2型糖尿病患者非酒精性脂肪性肝病与代谢及颈动脉内膜中层厚度的相关性研究

目的 探讨2型糖尿病(T2DM)患者非酒精性脂肪性肝病(NAFLD)与代谢指标及颈动脉内膜中层厚度(CIMT)的相关性.方法 根据肝脏B超结果,将321例T2DM患者分为合并NAFLD组和单纯T2DM组,比较2组患者的体重指数(BMI)、血压、血糖、血脂、尿酸、胰岛素、C肽、胰岛素抵抗指数(HOMA-IR)等代谢指标,并分析丙氨酸氨基转移酶(ALT)与上述指标的关系;比较合并NAFLD组与单纯T2DM组的CIMT,并通过相关及回归等方法探讨NAFLD及ALT与CIMT之间的相关性.结果 (1)合并NAFLD组BMI、甘油三酯(TG)、尿酸、空腹血糖(FBG)、空腹胰岛素(FIns)、空腹C肽(FCP)、HOMA-IR较单纯T2DM组显著升高,而高密度脂蛋白胆固醇(HDL-C)明显降低,其中BMI(OR=1.25,P＜0.001)、TG(OR=1.74,P=0.008)、HOMA-IR(OR=2.33,P=0.010)是NAFLD的独立危险因素,HDL-C(OR=0.04,P＜0.001)是其保护因素;(2)ALT与BMI(r=0.255,P＜0.001)、TG(r=0.156,P＜0.018)、尿酸(r=0.239,P＜0.001)、FIns(r=0.213,P=0.001)、FCP(r=0.199,P＜0.003)、HOMA-IR(r=0.247,P＜0.001)呈正相关,与HDL-C(r=-0.199,P=0.002)呈负相关,其中BMI(β=0.456,P=0.048)、尿酸(β=0.021,P=0.025)及HOMA-IR(β=3.634,P=0.004)是独立相关因素;(3)合并NAFLD组与单纯T2DM组之间的CIMT差异无统计学意义,而多元回归分析表明ALT与CIMT独立相关(β=0.002,P=0.013).结论 T2DM合并NAFLD患者存在更严重的代谢紊乱及胰岛素抵抗,ALT是T2DM患者颈动脉内膜中层增厚的独立危险因素.

Abstract：

Objective To investigate the association between nonalcoholic fatty liver disease (NAFLD) and metabolism or carotid intima-media thickness (CIMT) in Type 2 diabetic(T2DM). Methods According to the liver B-ultrasonography, a total of 321 T2DM patients were divided into two groups, with or without NAFLD. Metabolic indexes such as BMI, BP, blood glucose, blood lipid, uric acid ( UA ), insulin, C-peptipe,insulin resistance index(HOMA-IR) between the two groups were compared, and the relationships between alanine aminotransferase (ALT) and the above indexes were analyzed. Furthermore,the CIMT of the two groups were compared, and the relationships between NAFLD, ALT and CIMT were investigated by correlation and regression analysis. Results Compared with the group without NAFLD, the patients with NAFLD had higher level of BMI, triglyceride ( TG ), UA, fasting blood glucose ( FBG ), fasting insulin ( FIns ), fasting C peptide (FCP) ,HOMA-IR,and lower level of high density lipoprotein ( HDL-C ) significantly; BMI ( OR = 1.25, P ＜0. 001 ), TG ( OR = 1.74, P = 0. 008 ) and HOMA-IR ( OR = 2. 33, P = 0.010) were independent risk factors of NAFLD while H DL-C was independent protective factor; ALT was positively correlated with BMI (r = 0. 255, P ＜0. 001 ) ,TG(r =0. 156,P ＜0. 018) ,UA(r =0. 239,P ＜0. 001 ) ,FIns(r =0. 213,P =0. 001) ,FCP(r =0. 199,P ＜0. 003), HOMA-IR ( r = 0. 247, P ＜ 0. 001 ) and negatively correlated with HDL-C ( r = - 0. 199, P =0. 002) ,and BMI (β =0. 456,P =0. 048) ,UA (β =0. 021 ,P =0. 025) and HOMA-IR(β =3.634 ,P =0. 004)were independent associated facrors. The difference of CIMT between the two groups didn't reach statistical significance, while mutiple regression analysis revealed that ALT was independently associated with CIMT(β =0. 002,P = 0. 013). Conclusion T2DM patients with NAFLD show more serious disorder of metabolism and insulin resistance. ALT is an independent risk factor of CIMT in T2DM patients.

Association study between nonalcoholic fatty liver disease and metabolism or carotid intima-media thickness in type 2 diabetic patients

Objective To investigate the association between nonalcoholic fatty liver disease (NAFLD) and metabolism or carotid intima-media thickness (CIMT) in Type 2 diabetic(T2DM). Methods According to the liver B-ultrasonography, a total of 321 T2DM patients were divided into two groups, with or without NAFLD. Metabolic indexes such as BMI, BP, blood glucose, blood lipid, uric acid ( UA ), insulin, C-peptipe,insulin resistance index(HOMA-IR) between the two groups were compared, and the relationships between alanine aminotransferase (ALT) and the above indexes were analyzed. Furthermore,the CIMT of the two groups were compared, and the relationships between NAFLD, ALT and CIMT were investigated by correlation and regression analysis. Results Compared with the group without NAFLD, the patients with NAFLD had higher level of BMI, triglyceride ( TG ), UA, fasting blood glucose ( FBG ), fasting insulin ( FIns ), fasting C peptide (FCP) ,HOMA-IR,and lower level of high density lipoprotein ( HDL-C ) significantly; BMI ( OR = 1.25, P ＜0. 001 ), TG ( OR = 1.74, P = 0. 008 ) and HOMA-IR ( OR = 2. 33, P = 0.010) were independent risk factors of NAFLD while H DL-C was independent protective factor; ALT was positively correlated with BMI (r = 0. 255, P ＜0. 001 ) ,TG(r =0. 156,P ＜0. 018) ,UA(r =0. 239,P ＜0. 001 ) ,FIns(r =0. 213,P =0. 001) ,FCP(r =0. 199,P ＜0. 003), HOMA-IR ( r = 0. 247, P ＜ 0. 001 ) and negatively correlated with HDL-C ( r = - 0. 199, P =0. 002) ,and BMI (β =0. 456,P =0. 048) ,UA (β =0. 021 ,P =0. 025) and HOMA-IR(β =3.634 ,P =0. 004)were independent associated facrors. The difference of CIMT between the two groups didn't reach statistical significance, while mutiple regression analysis revealed that ALT was independently associated with CIMT(β =0. 002,P = 0. 013). Conclusion T2DM patients with NAFLD show more serious disorder of metabolism and insulin resistance. ALT is an independent risk factor of CIMT in T2DM patients.