2型糖尿病非酒精性脂肪性肝病肝功能异常的临床分析

目的探讨2型糖尿病非酒精性脂肪性肝病的肝功能异常及其影响因素。方法对我院413例2型糖尿病住院患者进行回顾性分析，记录患者的年龄、病程、身高、体重、腰围、臀围、体重指数（BMI）、腰臀比（WHR）、空腹血糖（FBG）、糖化血红蛋白（HbAlc）、胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、谷丙转氨酶（AIJrr）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（γ-GT）和肝脏B超检查结果，并分析肝功能异常的影响因素。结果剔除其他肝病及未进行肝脏B超检查的病例，合格的388例2型糖尿病患者中有214例非酒精性脂肪性肝病，患病率约为55．2％，214例2型糖尿病非酒精性脂肪性肝病患者中肝功能异常者47例，约占22％，46例患者ALT、AST和1-GT升高均未超过正常上限的5倍。随着肝脏B超脂肪肝程度增加，肝功能异常率逐渐升高（轻度、中度和重度分别为16％、24％和40％）。肝功能异常组与肝功能正常组的性别、腰围、WHR、BMI、HbAlc、TC、LDL和HDL无明显差异（P〉0．05），而两组的年龄、病程、FBG和TG有明显差异（P〈0．05）。结论2型糖尿病非酒精性脂肪性肝病患者中肝功能异常主要表现为ALT、AST和γ-GT的轻度升高，年龄、病程、FBG和TG可能是2型糖尿病非酒精性脂肪性肝病肝功能异常的危险因素。

Clinical analysis of liver function abnormality in type 2 diabetes mellitus patients with nonalcoholic fatty liver disease

Objective To investigate liver function abnormality and influcing factors in type 2 diabetes mellitus patients with nonalcoholic fatty liver disease. Methods Retrospective study was performed with a total of 413 inpatients with type 2 diabetes mellitus. Age, duration, body height, weight, waistline, hip circumference, body mass index （BMI）, waist to hip ratio （WHR）, fasting blood glucose （FBG）, glycosylated hemoglobin （HbAlc）, total cholesterol （TC）, triglyceride （TG）, high density lipoprotein （ HDL）, low density lipoprotein （ LDL）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, γ-glutamyhransferase （γ-GT） and ultrasonic examination were recorded. Influcing factors of liver function abnormality were also analyzed. Results Two hundred and fourteen patients with nonalcoholic fatty liver disease were enrolled after excluding patients with other chronic liver diseases or without ultrasoie examination. The incidence was 55.2% （214/388）. Liver function abnormality was found in 47 patients （22%）. ALT, AST and γ-GT were less than fivefold upper limit in 46 patients. Liver function abnormality increased with ultrasonic fat- ty liver severity （16%, 24% and 40% in mild, moderate and severe respectively）. Gender, waistline, WHR, BMI, HbAlc, TC, LDL and HDL were not significantly different between liver function abnormal group and liver function normal group （P 〉0.05）. However, age, duration of diseases, FBG and TG were significantly different between the two groups （ P 〈 0.05 ）. Conclusion Liver function abnormality in type 2 diabetes mellitus patients with nonalcoholic fatty liver disease mainly manifest mild increases of ALT, AST and γ-GT. Age, duration, FBG and TG may be the risk factors of liver function abnormality in type 2 diabetes mellitus patients with nonalcoholic fatty liver disease.