非酒精性脂肪性肝病与糖脂代谢异常

发布时间：2018-04-11 09:32

本文选题：非酒精性脂肪性肝病 + 糖代谢异常　；参考：《郑州大学》2014年硕士论文

【摘要】：1背景与目的非酒精性脂肪性肝病(NAFLD)及2型糖尿病（T2DM）是世界范围内的常见病、多发病,其发病率在近几十年来有了显著的增加。估计我国现有NAFLD患者约1.5亿[1]，已经达到了流行病的程度。NAFLD的发生与代谢综合征（MS）、糖耐量异常、T2DM有密不可分的联系。循证医学研究显示，NAFLD是T2DM和动脉粥样硬化相关疾病的高危因素, T2DM患者中约80%患者合并NAFLD，是加重肝脏和外周胰岛素抵抗、导致糖尿病进展和恶化的重要原因[2]。因此NAFLD的筛查将有助于预测T2DM和心血管疾病的发生，对NAFLD的预防和治疗也能帮助有效地防治T2DM。但目前体检人群中往往只关注空腹血糖（FBG）的水平，可能会漏诊FBG正常的糖代谢异常。本研究通过调查在我院体检的行政机关工作人员中NAFLD的患病率，了解其具体发病趋势。进一步于FBG正常的NAFLD患者中行OGTT试验、胰岛素释放试验，以便观察NAFLD患者中糖代谢异常的患病率，并同时观察了体检人群中肥胖、高血压病、高甘油三酯血症、高胆固醇血症、高LDL-C血症的患病率，探讨NAFLD与糖脂代谢异常及IR的联系，为早期干预提供帮助。 2对象与方法 2.1分组共纳入2013年1月-2013年7月在郑州大学第二附属医院体检中心体检的年龄在25-60岁空腹血糖正常的男、女城市居民（行政机关单位工作人员）1000例为调查对象。在患有NAFLD的人群中，，随机招募122例作为NAFLD组，其中男70例，女52例，平均年龄49.20±10.88岁，从非NAFLD人群中随机招募88例为正常对照组，其中男46例,女42例，平均年龄48.02±9.63岁。两组性别、年龄、病程等一般资料比较无明显差异。将122例NAFLD人群按脂肪变严重程度进一步分为轻度脂肪肝组、中度脂肪肝组、重度脂肪肝组。 2.2观测指标 2.2.1体检人群中肥胖、NAFLD、高血压病、高甘油三脂血症、高胆固醇血症、高LDL-C血症的患病率； 2.2.2体检人群中NAFLD与非NAFLD人群肥胖、高血压病、高甘油三酯血症、高胆固醇血症的患病率； 2.2.3NAFLD组及正常对照组中糖代谢异常患病率的比较； 2.2.4NAFLD组与正常对照组各生化指标及BMI、腰围、臀围、WHR、SBP、DBP相关性分析。 2.3统计方法统计分析采用SPSS17.0软件包进行，计量资料以均数±标准差表示，两组比较采用t检验，计数资料组间比较采用x2检验，检验水准α=0.05,不同程度脂肪肝与各指标的关系分析用spearman相关分析。 3结果 3.11000例体检人群中，代谢性疾病的患病率分别为高血压34.0%、肥胖12.0%、NAFLD30.1%、高甘油三酯血症25.4%、高胆固醇血症15.5%、高LDL-C血症12.0%; 3.2NAFLD人群中各种代谢性疾病的患病率均高于非NAFLD人群，分别为肥胖7.9%VS4.2%、高血压病47.6%VS25.7%、高胆固醇血症22.6%VS18.0%和高甘油三酯血症51.2%VS14.2%,差异均有显著性(P＜0.05)； 3.3NAFLD及正常对照组中糖代谢异常的患病率；根据OGTT检测结果，NAFLD组糖代谢异常50例（41.0％），其中合并糖尿病15例（12.3％），糖耐量减退30例（24.6％），空腹血糖调节受损5例（4.0％）。正常对照组糖代谢异常16例（18.2％）。NAFLD比正常对照组中糖代谢异常患病率明显升高，差异有显著性（P＜0.05）； 3.4NAFLD及正常对照组各生化指标及BMI、腰围、臀围、WHR、SBP、DBP的比较； NAFLD组BMI、腰围、TG、HOMA-IR、FINS、2hINS、HbA1C、PBG、SBP的平均水平均显著高于正常对照组，差异有显著性(P＜0.05)。两组患者TC、LDL-C、HDL-C、WHR、DBP、臀围的比较则无显著差异(P＞0.05)；3.5不同程度脂肪肝与各生化指标及BMI、腰围、臀围、WHR、SBP、DBP分析。不同程度脂肪肝与HOMA-IR、BMI、TG、FINS、2hINS、腰围、HbA1c和PBG呈正相关。 4结论 4.1NAFLD合并肥胖、高血压病、高甘油三酯血症、高胆固醇血症的患病率高于健康人群； 4.2NAFLD患者较健康人群存在明显的胰岛素抵抗及糖脂代谢异常； 4.3NAFLD人群中HOMA-IR、BMI、TG、FINS、2hINS、腰围、HbA1C、PBG与NAFLD严重程度呈正相关； 4.4空腹血糖正常的NAFLD患者应行OGTT试验以发现以餐后血糖高为主的糖代谢异常。
[Abstract]:1 Background and Purpose

Non - alcoholic fatty liver disease and type 2 diabetes mellitus ( T2DM ) are common diseases in the world . The incidence of the disease has been significantly increased in recent decades . It is estimated that about 150 million LD patients in our country have reached epidemic proportions . According to the evidence - based medical study , the incidence and metabolic syndrome ( MS ) , impaired glucose tolerance and T2DM are closely related to the disease . Therefore , the screening of naf ld will help to predict the onset of T2DM and cardiovascular disease , and the prevention and treatment of naf ld can also help to effectively prevent T2DM .

In the present study , the prevalence of fasting blood glucose ( FBG ) is usually focused on fasting plasma glucose ( FBG ) , and the abnormal glucose metabolism may be missed . In this study , the prevalence of the abnormal glucose metabolism in the staff of the administrative organ in our hospital is investigated . The prevalence of obesity , hypertension , triglyceride , hypercholesterolemia and high LDL - C in the patients with healthy subjects were investigated .

2 Objects and Methods

2.1 Grouping

A total of 1000 cases of male and female urban residents ( administrative organs ) were enrolled in the physical examination center of the Second Affiliated Hospital of Zhengzhou University from January 2013 to July 2013 . Among them , 122 cases were randomly recruited as control group . Among them , there were 46 males and 42 females , the average age was 48.02 卤 9.63 years .

2.2 Observation indicators

2.2 . 1 Prevalence of obesity in the physical examination population , NALD , hypertension , hyperlipidemia , hypercholesterolemia , and high LDL - C ;

2.2 . 2 Prevalence of obesity , hypertension , high triglyceride and hypercholesterolemia in the population of the physical examination .

2.2 . 3Comparison of the prevalence of glucose metabolism in the patients with naf LD group and normal control group ;

2.2 . 4Analysis of correlation between the biochemical indexes and BMI , waist circumference , hip circumference , WHR , SBP , DBP and DBP of the healthy control group were analyzed .

2.3 Statistical method

Statistical analysis was carried out with SPSS 17.0 software package , and the measurement data was expressed by mean 卤 standard deviation . The comparison between the two groups was t - test , and the comparison between the two groups was x2 test , the test level was 伪 = 0.05 , and the relationship between fatty liver and each index was analyzed by the correlation analysis .

3 Results

Among them , the prevalence of metabolic diseases was 34.0 % , 12.0 % in obesity , 30.1 % in LD , 25.4 % in high triglyceride , 15.5 % in hypercholesterolemia , and 12.0 % in high LDL - C , respectively .

3 . The prevalence of various metabolic diseases in the population of the disease was higher than that in the non - naoLD group ( 7.9 % VS4.2 % , 47.6 % VS21.7 % ) , hypercholesterolemia ( 22.6 % ) and high triglyceride ( 51.2 % VS14.2 % ) ( P < 0.05 ) .

3 . The prevalence of glucose metabolism abnormality in the normal control group .

According to the results of OGTT , there were 50 cases ( 41.0 % ) of glucose metabolism abnormality in the patients with diabetes mellitus , including 15 cases of diabetes mellitus ( 12.3 % ) , 30 cases of impaired glucose tolerance ( 24 . 6 % ) , impaired fasting blood glucose regulation ( 4.0 % ) , and abnormal glucose metabolism in normal control group ( 18.2 % ) .

3 . The biochemical indexes and BMI , waist circumference , hip circumference , WHR , SBP and DBP of the patients were compared with those of normal control group .

The average levels of BMI , waist circumference , TG , homeostasis - IR , FBG , 2hINS , HbA1C , pbg and SBP were significantly higher than those in the normal control group ( P < 0.05 ) . There was no significant difference in TC , LDL - C , HDL - C , WHR , DBP and hip circumference in both groups ( P > 0.05 ) .
3.5 Fatty liver and biochemical indexes and BMI , waist circumference , hip circumference , WHR , SBP and DBP were analyzed .

Different levels of fatty liver were positively correlated with BMI , TG , FBG , 2hINS , waist circumference , HbA1c and pbg .

4 Conclusion

4 . The prevalence of high - cholesterol was higher than that in healthy population by combining with obesity , hypertension , triglyceride and hypercholesterolemia .

4 . There were obvious insulin resistance and glycolipid metabolism abnormality in the healthy population of the patients with the disease .

4 . There was a positive correlation between BMI , TG , FBG , 2hINS , waist circumference , HbA1C and PBLD severity among the patients with the disease .

4.4 Patients with normal fasting blood glucose should undergo OGTT test to find the abnormal glucose metabolism based on postprandial blood glucose .

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.1

【参考文献】