2型糖尿病合并非酒精性脂肪肝病患者凝血状态的探讨

目的 探讨2型糖尿病（T2DM）合并非酒精性脂肪肝病（NAFLD）患者凝血指标的变化,及其在临床上的意义.方法 对426例T2DM患者根据是否合并NAFLD分为合并NAFLD组70例及不合并NAFLD组356例,分别检测两组患者的空腹血糖（FPG）、空腹胰岛素（FINS）、血浆凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）、甘油三酯（TG）、胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血尿酸（UA）、血清转氨酶等指标,并计算体重指数（BMI）及胰岛素抵抗指数（HOMA-IR）.结果 发现T2DM患者中NAFLD的患病率为16.43%,男性为11.21%,女性为22.68%,两者差异有统计学意义（P〈0.05）.T2DM合并NAFLD组与不合并NAFLD组相比,BMI、LDL-C及HOMA-IR均升高,差异有统计学意义（P〈0.05,P〈0.01）;APTT下降,差异有统计学意义（P＜0.05）.通过非条件Logistic 回归分析显示NAFLD与BMI、LDL-C及HOMA-IR密切相关.结论 T2DM合并NAFLD患者存在明显的超重、胰岛素抵抗、脂代谢紊乱及高凝状态,故临床上在强化血糖治疗的同时应重视减肥、改善胰岛素抵抗、降脂、抗凝,从而有利于阻止或延缓病情的发生与发展.

Analysis of Coagulation of Type 2 Diabetes Associated with Nonalcoholic Fatty Liver

Objective To investigate changes of blood coagulation in type 2 diabetes mellitus complicated with nonalcoholic fatty liver, and its clinical significance.Methods A total of 426 type 2 diabetes were selected. These subjects were divided into fatty liver group（n=70） and without fatty liver group（n=356） by the presence of NAFLD.The levels of FPG,FINS,PT, APTT, FIB,TG,TC,HDL-C,LDL-C,UA,ALT, BMI,HOMA-IR were determined;body mass index（BMI） and insulin resistance index were calculated in patients between the two groups.Results Prevalence of NAFLD was 16.43% in type 2 diabetic patients.It was 11.21% in males and 22.68% in females.The prevalence of NAFLD in females was significantly higher than that in males（P〈0.05）.Of the patients with T2DM,those complicated with NAFLD had significantly higher BMI, LDL-C,HOMA-IR and lower APTT（P〈0.05 or P〈0.01）.Logistic regression revealed that NAFLD was correlated with BMI,LDL-C,HOMA-IR. Conclusions Because NAFLD in patients with T2DM had remarkable overweight,insulin resistance,dyslipidemia and hypercoagulabale,we should pay attention to reducing weight,improving insulin resistance,droping fat,anticoagulation when we strengthened the treatment of blood sugar to prevent or delay the genesis and development of disease.