CIMT、FFA、抵抗素与T2DM合并NAFLD相关研究

发布时间：2018-03-29 01:04

  本文选题：2型糖尿病　切入点：非酒精性脂肪肝　出处：《承德医学院》2017年硕士论文

【摘要】：近30年来,我国糖尿病(diabetes mellitus,DM)的患病率显著升高,2010年的调查发现我国18岁以上人群DM的患病率已高达11.6%。同时,我国非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)的发病率及检出率也呈逐年增加趋势。流行病学资料显示,约34%-74%的2型糖尿病(type 2 diabetes mellitus,T2DM)患者合并NAFLD。T2DM与NAFLD共同的发病机制是胰岛素抵抗(insulin resistance,IR)。T2DM患者常存在IR及脂质的代谢障碍,脂毒性是其作用机制之一。血清游离脂肪酸(free fatty acid,FFA)为脂代谢的中间产物,当其水平升高或细胞内脂肪的含量增加时,能够诱发或加重IR及对胰岛β细胞功能的损害,从而促使T2DM的发生,其主要作用于胰腺、肝脏、肌肉等部位。脂肪组织不单单因为是存储能量的器官而在人体内存在,其也是机体最大的内分泌器官。脂肪组织分泌的抵抗素、TNF-a等细胞因子,不仅在炎症免疫调节方面发挥作用,而且参与机体的代谢调节。近些年的研究表明,脂肪组织分泌的抵抗素与IR之间有着密切的联系,可通过减弱胰岛素信号级联反应中多个环节的作用而导致IR,参与T2DM及NAFLD等疾病的发病过程。大量研究表明,T2DM合并NAFLD者心血管等大血管并发症的发生风险增高,且独立于其他危险因素。T2DM和NAFLD皆为动脉粥样硬化(atherosclerosis,AS)的独立危险因素。颈动脉是早期AS常见的发生部位,在临床工作中常将颈动脉内膜中层厚度(carotid artery intima media thickness,CIMT)作为AS的预测因素。因此,本研究拟通过对138例T2DM患者的临床资料进行分析,来探讨CIMT、FFA、抵抗素与T2DM合并NAFLD的关系。目的:本研究旨在通过观察T2DM合并不同程度NAFLD患者间CIMT、FFA、抵抗素的差异,探讨CIMT、FFA、抵抗素与T2DM合并NAFLD的关系,为临床上该类人群制定预防控制策略提供临床依据。方法:连续入选承德医学院附属医院内分泌科2015年3月~2015年10月期间住院的t2dm患者143例,其中138例符合入选标准。收集以下资料:(1)患者一般资料:性别、年龄、血压、身高、体重、腰围(wc)等;(2)生化指标:所有患者均于隔夜清晨空腹状态下抽取静脉血,送至检验科测定总胆固醇(tch)、甘油三酯(tg)、低密度脂蛋白胆固醇(ldl-c)、高密度脂蛋白胆固醇(hdl-c)、糖化血红蛋白(hba1c)、空腹血糖(fpg);(3)进行肝脏和颈动脉彩超检查;(4)计算体质量指数(bmi)。按照超声检查回报的结果将研究对象分为t2dm不合并nafld组(a组,n=44)、t2dm合并轻度nafld组(b组,n=39)及t2dm合并中重度nafld组(c组,n=55)。结果:1一般资料比较单因素方差分析结果显示三组在性别、年龄、血压方面差异无统计学意义(p0.05)。b组、c组的wc、bmi测定值分别为:(92.77±5.86)cm、(95.69±5.86)cm和(26.25±3.01)kg/m2、(27.53±2.92)kg/m2,均显著高于a组的(88.02±6.78)cm、(24.60±2.51)kg/m2,差异有统计学意义(p0.05)。与b组相比,c组患者的bmi升高(p0.05)。2糖脂代谢方面比较三组间单因素方差分析结果显示组间差异在tch差异无统计学意义(p0.05),在fpg、hba1c、tg、hdl-c、ldl-c差异有统计学意义(p0.05)。进一步行两两比较显示:与a组的tg(1.40±0.51)mmol/l、fpg(8.84±2.32)mmol/l、hdl-c(0.89±0.13)mmol/l相比,b组的tg(2.08±0.69)mmol/l、fpg(10.16±3.21)mmol/l和c组的tg(2.13±0.60)mmol/l、fpg(10.50±3.15)mmol/l升高,b组的hdl-c(0.82±0.15)mmol/l、c组的hdl-c(0.81±0.11)mmol/l降低,差异有统计学意义(p0.05)。与b组的ldl-c(2.05±0.75)mmol/l、hba1c(9.03±1.56)%相比,c组的ldl-c(2.37±0.65)mmol/l、hba1c(9.69±1.59)%升高,差异有统计学意义(p0.05)。3ffa、抵抗素、cimt水平比较单因素方差分析结果显示三组间ffa、抵抗素及cimt差异均有统计学意义(p0.05)。进一步行两两比较显示:与a组的ffa(513.57±238.02)ng/mL、抵抗素(24.56±8.39)ng/mL、CIMT(0.90±0.17)mm相比,C组的FFA(656.59±250.64)ng/mL、抵抗素(29.94±10.98)ng/mL、CIMT(1.03±0.17)mm均升高,差异有统计学意义(P0.05)。B组的FFA(556.94±248.78)ng/mL、抵抗素(28.20±11.21)ng/mL、CIMT(0.94±0.16)mm与A组、C组相比,差异均无统计学意义(P0.05)。4合并NAFLD的程度与各指标的相关性合并NAFLD的程度与WC、BMI、FPG、HbA1c、TG、LDL-C、CIMT、FFA、抵抗素呈正相关关系(r=0.459,0.403,0.208,0.305,0.438,0.231,0.309,0.244,0.198,P0.05),而与HDL-C呈负相关关系(r=-0.252,P0.01)。结论:T2DM合并NAFLD者肥胖及糖脂代谢紊乱状态更明显,血清FFA、抵抗素水平更高,CIMT值更大;并且随NAFLD严重程度的增加而更严重。
[Abstract]:In the past 30 years, China's diabetes (diabetes mellitus, DM) significantly increased the prevalence rate, the 2010 survey found that people over the age of 18 the prevalence of DM in China has reached 11.6%. at the same time, China's non alcoholic fatty liver (nonalcoholic fatty liver disease, NAFLD) the incidence and prevalence is also increased trend year by year. Epidemiological data show that type 2 diabetes is about 34%-74% (type 2 diabetes mellitus, T2DM NAFLD.T2DM and NAFLD) with the pathogenesis of patients with common insulin resistance (insulin resistance, IR) metabolic disorders are common in patients with.T2DM IR and lipid, lipid toxicity is one of the mechanisms of serum free fatty acids (free. Fatty acid, FFA) for intermediate products of lipid metabolism, as the increase of the content of elevated levels or intracellular fat, can induce or aggravate IR and damage to the function of islet beta cells, can induce T2DM, as the main In the pancreas, liver, muscle and other parts. The adipose tissue is not only because of the energy storage organs in the human body, which is the body's largest endocrine organ. Adipose tissue secretion of resistin, cytokines such as TNF-a, not only in the inflammatory immune regulation play a role, but also involved in metabolic regulation in recent years. Show that there is a close relationship between resistin and IR secreted by adipose tissue, can be caused by weakening the IR aspects of insulin signaling cascade plays a role in the pathogenesis of T2DM and NAFLD in other diseases. Many studies showed that T2DM and NAFLD in cardiovascular macrovascular complications increased the risk, and independent other risk factors for.T2DM and NAFLD are atherosclerosis (atherosclerosis, AS). The independent risk factors of carotid artery is common occurrence site of early AS, in clinical work The carotid intima-media thickness (carotid artery intima media thickness, CIMT) as predictors of AS. Therefore, this study based on the clinical data of 138 cases of T2DM were analyzed to explore the CIMT, FFA, T2DM and NAFLD and the relationship between resistin. Objective: This study aimed to observe the T2DM with different degree among NAFLD patients CIMT, FFA, resistin differences of CIMT, FFA, T2DM and NAFLD and the relationship between resistin, clinical on the population to develop to provide a clinical basis for the prevention and control strategy. Methods: a total of 143 consecutive patients with T2DM admitted to the Department of endocrinology of Affiliated Hospital of Chengde Medical College during October March 2015 ~2015 cases, including 138 cases of eligible to collect. The following information: (1) patients with general information: gender, age, blood pressure, height, weight, waist circumference (WC); (2): biochemical indexes in all patients were taken in the fasting state overnight 闈欒剦琛，

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