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目的研究2型糖尿病合并非酒精性脂肪肝(NAFLD)患者的代谢特征、胰岛功能及胰岛素抵抗水平,并探讨其主要危险因素。方法根据肝脏B超结果,将113例2型糖尿病患者分为NAFLD组和非NAFLD组,比较两组之间的体质指数(BMI)、血脂、血糖、胰岛素、C肽、肝酶、尿酸、胰岛素抵抗、胰岛β细胞功能等指标,并采用Logistic回归分析2型糖尿病患者合并NAFLD的独立危险因素。结果 NAFLD组BMI、甘油三酯(TG)、空腹血糖(FBG)、餐后2h血糖(2hPG)、空腹胰岛素(FIns)和C肽(FCP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、胰岛素抵抗指数(HOMA-IR)较非NAFLD组均显著升高,而年龄、高密度脂蛋白(HDL)则显著降低。Logistic回归显示年龄、BMI、TG、HOMA-IR与2型糖尿病患者合并NAFLD独立相关(OR=0.95,P=0.024;OR=1.24,P=0.024;OR=2.81,P=0.025;OR=11.96,P=0.001),其中HOMA-IR是主要的危险因素。结论 2型糖尿病合并非酒精性脂肪肝患者存在更严重的肥胖倾向和代谢紊乱,而胰岛素抵抗是其主要危险因素。
Objective To investigate the metabolic characteristics, islet function and insulin resistance in type 2 diabetic patients with non-alcoholic fatty liver disease (NAFLD) and to explore the main risk factors. Methods According to the results of liver ultrasonography, 113 patients with type 2 diabetes were divided into NAFLD group and non-NAFLD group. The body mass index (BMI), blood lipid, blood glucose, insulin, C peptide, liver enzymes, uric acid, insulin Resistance, islet β cell function and other indicators, and the use of Logistic regression analysis of type 2 diabetes patients with NAFLD independent risk factors. Results BMI, triglyceride (TG), fasting blood glucose (FBG), postprandial 2h blood glucose (2hPG), fasting insulin (FFP) and alanine aminotransferase (ALT), aspartate AST, HOMA-IR increased significantly compared with those in non-NAFLD group, but age and high density lipoprotein (HDL) decreased significantly. Logistic regression analysis showed that age, BMI, TG and HOMA-IR were independently associated with NAFLD in type 2 diabetic patients (OR = 0.95, P = 0.024; OR = 1.24, P = 0.024; OR = 2.81, P = 0.001), HOMA-IR is the main risk factor. Conclusion Patients with type 2 diabetes mellitus and non-alcoholic fatty liver have more serious obesity tendency and metabolic disorder, and insulin resistance is the main risk factor.