2型糖尿病合并脂肪肝患者同单纯性脂肪肝患者的比较

目的:比较初诊2型糖尿病(T2DM)合并脂肪肝患者和单纯性脂肪肝患者的生化指标的差异。方法:选择56例合并单纯性脂肪肝的初诊T2DM患者,进行临床指标血压、腹围的测定,并行75gOGTT测定空腹及餐后2h血糖(BG),放免法测定胰岛素(INS)、C肽(CP),采用McAuley指数、稳态模型胰岛素抵抗指数(HOMA-IR)和空腹胰岛素(FINS)评价胰岛素抵抗(IR),并于18例非DM的单纯性脂肪肝患者(NAFLD组)比较。结果:T2DM组与单纯性脂肪肝组比较:两组的体重指数(BMI)、血脂均高于正常值,两者之间差异无显著性;餐后INS、CP较脂肪肝组显著降低(P<0.01、P<0.05);空腹载脂蛋白A1(Apo-a1)显著降低(P<0.05);计算HOMA-IR显著升高(P<0.001),McAuley指数降低(P<0.05);Logistic逐步回归分析显示在脂肪肝患者中,2hINS的降低、HOMA-IR的增加同T2DM的发生呈正相关。结论:单纯性脂肪肝的人群已经存在超重、高脂血症,而合并糖尿病的脂肪肝患者IR更明显,餐后INS分泌功能下降。

The Clinical Comparison Between the DM and Non-DM Parients with Nonalcoholic Fatty Liver Disease

Objective To evaluate the metabolic disorder between the DM and non-DM parients with nonalcoholic fatty liver disease. McAuley index ,homeostasis model assessment insulin resistance index(HOMA-IR) and fasting insulin (FINS) were applied to assess the status of insulin resistance. Methods We studied blood concentrations of glucose, lipid ,C-peptide, insulin, measured during a 75-g oral glucose tolerance test (OGTT) in the fifty-six newly diagnosed type 2 diabetic patients with nonalcoholic fatty liver disease and eighteen nonalcoholic fatty liver disease patients. Results Adjusted with age,sex,body mass index(BMI) and lipid, HOMA-IR were significantly higher in dabitec patients than those in controls(P <0.001), 2 h insulin,cp,apoA1, McAuley index were significantly lower than those in controls(P <0.01,P <0.05, P <0.05, P <0.05).Logistic regression analysis showed that 2 h inslin and HOMA-IR were the main risk factors forming type 2 Diabetes mellitus. Conclusion It showed that the independent risk factors for forming type 2 diabetes mellitus in nonalcoholic fatty liver patients are a increasing Insulin resistance and a despaired postprandial Insulin action.