2型糖尿病患者非酒精性脂肪肝与尿白蛋白排泄率的关系

目的 探讨合并非酒精性脂肪肝(NAFLD)的2型糖尿病(T2DM)患者尿白蛋白排泄率(UAER)的变化特点及其相关性.方法 T2DM患者228例,根据是否合并NAFLD分为糖尿病合并NAFLD组(135例)和糖尿病无NAFLD组(93例),另选年龄、性别匹配的40例健康受试者为对照组,比较两组患者体重指数(BMI)、空腹血糖(FPG)、血脂、空腹胰岛素(FINS)、空腹C肽、胰岛素抵抗指数(HOMA-IR)、24h UAER的差异,用卡方检验分析两组间正常、微量和大量UAER的分布差异,进一步以T2DM合并NAFLD为应变量,以各临床生化指标为自变量,用单因素和多因素Logistic回归分析方法分析T2DM合并NAFLD的危险因素.结果 糖尿病合并NAFLD组BMI、甘油三酯(TG)、FINS和空腹C肽、HOMI-IR、UAER高于非NAFLD组,差异有统计学意义(P均<0.05).卡方检验显示,糖尿病合并NAFLD患者微量白蛋白尿和大量白蛋白尿发生率高于无NAFLD组,差异有统计学意义(χ2=23.905,P=0.001).Logistic回归分析显示,BMI(OR=4.66,P=0.001)、TG(OR=8.46,P=0.000)及UAER(OR=3.73,P=0.003)升高是T2DM合并NAFLD的危险因素.结论 T2DM患者中NAFLD与BMI、TG及UAER的升高密切相关,T2DM合并NAFLD患者糖尿病肾病的发病率显著高于无合并NAFLD患者.

Association of non-alcoholic fatty liver disease and urinary albumin excretion rate in patients with type 2dibetes mellitus

Objective To investigate the relationship between urinary albumin excretion rate （UAER）and non-alcoholic fatty liver disease（NAFLD） in patients with type 2 dibetes mellitus （T2DM）. Methods Two hundred twenty eight patients were investigated respectively. The patients were divided into two groups （NAFLD group and non-NAFLD group）by liver ultrasonography and disease history,forty heathy persons who were matched for age and sex were served as control, then their clinical data were collected and compared in order to find the differences of biochemical indicators and UAER. Results NAFLD group had higher levels of body mass index（ BMI）, triglyceride （TG） ,fast insulin and C peptide level, uric acid, homeostasis model assessment（HOMA-IR） than those of without NAFLD （P 〈 0. 05 ）. Results of the Chi-square test showed that the mobility of trace albuminuria and mass albuminuria was higher in NAFLD group than that of without NAFLD （ X^2 = 23.905, P = 0. 001 ）. Logistic analysis showed that BMI （ OR = 4. 66, P = 0. 001 ）, TG （ OR = 8.46, P = 0. 000 ） and UAER （ OR = 3.73, P = 0. 003 ） were important risk factors for T2DM complicated with NAFLD. Conclusions NAFLD is closely related with higher BMI, TG and UAER in T2DM patients. The mobility of diabetic nephropathy is significantly higher in T2DM complicated with NAFLD than that of without NAFLD.