2型糖尿病合并脂肪性肝病患者炎性因子和脂联素的变化及意义

目的 探讨炎性因子和脂联素在2型糖尿病(T2DM)合并非酒精性脂肪性肝病患者中的变化及意义.方法 共纳入观察者210例,其中健康对照组40名,T2DM组60例,非酒精性脂肪性肝病(NAFLD)组65例,T2DM合并NAFLD组45例.检测各组的血清丙氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶(GGT)、空腹血糖(FPG)、糖化血红蛋白(GHbA1c)、肌酐(Cr)、尿酸(UA)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)以及总胆固醇(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),计算胰岛素抵抗指数(HOMA-IR)、体质量指数(BMI)和腰臀比.测定血清肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)及脂联素.结果 NAFLD组与T2DM合并NAFLD组患者的血清ALT、GGT和BMI、腰臀比高于T2DM和健康对照组ALT:(43.4±9.3)、(46.2±7.6)、(27.5±5.7)、(28.3±6.5)U/L,GGT:(55.3±10.4)、(54.5±11.3)、(40.3±8.4)、(38.2±10.5) U/L,BMI:(27.9±2.6)、(26.2±2.6)、(23.6±3.6)、(22.7±2.5)kg/m2,腰臀比:(0.94±0.05)、(0.96±0.07)、(0.91±0.08)、(0.89±0.05),P＜0.05或P＜0.01],T2DM组、NAFLD组与T2DM合并NAFLD组的TG、LDL-C均高于健康对照组TG:(2.9±0.5)、(3.5±0.4)、(4.0±0.8)、( 1.3±0.2)mmol/L,LDL-C:(3.6±0.4)、(3.1±0.5)、(3.9±0.7)、(2.1±0.2)mmol/L,P均＜0.05],其中T2DM合并NAFLD组的TG高于T2DM组(P＜0.05).T2DM与T2DM合并NAFLD组的FPG、GHbAlc高于NAFLD和健康对照组FPG:(8.5±0.6)、(8.9±0.9)、(4.6±0.7)、(4.7±0.4) mmol/L,GHbAlc:(9.3±3.6)％、(10.1±2.7)％、(5.0±0.2)％、(5.1±0.5)％,p＜0.05或P＜0.01],T2DM组、NAFLD组与T2DM合并NAFLD组的TNF-α、hs-CRP和HOMA-IR高于健康对照组TNF-α:(90.5±10.5)、(115.3±10.1)、(197.5±13.8)、(34.3±7.5)ng/L,hs-CRP:(4.9±0.5)、(4.6±0.8)、(8.1±0.7)、(2.1±0.4) mg/L,HOMA-IR:(6.7±0.8)、(6.2±1.2)、(11.3±1.7)、(1.8±0.3),P＜0.05或P＜0.01],其中T2DM合并NAFLD组的TNF-α、hs-CRP、HOMA-1R高于单纯T2DM组(P均＜0.05).T2DM组、NAFLD组与T2DM合并NAFLD组患者的血清脂联素均低于健康对照组(25.3±7.4)、(22.9±4.5)、(17.0±3.2)、(36.9±5.7) μg/L,P均＜0.05],其中T2DM合并NAFLD组的脂联素低于T2DM组(P＜0.05).T2DM合并NAFLD组患者血清脂联素浓度与TNF-α、hs-CRP和HOMA-IR之间呈负相关(r值分别为-0.635、-0.668、-0.752,P均＜0.01),HOMA-IR与TNF-α、hs-CRP之间呈正相关(r值分别为0.667、0.706,P均＜0.01).结论 炎性因子和脂联素参与了T2DM与脂肪性肝病的发病机制,而脂联素可能通过拮抗炎症反应减轻胰岛素抵抗,对脂肪性肝病有一定的改善作用.

Clinical research for the significance of inflammatory factors and adiponectin in type 2 diabetes complicated with non-alcohoic fatty liver disease

Objective To investigate the clinical significance of inflammatory factors and adiponectin in type 2 diabetes milletus complicated with non-alcoholic fatty liver disease.Methods Two hundred and ten subjects aging from 25.0 to 65.0 years old,including 106 men and 104 women,were recruited into this study.They were divided into four groups: Forty cases of healthy control (NC),60 cases with newly-diagnosed type 2 diabetes (T2DM),65 cases with simple non-alcoholic fatty liver disease (NAFLD) and other 45 cases with newly-diagnosed T2DM complicated with NAFLD.The physical examination was performed for each patient.Serum levels of alanine aminotransferase (ALT),gamma-glutamyl transpeptidase (GGT),fasting plasma glucose (FPG),glycation hemoglobin A 1 c ( GHbA1c ),creatinine ( Cr),uric acid ( UA ),2 hours postprandic plasma glucose (2hPG),fasting insulin (FINS),lipid profiles were measured.Insulin resistance index (HOMAIR) was calculated.Tumor necrosis factor-α (TNF-α),high sensitive C-reactive protein (hs-CRP) and adiponectin were also detected.Results The serum levels of ALT and GGT,body mass index and waist/hip ratio were higher in the NAFLD,T2DM with NAFLD patient groups than that in T2DM and NC group ( P ＜0.05or P ＜0.01 ).The serum levels of TG and LDL-C were significantly higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.And serum TG levels in T2DM with NAFLD group were higher than that of T2DM group (P ＜ 0.05).FPG and GHbAl c were higher in T2DM and T2DM with NAFLD groups than that of NAFLD and NC groups.The serum levels of TNF-α,hs-CRP and HOMA-IR were higher in T2DM,NAFLD and T2DM with NAFLD groups than that of NC group.T2DM with NAFLD group had higher levels of TNF-α,hs-CRP and HOMA-IR compared with T2DM group.However,serum adiponectin levels of T2DM,NAFLD and T2DM with NAFLD groups were lower than that of NC group.And it was lower in T2DM with NAFLD group when compared with NC group ( P ＜ 0.05 ).Adiponectin was negatively associated with TNF-α,hs-CRP and HOMA-IR (r =-0.635,-0.668,-0.752 respectively,P ＜ 0.0l ).But HOMA-IR was positively associated with TNF-α,hs-CRP( r =0.667,0.706 respectively,P ＜ 0.01 ).Conclusion Inflammatory factors and adiponectin may play important roles in the pathophysiology and progression of T2DM and NAFLD.The protective effects of adiponectin may come from its anti-inflammatory activity to relieve insulin resistance for NAFLD.