老年2型糖尿病合并非酒精性脂肪性肝病与25-OH-D3的相关性研究

发布时间：2018-07-28 14:04

【摘要】：目的本研究旨在通过观察老年2型糖尿病(T2DM)患者合并或不合并非酒精性脂肪性肝病(NAFLD)时,血糖、血压、血脂、肝功、血尿酸、25-OH-D3等指标的变化,探讨老年2型糖尿病患者发生非酒精性脂肪性肝病的相关影响因素及其与25-OH-D3的关系。方法收集2015年8月至2016年7月兰州大学第一医院老年病科及内分泌科住院患者201例,年龄在60-87岁,分为老年T2DM合并(103例)或不合并(98例)NAFLD两组。采用离子层析高效液相、酶联免疫、B型超声检测等技术手段,比较两组患者的年龄构成、性别、病程、常见合并症患病情况、体重指数(BMI)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血尿酸(UA)、甘油三酯(TG)、血清总胆固醇(TC)、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(HbAlc)、空腹血糖(FBG)、空腹胰岛素(FINS)、空腹C肽、餐后2小时血糖(2hPBG)、胰岛素抵抗指数(HOMA-IR)、25羟基维生素D3(25-OH-D3)。应用SPSS18.0软件进行统计学分析,探讨老年T2DM患者发生NAFLD的相关危险因素以及与25-OH-D3的关系。结果(1)老年T2DM合并NAFLD组的患者发生高血压、冠心病、颈动脉粥样硬化的机率均高于老年T2DM不合并NAFLD组的患者,差异具有统计学意义(P0.05)。(2)老年T2DM合并NAFLD组的患者,其糖尿病患病病程、BMI、FINS、C肽、UA、TC、TG、SBP、DBP、HOMA-IR均高于老年T2DM不合并NAFLD组患者,差异具有统计学意义(P0.05)。HDL-C、25-OH-D3水平低于老年T2DM不合并NAFLD组患者,差异具有统计学意义(P0.05)。(3)老年T2DM合并NAFLD组患者的维生素D缺乏及维生素D不足发生的比例明显高于老年T2DM不合并NAFLD组患者,差异具有统计学意义(P0.05)。(4)老年T2DM合并NAFLD组患者的25-OH-D3水平与年龄、FBG、HbAlc、2hPBG、TG、TC、LDL-C、HOMA-IR呈负相关,差异均具有统计学意义(P0.05)。(5)多因素logistic回归分析,结果显示,BMI(OR=1.188,P0.05)、TG(OR=1.660,P0.05)、HOMA-IR(OR=1.660,P0.001)是老年T2DM患者NAFLD发生的危险因素,HDL-C、25-OH-D3则为老年T2DM患者NAFLD发生的保护因素。结论(1)老年T2DM合并NAFLD的患者较老年T2DM不合并NAFLD的患者具有更多的心、脑血管合并症发病的危险因素,其发生心、脑血管系统并发症的机率明显升高。(2)老年T2DM合并NAFLD的患者较老年T2DM不合并NAFLD的患者25羟基维生素D3的水平明显降低。25羟基维生素D3的缺乏会使非酒精性脂肪性肝病的患病率增加。探讨25羟基维生素D3与非酒精性脂肪性肝病的关系,对提早发现心、脑血管并发症,并及时进行干预和治疗具有重要的临床意义。
[Abstract]:Objective to investigate the changes in blood glucose, blood pressure, blood lipid, liver function, blood uric acid and 25-OH-D3 by observing the changes of blood glucose, blood pressure, blood lipid, liver function, blood uric acid and 25-OH-D3 in elderly type 2 diabetes mellitus (T2DM) patients with or without nonalcoholic fatty liver disease (NAFLD), and to explore the related factors of non-alcoholic fatty liver disease in elderly patients with type 2 diabetes and their relationship with 25-OH-D3. Methods 201 hospitalized patients in the Department of geriatrics and Department of endocrinology of First Hospital Affiliated to Lanzhou University from August 2015 to July 2016 were collected, aged at 60-87 years old, divided into aged T2DM (103 cases) or no (98 cases) NAFLD two groups. The age composition of the two groups was compared by ion chromatography high performance liquid, enzyme linked immunosorbent assay and B type superacoustic detection. Course of disease, common complication, body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum uric acid (UA), triglyceride (TG), serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glycated hemoglobin (HbAlc), fasting blood glucose (FBG), fasting pancreas Isisin (FINS), fasting C peptide, 2 hour postprandial blood glucose (2hPBG), insulin resistance index (HOMA-IR), and 25 hydroxyvitamin D3 (25-OH-D3). Statistical analysis was carried out with SPSS18.0 software to explore the risk factors of NAFLD in elderly T2DM patients and the relationship with 25-OH-D3. Results (1) elderly T2DM combined with NAFLD group had hypertension and coronal heart. The risk of disease and carotid atherosclerosis was higher than that of the elderly T2DM without NAFLD group, and the difference was statistically significant (P0.05). (2) the elderly T2DM combined with NAFLD group had the course of diabetes, BMI, FINS, C peptide, UA, TC, TG, SBP, and the difference was statistically significant. The 25-OH-D3 level was lower than that of the elderly T2DM without NAFLD group, and the difference was statistically significant (P0.05). (3) the proportion of vitamin D deficiency and vitamin D deficiency in the elderly T2DM combined with NAFLD group was significantly higher than that in the elderly T2DM without NAFLD group, the difference was statistically significant (P0.05). (4) the elderly T2DM merged patients The 3 level was negatively correlated with age, FBG, HbAlc, 2hPBG, TG, TC, LDL-C, and HOMA-IR, and the difference was statistically significant (P0.05). (5) multiple factor Logistic regression analysis. The results showed that BMI (OR=1.188, P0.05) was the risk factor for the elderly patients. Conclusions (1) 1 patients with NAFLD in elderly patients with T2DM without NAFLD have more heart and risk factors for cerebrovascular complication, their incidence of cardiovascular system complications is significantly higher. (2) elderly T2DM with NAFLD in patients with older T2DM without NAFLD with 25 hydroxyl groups The level of.25 hydroxyl vitamin D3 is obviously reduced by the level of prime D3, which will increase the prevalence of nonalcoholic fatty liver disease. The study of the relationship between 25 hydroxyvitamin D3 and non-alcoholic fatty liver disease is of significant clinical significance for early detection of heart, cerebrovascular complications, and timely intervention and treatment.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R575

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