中青年男性2型糖尿病高甘油三酯血症—腰围表型与肝脏脂肪含量及内脏脂肪面积的相关性研究

发布时间：2018-03-12 11:02

  本文选题：高甘油三酯血症-腰围表型　切入点：内脏脂肪面积　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本文旨在探讨中青年男性2型糖尿病患者合并高甘油三酯血症-腰围表型(hypertriglyceridemic-waist circumference phenotype,HTWC)与肝脏脂肪含量(liver fat content,LFC)及内脏脂肪面积(visceral fat area,VFA)的关系,并分析LFC与VFA的相关性。方法:随机选取2015年10月~2016年8月于秦皇岛市第一医院内分泌科住院的男性2型糖尿病患者134例,年龄分布为20-64岁,平均年龄为46.69±10.72岁。入组要求严格遵守2006年世界卫生组织修订的糖尿病诊断标准。将134人分成四组:1)甘油三酯1.7mmol/l、腰围90cm(A组,30人);2)甘油三酯≥1.7mmol/l、腰围90cm(B组,32人);3)甘油三酯1.7mmol/l、腰围≥90cm(C组,33人);4)甘油三酯≥1.7mmol/l、腰围≥90cm(HTWC表型组,39人)。内脏脂肪型肥胖(VFO)诊断标准:VFA≥100cm2。被选患者需排除:1)1型糖尿病、特殊类型糖尿病;2)大于5年饮酒史,换算成酒精每周摄入≥140g;3)病毒、自身免疫等因素引起的肝病;4)糖尿病酮症及酮症酸中毒;5)入院前应用调脂药物史、恶性肿瘤史、精神疾患史、近期感染史。所有患者采集信息如下:年龄、身高、体重、腰围(waist circumference,WC)、VFA、LFC、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、血小板、白蛋白、空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(Hb A1c)。计算体重指数(body mass index,BMI)。计算非酒精性脂肪性肝病纤维化评分(NAFLD fibrosis score,NFS),NFS=-1.675+0.037×年龄(岁)+0.094×BMI(kg/m2)+1.13×空腹血糖受损/糖尿病(是=1,否=0)+0.99×AST/ALT-0.013×血小板(×109/L)-0.066×白蛋白(g/L)。VFA的测量方法为生物电阻抗法,使用仪器为我院实验室生物电阻抗人体成分分析仪(型号为S10)。LFC的测量方法为肝脏回声衰减系数法,利用imige J软件对选取的肝脏超声图像进行分析,并带入特定公式进行计算。使用SPSS 17.0软件进行数据分析。分析前对数据进行正态性及方差齐性检验。符合正态分布的计量资料采用x±s表示,非正态分布资料进行对数转换。组间正态分布的计量资料比较采用方差分析,多重比较采用LSD检验,组间非正态分布的计量资料采用秩和检验(Kruskal-Wallis H检验)。单因素相关分析采用Pearson相关分析法并逐个绘制散点图。计数资料比较采用Χ2检验,筛选危险因素采用Logistic回归分析。P0.05为差异有统计学意义。结果:1 A、B、C、HTWC组平均VFA分别是72.50±12.07、91.15±18.89、97.11±15.57、121.75±20.2。HTWC组平均VFA明显高于A、B、C组(P值分别为0.00、0.00、0.00),C组平均VFA明显高于A组(P=0.00),B组平均VFA明显高于A组(P=0.006),B、C组间VFA差异无统计学意义(P=0.367);2 A、B、C、HTWC组平均LFC分别为12.22±2.16、23.16±5.75、23.53±5.07、32.39±6.78。HTWC组平均LFC明显高于A、B、C组(P值分别为0.00、0.031、0.025),C组平均LFC明显高于A组(P=0.004),B组平均LFC明显高于A组(P=0.008),B、C组间LFC差异无统计学意义(P=0.927);3 HTWC表型组平均NFS显著大于A、B、C组(P值分别为0.002、0.033、0.029),C组平均NFS水平显著大于A组(P=0.009),B组平均NFS显著大于A组(P=0.007)。B、C组间NFS差异无统计学意义(P=0.397);4 VFA与HDL-C(r=-0.209,P0.05)呈负相关。VFA与WC(r=0.457,P0.05)、BMI(r=0.323,P0.05)、LFC(r=0.812,P0.05)、TG(r=0.251,P0.05)、TC(r=0.200,P0.05)、LDL-C(r=0.225,P0.05)呈正相关。VFA与年龄、AST、ALT、FBG、Hb A1c无相关性;5 A组、B组、C组、HTWC表型组中,VFA≥100cm2的检出率分别为16.7%、44%、54.5%、74.4%。以VFA是否大于或等于100cm2为因变量(否=0,是=1),以TG、TC、LDL-C、HDL-C、AST、ALT、BMI、WC、LFC、TG与WC分层(TG1.7mmol/l、WC90cm设为1;TG≥1.7mmol/l、WC90cm设为2;TG1.7mmol/l、WC≥90cm设为3;TG≥1.7mmol/l、WC围≥90cm设为4)作为自变量,进行Logistic回归分析,结果显示除LFC外,HTWC表型也是中青年男性2型糖尿病合并VFA≥100cm2的危险因素,校正TG、TC、LDL-C、HDL-C、AST、ALT、BMI、WC、LFC后,HTWC表型组VFA≥100cm2的检出率仍是A组的12.597倍,(OR=12.597,95%:1.359~116.730)。结论:1患有2型糖尿病且合并HTWC表型的中青年男性人群中,其VFA及LFC水平明显上升。HTWC表型是中青年男性2型糖尿病伴VFA升高的危险因素,可作为初步筛查VFA是否大于或等于100cm2的简单指标。2中青年男性2型糖尿病患者中,VFA与LFC存在明显的正相关性。考虑到肝脏活检、质子磁共振波谱分析等测量LFC的方法成本高、难以推广,肝脏回声衰减系数法测量LFC工作量大、耗时多,而生物电阻抗法测量VFA操作简便、成本低廉等原因,可利用生物电阻抗法测得的VFA水平去判断LFC的增减趋势。3患有2型糖尿病且合并HTWC表型的中青年男性人群中,其NFS明显上升,较非HTWC表型者更易进展为肝纤维化。
[Abstract]:Objective: To study the young and middle-aged male patients with type 2 diabetes and hypertriglyceridemic waist phenotype (hypertriglyceridemic-waist circumference, phenotype, HTWC) and liver fat content (liver fat, content, LFC) and visceral fat area (visceral fat, area, VFA) of the relationship, and to analyze the correlation between LFC and VFA. Methods: 134 cases randomly from October 2015 ~2016 year in August in the Department of endocrinology of Qinhuangdao First Hospital hospitalized male patients with type 2 diabetes, distribution of 20-64 years of age, the average age was 46.69 + 10.72 years old. The group requires strict adherence to the diagnostic criteria for diabetes in 2006. The 134 amendment WHO were divided into four groups: 1) triglyceride 1.7mmol/l, waist 90cm (group A, 30 people) 2); triglycerides than 1.7mmol/l, waist 90cm (group B, 32 people); 3) triglyceride 1.7mmol/l, waist circumference is greater than or equal to 90cm (C, 33); 4) were larger than 1.7mmol/l, waist circumference is greater than or equal to 9 0cm (HTWC phenotype group, 39). Visceral fat obesity (VFO) diagnostic criteria: VFA = 100cm2. was selected to exclude patients with type 1 diabetes: 1), a special type of diabetes; 2) more than 5 years history of drinking alcohol, converted into a weekly intake of more than 140g; 3) virus, caused by autoimmune factors liver disease; 4) diabetic ketosis and ketoacidosis; 5) before admission application of lipid-lowering drug history, history of malignancy, history of psychiatric disorders, recent infection history. All patients collected information as follows: age, height, weight, waist circumference (waist, circumference, WC, VFA, LFC), triglycerides (triglyceride, TG), total cholesterol (total cholesterol, TC), low density lipoprotein cholesterol (low density, lipoprotein-cholesterol, LDL-C), high density lipoprotein cholesterol (high density, lipoprotein-cholesterol, HDL-C), alanine aminotransferase (alanine, aminotransferase, ALT), aspartate aminotransferase (aspartate aminotransferase, AST) , platelet, albumin, fasting blood glucose (fasting blood, glucose, FBG), glycosylated hemoglobin (Hb A1c). Body mass index (body mass index, BMI). The calculation of nonalcoholic fatty liver fibrosis score (NAFLD fibrosis score, NFS, NFS=-1.675+0.037) * age (years old) +0.094 * BMI (+1.13 * kg/m2) impaired fasting glucose / diabetes (=1, =0) +0.99 * AST/ALT-0.013 * -0.066 * (* 109/L) platelet albumin (g/L).VFA measurement method for bioelectrical impedance analysis, the use of instruments for laboratory bio impedance body composition analyzer (model S10).LFC measurement method for liver echo attenuation coefficient method the liver ultrasound image selected, analyzed by IMIGE J software, and into the specific calculation formula. Using the SPSS 17 software was used for data analysis. The data of normality and homogeneity of variance before analysis with the measurement of normal distribution. The data are expressed by X + s, the non normal distribution data of logarithmic transformation. Compared with normal distribution measurement data between groups variance analysis, multiple comparison between groups using LSD test, non normal distribution measurement data using the Wilcoxon rank sum test (Kruskal-Wallis H test). Single factor correlation analysis using Pearson correlation analysis method and by drawing scatter plot. Count data were compared using the x 2 test, screening the risk factors by Logistic regression analysis.P0.05 the difference was statistically significant. Results: 1 A, B, C, HTWC group of average VFA were 72.50 + 12.07,91.15 + 18.89,97.11 + 15.57121.75 + 20.2.HTWC group was significantly higher than the average VFA A, B, C group (P = 0.00,0.00,0.00), C group average VFA was significantly higher than A group (P=0.00), B group average VFA was significantly higher than A group (P=0.006), B VFA C, there was no significant difference between groups (P=0.367); 2 A, B, C, HTWC group average LFC was 12.22 + 2.16,23.16 + 5. 75,23.53卤5.07,32.39卤6.78.HTWC缁勫钩鍧嘗FC鏄庢樉楂樹簬A,B,C缁，

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