左侧股骨和左前臂骨密度呈负相关(均P0.05),与体重指数、三酰甘油、总胆固醇、空腹C肽、尿微量蛋白呈正相关。左侧股骨颈骨密度值与年龄、病程、血糖、糖化血红蛋白A1C、总胆固醇呈负相关(均P0.05),与体重指数、高密度脂蛋白、肌酐呈正相关(P0.05)。体重指数、三酰甘油、尿酸与NAFLD独立相关(P0.05)。结论 T2DM合并NAFLD患者骨密度水平低于单纯2型糖尿病患者,二者有相关性。体重指数、空腹C肽、血脂是影响T2DM合并NAFLD患者骨密度水平的因素。     

中国北方地区2型糖尿病患者摄盐量与非酒精性脂肪性肝病的相关性

目的探寻中国北方地区2型糖尿病患者摄盐量与非酒精性脂肪性肝病(NAFLD)之间的相关性。方法选取2016年10月至2018年11月期间在哈尔滨医科大学附属第一医院内分泌科就诊的2型糖尿病患者978例为研究对象。依据是否合并NAFLD分为2组:NAFLD组(n=801)和非NAFLD组(n=177)。采用24 h尿钠结果评估患者摄盐量。对比2组患者的体质量指数(BMI)、舒张压(DBP)、收缩压(SBP)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、胰岛素总量、糖化血红蛋白(HbA1c)、空腹C肽、空腹血糖(FBG)等临床资料。采用SPSS 17.0软件进行统计分析。对单因素分析有统计学意义的指标进行多因素logistic回归分析,筛选出独立的危险因素。采用Spearman相关分析判断受试者摄盐量与NAFLD之间的相关性。结果 Spearman相关分析结果显示,摄盐量与NAFLD呈显著正相关(r=0.129,P0.001)。多因素logistic回归分析结果显示,BMI(OR=5.321,95%CI 3.514～8.057)、HbA1c(OR=1.126,95%CI 1.006～1.260)、空腹C肽(OR=1.656,95%CI 1.273～2.156)、FBG(OR=1.697,95%CI 1.060～2.717)和摄盐量10.83 g/d(10.83 g/d摄盐量≤14.52 g/d:OR=2.181,95%CI 1.225～3.882;摄盐量14.52 g/d:OR=2.140,95%CI 1.167～3.926)是2型糖尿病患者合并NAFLD的危险因素(P0.05)。结论高摄盐量(10.83 g/d)是中国北方2型糖尿病患者合并NAFLD的风险因素。     

Relationship between serum osteocalcin levels and glucolipid metabolism in elderly type 2 diabetic patients with non-alcoholic fatty liver disease

<正>Objective To explore the relationship between serum osteocalcin levels and glucolipid metabolism in elderly type 2 diabetic patients with non-alcoholic fatty liver disease(NAFLD).Methods Data collected from 97 pa-tients with type 2 diabetes mellitus(T2DM)admitted to the Department of Geriatric Endocrinology of the First Affiliated hospital of Zhengzhou University from June 2014     

Association between non-alcoholic fatty liver disease and bone turnover biomarkers in post-menopausal women with type 2 diabetes

AimInformation is lacking on the association between non-alcoholic fatty liver disease (NAFLD) and bone mineral density (BMD) or circulating bone turnover biomarkers in post-menopausal women with type 2 diabetes (T2DM).MethodsWe recruited 77 white post-menopausal women with T2DM, who consecutively attended our diabetes outpatient service during a 3-month period. Liver ultrasonography and transient elastography (Fibroscan^®) were used for diagnosing and staging NAFLD. A dual energy X-ray absorptiometry, and serum levels of 25-hydroxyvitamin D₃ [25(OH)D], parathyroid hormone and multiple bone turnover biomarkers (periostin, sclerostin, dickkopf-related protein-1 [DKK-1], C-terminal telopeptide of type 1 collagen [sCTX], procollagen type 1 N-terminal propeptide [P1NP], receptor activator of nuclear factor-kB ligand [RANKL]) were also measured.ResultsOverall, 10 patients had NAFLD with clinically significant fibrosis (i.e., liver stiffness measurement > 7 kPa), 52 had NAFLD without fibrosis and 15 patients were free from steatosis. Although the three patient groups had comparable values of BMD, after adjustment for age, waist circumference, HOMA-insulin resistance and serum 25(OH)D levels, patients with NAFLD and significant fibrosis had significantly higher sclerostin levels (54.1 ± 16.4 vs. 36.1 ± 11.9 vs. 42.3 ± 14.7 pmol/L) and lower levels of serum DKK-1 (26.6 ± 17.8 vs. 49.0 ± 22.4 vs. 42.9 ± 19.4 pmol/L), RANKL (0.04 ± 0.03 vs. 0.08 ± 0.06 vs. 0.11 ± 0.06 pmol/L) and sCTX (0.16 ± 0.09 vs. 0.29 ± 0.17 vs. 0.40 ± 0.28 ng/mL) compared to other groups. Serum periostin and P1NP levels did not significantly differ between the groups.ConclusionIn post-menopausal women with T2DM, the presence of NAFLD and clinically significant fibrosis was strongly associated with a low bone turnover, which may reflect the presence of qualitative bone abnormalities.     

Sarcopenia is associated with non-alcoholic fatty liver disease in men with type 2 diabetes

AimsRecent epidemiological studies have suggested an association between sarcopenia and non-alcoholic fatty liver disease (NAFLD) in the general population, prompting our investigation into the gender-specific association between sarcopenia and NAFLD in patients with type 2 diabetes mellitus (T2DM).MethodsIn this cross-sectional study, 4210 patients with T2DM were recruited from the Seoul Metabolic Syndrome Cohort. Appendicular skeletal muscle mass (ASM) was estimated from bioimpedance analysis measurements, and the skeletal muscle mass index (SMI) was calculated by dividing the sum of ASM by body weight. Sarcopenia was defined as a gender-specific SMI value > 2 standard deviations (SDs) below the mean for healthy young adults. NAFLD was defined as the presence of hepatic steatosis on ultrasonography with no other causes of chronic liver disease.ResultsAmong the entire study population (mean age: 57.4 ± 10.8 years), 1278 (30.4%) had NAFLD and 1240 (29.5%) had sarcopenia, and the prevalence of NAFLD was significantly higher in those with sarcopenia: 46.2% vs 25.1% (P < 0.001) in men; 38.3% vs 25.4% (P < 0.001) in women. Sarcopenia was significantly associated with higher risk of NAFLD in men (adjusted odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.15–2.17), whereas the association was attenuated in women after adjusting for clinical risk factors.ConclusionSarcopenia is independently associated with NAFLD in men with T2DM, which suggests that sarcopenia may be a risk factor for NAFLD in men with T2DM.     

2型糖尿病对非酒精性脂肪性肝病的影响

2型糖尿病与非酒精性脂肪性肝病关系密切,其对非酒精性脂肪性肝病流行病学与抗糖尿病治疗对非酒精性脂肪性肝病病情转归均有影响。此文就2型糖尿病对NAFLD发病、进展及抗糖尿病治疗中生活方式干预和胰岛素增敏剂应用对NAFLD的影响作一综述,旨在为临床决策提供参考。     

非酒精性脂肪性肝病合并T2DM患者肠道菌群结构变化研究*

目的 探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者肠道菌群结构的变化。方法 2018年6月～2020年7月我院诊治的NAFLD合并T2DM患者58例、NAFLD患者66例和健康人60例,采用二代基因测序技术,针对16 srRNA基因V3～V4高变序列进行扩增测序,通过与肠道菌群GENBA-NK数据库进行序列比对,分析肠道菌群的种类和结构。采用化学发光法测定血清空腹胰岛素(FINS),并计算稳态模型胰岛素抵抗(HOMA-IR)指数;采用ELISA法测定血清肿瘤坏死因子-α(TNF-α),采用免疫层析法测定血清超敏C反应蛋白(hs-CRP)。结果 NAFLD合并T2DM组粪拟杆菌门显著高于NAFLD组或健康人(P＜0.05),NAFLD组粪拟杆菌门又显著高于健康人(P＜0.05);NAFLD合并T2DM组粪厚壁菌门、柔嫩梭菌属、厌氧棍状菌属和布劳特菌属丰度均显著低于NAFLD组或健康人(P＜0.05),NAFLD组厚壁菌门、柔嫩梭菌属、厌氧棍状菌属和布劳特菌属丰度又均显著低于健康人(P＜0.05);NAFLD合并T2DM组HOMA-IR指数、血清TNF-α和hs-CRP水平分别为(2.8±1.3)、(52.3±11.7)ng/mL和(2.3±1.1)mg/L,显著高于NAFLD组【分别为(1.6±0.7)、(48.7±10.2)ng/mL和(1.6±0.9)mg/L,P<0.05】或健康人【分别为(1.3±0.3)、(33.2±8.4)ng/mL和(1.2±0.4)mg/L,P<0.05】。结论 NAFLD合并T2DM患者存在胰岛素抵抗和血清炎性因子水平的变化,而且肠道菌群结构也发生了显著的改变,需进一步研究其临床意义。     

2型糖尿病合并非酒精性脂肪肝动物模型的建立

目的用高脂饲料喂养2型糖尿病MKR鼠建立2型糖尿病并发非酒精性脂肪肝（NAFLD）动物模型。方法用高脂饲料诱发MKR鼠形成NAFLD模型,观察其肝脏形态、糖耐量、肝功能和血脂变化。结果高脂饲料诱发MKR鼠形成NAFLD模型肝细胞呈小泡性脂变,细胞内有大小不一的脂滴存在;糖耐量异常,异常程度高于MKR组。与C57野生组比较,MKR组小鼠肝质量、肝指数和血脂LDL-C升高差异无统计学意义（P〉0.05）,肝功能指标ALT、AST和血脂TG、TCHO、HDL-C升高差异有统计学意义（P〈0.05或0.01）;MKR高脂组小鼠肝质量、肝指数、肝功能指标（ALT、AST）和血脂（TCHO、HDL-C、LDL-C）进一步升高,高于MKR组（P〈0.05或0.01）,而TG下降,低于MKR组（P〈0.01）,高于C57野生组小鼠（P〈0.05）。结论高脂饲料喂养MKR鼠可以建立稳定的、与临床2型糖尿病并发NAFLD一致的动物模型。     

Association of non-alcoholic fatty liver disease with microvascular complications of type 2 diabetes

IntroductionNon-alcoholic fatty liver disease (NAFLD) affects risks of type 2 diabetes (T2D), diabetes-related complications, and cardiovascular disease in a complex manner. This study is designed to clarify associations of sonographically-detected NAFLD and serum liver enzymes with diabetes-related microvascular complications.MethodsA matched case-contorl study was designed for 440 patients with T2D and at least one of the chronic diabetes-related microvascular complications and 495 age- and gender-matched control patients with T2D.ResultsConsidering pre-existing and newly developed chronic microvascular complications, diabetic peripheral neuropathy was found in 347 out of 935 (37.1%) study patients, diabetic retinopathy in 141/935 (15.1%), and diabetic nephropathy in 103/935 (11.0%). Diagnosis of diabetic retinopathy and diabetic nephropathy were inversely associated with the presence of NAFLD in the crude logistic regressions (OR [95% CI] = 0.18 [0.05–0.63], p value = 0.007; OR [95% CI] = 0.17 [0.04–0.59], p value = 0.011, respectively). The subgroup of NAFLD with elevated liver enzymes had lower odds of having diabetic peripheral neuropathy in the fully adjusted model (OR [95% CI] = 0.34 [0.12–0.98], p value = 0.048).ConclusionDiagnosis of NAFLD with or without elevated serum liver enzymes was inversely correlated with certain chronic diabetes microvascular complications. Possible explanations for this counter-intuitive and unexpected finding are discussed and center on reverse-causality, wherein sicker patients may develop beneficial compensatory physiological and behavioral adaptations. Diversity of studied patients, in particular with regards to the ethnic and racial differences among the Western and Asian populations may also partly account for contrasting findings of the relationship between NAFLD and microvascular complications of diabetes.     

Relationship between serum uric acid level and nonalcoholic fatty liver disease in type 2 diabetes patients

This study aimed to investigate the association between serum uric acid (SUA) level and nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2DM).T2DM patients hospitalized in the Department of Hepatology, Yantai Qishan Hospital, between April 2012 and December 2018 were classified into the NAFLD group and the non-NAFLD group. Clinical data, glucose and lipid metabolism biomarkers, and liver and kidney function parameters were retrospectively collected.Five hundred eighty-three T2DM patients met the inclusion and exclusion criteria; 227 patients were included in the non-NAFLD group and 356 patients were included in the NAFLD group. Multiple linear regression analyses showed that SUA was positively correlated with body mass index (P = .003), triglycerides (P = .009), aspartate aminotransferase (P = .036), and alanine aminotransferase (P = .038) and negatively correlated with estimated glomerular filtration rate (P < .001) in T2DM patients. Multivariate regression analyses demonstrated that after adjusting for confounding factors, the SUA tertile was still significantly associated with NAFLD occurrence in T2DM patients (P for trend = .008). With reference to SUA tertile I, the odds ratios for NAFLD in the SUA tertile II and tertile III groups were 1.729 (95% confidence interval [CI]: 1.086–2.753) and 2.315 (95% CI: 1.272–4.213), respectively.The level of SUA in T2DM patients was associated with the occurrence of NAFLD. Elevated SUA was associated with a significantly increased prevalence of NAFLD. The SUA level was an independent risk factor for NAFLD occurrence in patients with T2DM.     

2型糖尿病合并非酒精性脂肪性肝病的研究进展

非酒精性脂肪性肝病(NAFLD)是以肝细胞脂肪变性和脂肪蓄积为病理特征,但无过量饮酒史的临床综合征,它是代谢综合征在肝脏的表现.胰岛素抵抗是NAFLD与2型糖尿病的共同发病基础.NAFLD是转氨酶慢性升高的常见原因之一.转氨酶升高在2型糖尿病患者中的发生率明显高于普通人群,并与心血管危险因素的聚集有关.运动和节制饮食可控制体重、改善胰岛素抵抗、纠正血脂紊乱和减轻脂肪肝.二甲双胍和格列酮类可降低血转氨酶水平和部分逆转脂肪肝组织学变化.     

2型糖尿病合并非酒精性脂肪肝患者血浆同型半胱氨酸与胰岛素抵抗相关性研究

目的探讨2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者血浆同型半胱氨酸与胰岛素抵抗的关系。方法选择2011年3月至2012年3月上海复旦大学附属中山医院青浦分院内分泌科住院治疗的156例T2DM患者。按病史和B超结果分为NAFLD组(DM+N)组和非NAFLD组(DM组),另选取健康体检者65名为对照(NC)组,测定3组空腹血糖(FPG)、胰岛素(FINS)及同型半胱氨酸(HCY)等,计算胰岛素抵抗指数(HOMA-IR指数)。结果与NC组相比,DM+N及DM组空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、体重指数(BMI)、丙氨酸转氨酶(ALT)、HOMA-IR指数及HCY均升高(P<0.05或P<0.01)。与DM组比较,DM+N组ALT、TG、FPG、FINS、HOMA-IR指数及HCY均升高(P<0.05或P<0.01)。HOMA-IR和TG是HCY的独立危险因素。结论 T2DM合并非酒精性脂肪肝患者血浆同型半胱氨酸升高,与胰岛素抵抗存在明显相关性。     

2型糖尿病合并非酒精性脂肪肝患者动脉硬化危险因素的分析

目的分析2型糖尿病合并非酒精性脂肪肝患者颈动脉内膜中层厚度(IMT)与细胞间黏附分子1(ICAM-1)和C反应蛋白(CRP)的关系。方法选择2型糖尿病患者85例,按是否合并非酒精性脂肪肝分为合并组41例、糖尿病组44例,检测血脂、ICAM 1、CRP及IMT和胰岛素抵抗指数(HOMA-IR)进行分析。结果与糖尿病组比较,合并组患者LDL-C、TG、HOMA-IR、CRP和IMT明显升高(P<0.05,P<0.01),2组ICAM-1比较,差异无统计学意义(P>0.05)。ICAM-1和CRP与IMT呈正相关;HOMA-IR、LDL-C、CRP和TG是IMT的危险因素。结论 2型糖尿病合并非酒精性脂肪肝更易出现大血管病变;血清CRP水平升高与动脉粥样硬化的形成相关。     

非酒精性脂肪性肝病与肠道菌群的关系

非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)是一种多病因导致的临床病理综合征,已成为最常见的慢性肝病之一,目前NAFLD完整的生理机制尚不完全清楚,近年来提出肠道菌群通过调控能量代谢、增加内源性乙醇、调节胆汁酸及胆碱代谢,破坏免疫平衡引发机体低度炎症等途径促进NAFLD的发生、发展,本文就肠道菌群与NAFLD的相关机制做一概述。     

2型糖尿病患者血尿酸水平与非酒精性脂肪肝的相关性研究

回顾性分析1 007例住院2型糖尿病患者,分为伴和不伴非酒精性脂肪肝(NAFLD)2组,收集患者临床及生化资料.结果表明,血尿酸与血糖呈负相关,与体重指数及肾功能呈正相关(P＜0.01),伴NAFLD组年龄较低、2型糖尿病病程均短,血清尿酸升高,尿酸清除率降低;随血尿酸水平升高,发生NAFLD的风险增大.