2型糖尿病合并非酒精性脂肪性肝病的代谢相关危险因素分析

发布时间：2018-06-04 08:25

本文选题：2型糖尿病 + 非酒精性脂肪性肝病　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的通过比较2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的年龄、血压、体重指数(BMI)、血糖、血脂、肝功能、血尿酸(SUA)、胰岛素敏感性及胰岛β细胞功能的变化并分析2型糖尿病合并NAFLD的独立危险因素，来探讨这些代谢相关危险因素在2型糖尿病合并NAFLD发病机制中可能的作用。方法选取2012年10月-2013年7月山西大医院内分泌科住院的2型糖尿病患者389例，根据中华医学会肝脏病分会脂肪肝和酒精性肝病学组2010年1月修订的非酒精性脂肪性肝病诊疗指南诊断非酒精性脂肪肝病诊断标准，分为单纯2型糖尿病组(DM组，204例)，年龄27-85岁，平均(57.9±11.1)岁，病程0.01-22年，平均(6.9±5.9)年。2型糖尿病合并非酒精性脂肪性肝病组(DM+NAFLD组，185例)，年龄29-78岁，平均(52.4±9.7)岁，病程0.01-23年，平均(6.0±4.7)年。由医学专人收集两组患者的年龄、病程、收缩压(SBP)、舒张压(DBP)，测量身高，体重，计算BMI，，采用AU5421全自动生化仪检测血甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶(GGT)、血尿酸(SUA)、采用Dxc800全自动生化分析仪检测糖化血红蛋白水平(HbAlc)，行口服葡萄糖耐量试验(OGTT)、胰岛素释放及C肽释放试验，以改良胰岛素C肽指数[HOMA-IR(CP)]和全身胰岛素敏感指数[ISI comp]评估胰岛素敏感性；以改良胰岛素C肽分泌功能指数[HOMR-islet(CP)]、早期胰岛素分泌功能指数(△I30/△G30)、修正的胰岛β细胞功能指数(MBCI)、葡萄糖处置指数(DI)评估胰岛β细胞功能，两组间比较采用独立样本t检验和重复测量数据应用重复测量因素方差分析，采用非条件二分类Logistic回归分析筛选2型糖尿病合并NAFLD独立危险因素。结果1. DM组和DM+NAFLD组的临床特征资料比较：与DM组比较， DM+NAFLD组BMI(25.07±3.11vs.27.55±3.59)升高，而平均年龄DM+NAFLD组低于DM组(52.4±9.7vs.57.9±11.1)，差异有统计学意义(P0.05)；两组的病程(6.9±5.9vs.6.0±4.7)、SBP (135.3±20.4vs.134.7±14.2)、DBP(82.9±9.7vs.84.5±10.0)水平差异无统计学意义(均P0.05)。2. DM组和DM+NAFLD组的生化指标比较：与DM组比较，DM+NAFLD组TG(1.94±1.47vs.2.78±2.46)、ALT (21.16±11.35vs.29.68±21.13)、 AST(19.54±7.19vs.21.87±9.51)、GGT(30.99±28.26vs.43.86±43.59)、 SUA(271.89±71.21vs.299.93±71.96)升高，而HDL-C(1.11±0.25vs.1.02±0.25)降低，差异均有统计学意义(P0.05)；两组的TC(4.77±1.01vs.4.74±1.13)、LDL-C (2.52±0.56vs.2.54±0.61)、HbAlc (7.68±1.92vs.7.91±1.67)水平差异无统计学意义(均P0.05)。3. DM组和DM+NAFLD组的胰岛素敏感性及胰岛β细胞功能比较：①两组胰岛素敏感性比较：与DM组比较，DM+NAFLD组的HOMA-IR(CP)(1.505±0.004vs.1.507±0.005)升高，ISI(comp)(90.09±69.31vs.59.93±24.52)降低，差异均有统计学意义(P0.05)；②两组胰岛β细胞功能比较：与DM组比较，DM+NAFLD组的糖负荷后30min血糖(G30)(10.88±2.87vs.12.18±2.79)、60min血糖(G60)(14.65±3.69vs.15.99±3.12)、120min血糖(G120)(16.56±5.11vs.17.65±4.29)、180min血糖(G180)(13.92±5.10vs.14.71±4.91)、60min胰岛素(I60)(28.62±23.51vs.36.91±33.47)、120min胰岛素(I120)(36.36±25.60vs.44.38±34.95)、30minC肽(C-P30)(2.74±1.70vs.4.30±6.51)、60minC肽(C-P60)(4.17±2.49vs.5.19±2.96)、120minC肽(C-P120)(6.08±2.79vs.6.76±3.10)升高，而MBCI(4.68±4.31vs.3.83±2.41)、DI (35.40±71.83vs.15.37±13.93)降低，差异均有统计学意义(P0.05)；两组的空腹血糖(G0)(7.91±2.63vs.8.67±2.32)、空腹胰岛素(I0)(10.80±11.54vs.11.50±6.82)、30min胰岛素(I30)(17.36±13.99vs.21.12±14.12)、180min胰岛素(I180)(27.24±25.56vs.31.48±20.05)、空腹C肽(C-P0)(1.88±1.18vs.2.10±1.69)、180min C肽(C-P180)(5.87±2.75vs.6.36±2.79)、HOMR-islet(CP)(50.15±0.16vs.50.14±0.16)、△I30/△G30(2.41±6.84vs.0.97±12.19)差异无统计学意义(均P0.05)。4.2型糖尿病合并非酒精性脂肪性肝病相关因素的Logistic回归：以是否合并NAFLD为应变量，其他可疑影响因素作为自变量，先采用单因素分析，筛选出有统计学意义的16个可疑影响因素，然后采用非条件二分类logistic回归分析，结果显示BMI、ALT、SUA是2型糖尿病合并NAFLD独立危险因素，差异有统计学意义(P0.05)。结论（1）合并NAFLD的2型糖尿病患者普遍较不合并NAFLD的2型糖尿病患者发病年龄早。（2）并发NAFLD的2型糖尿病患者较无NAFLD合并症患者脂质代谢紊乱程度更严重。（3）合并NAFLD的2型糖尿病患者胰岛素敏感性，糖负荷后胰岛β细胞分泌功能和调节血糖稳态能力下降，糖负荷后血糖紊乱程度更严重。（4）BMI、ALT及SUA升高可促进2型糖尿病合并NAFLD发生、发展。
[Abstract]:Objective to compare the age, blood pressure, body mass index (BMI), blood sugar, blood lipid, liver function, blood uric acid (SUA), insulin sensitivity and islet beta cell function in type 2 diabetes (T2DM) with non-alcoholic fatty liver disease (NAFLD), and to analyze the independent risk factors of type 2 diabetes combined with NAFLD, to explore these metabolic risk factors in 2. The possible role of type NAFLD diabetes mellitus in the pathogenesis of type 2 diabetes mellitus.
Methods 389 patients with type 2 diabetes hospitalized in the Department of Endocrinology, Shanxi large hospital, October 2012, were selected to diagnose nonalcoholic fatty liver disease (nonalcoholic fatty liver disease) according to the guidelines for diagnosis and treatment of nonalcoholic fatty liver disease (nonalcoholic fatty liver disease), which was revised by the fatty liver of the Chinese Medical Association and the alcoholic liver disease group in January 2010, and divided into the simple type 2 diabetes group (D Group M, 204 cases, age 27-85 years, average (57.9 + 11.1) years, course of disease 0.01-22, the average (6.9 + 5.9) years of type.2 diabetes combined with non-alcoholic fatty liver disease (group DM+NAFLD, 185 cases), age 29-78 years, average (52.4 + 9.7) years, the course of 0.01-23 years, average (6 + 4.7) years. Zhang Ya (DBP), measuring height, weight, and calculating BMI, using a AU5421 automatic biochemical analyzer to detect blood glycerin three fat (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), blood uric acid (SUA), Dxc, and Dxc 800 fully automated biochemical analyzer test glycosylated hemoglobin level (HbAlc), oral glucose tolerance test (OGTT), insulin release and C peptide release test, to improve the insulin C peptide index [HOMA-IR (CP) and the whole body insulin sensitivity index [ISI comp] to evaluate Shima Somin sensibility; to improve the insulin C peptide secretory function index [HOMR-islet (CP) The early insulin secretion function index (delta I30/ Delta G30), the modified islet beta cell function index (MBCI) and the glucose disposal index (DI) were used to evaluate the islet beta cell function. The two groups were compared with the independent sample t test and repeated measurement data to apply the variance analysis of the repeated measurement factors, and the non conditional two classification Logistic regression analysis was used to screen the 2 types. Diabetes combined with NAFLD independent risk factors.
Results compared with group 1. DM and group DM+NAFLD, compared with group DM, BMI (25.07 + 3.11vs.27.55 + 3.59) in group DM+NAFLD was higher, while the average age of DM+NAFLD group was lower than that of DM group (52.4 + 9.7vs.57.9 + 11.1), and the difference was statistically significant (P0.05); the course of disease in the two group (6.9 + + 4.7), SBP (135.3 + 14.2), 82.9 + 9. 7vs.84.5 + 10) there was no statistical significance (P0.05) in.2. DM group and DM+NAFLD group: compared with group DM, DM+NAFLD group TG (1.94 + 1.47vs.2.78 + 2.46), ALT (21.16 + + 21.13), AST (19.54 + 9.51), 30.99 + 43.59 + 43.59, and 271.89 + 271.89 + 71.96. And HDL-C (1.11 + 0.25vs.1.02 + 0.25) decreased, the difference was statistically significant (P0.05), TC (4.77 + 1.01vs.4.74 + 1.13), LDL-C (2.52 + 0.56vs.2.54 + 0.61), HbAlc (7.68 + 1.92vs.7.91 + 1.67), HbAlc (P0.05) HbAlc (P0.05).3. DM group and insulin sensitivity and islet beta cell function comparison: (1) two Group insulin sensitivity comparison: compared with group DM, HOMA-IR (CP) (1.505 + 0.004vs.1.507 + 0.005) in group DM+NAFLD and ISI (COMP) (COMP) (90.09 + 69.31vs.59.93 + 24.52) decreased, and the difference was statistically significant (P0.05). (2) the function of islet beta cells in the two group was compared with the DM group, and the 30min glucose (10.88 +) after the sugar load in the DM+NAFLD group (10.88 +) 2.18 + 2.79), 60min blood glucose (G60) (14.65 + 3.69vs.15.99 + 3.12), 120min blood glucose (G120) (16.56 + 5.11vs.17.65 + 4.29), 180min glucose (G180) (13.92 + 5.10vs.14.71 +), 60min insulin (I60) (28.62 + + 33.47), pancreatic islet (36.36 + + 34.95). (C-P60) (4.17 + 2.49vs.5.19 + 2.96), 120minC peptide (C-P120) (6.08 + 2.79vs.6.76 + 3.10) increased, and MBCI (4.68 + 4.31vs.3.83 + 2.41), DI (35.40 + 71.83vs.15.37) decreased, the difference was statistically significant (P0.05); the two group of fasting glucose (7.91 + 2.63vs.8.67 2.32), fasting insulin (10.80 + + 6.82), pancreas Isle (I30) (17.36 + 13.99vs.21.12 + 14.12), 180min insulin (I180) (27.24 + 25.56vs.31.48 + 20.05), C-P0 (1.88 + 1.18vs.2.10 + 1.69), 180min C peptide (C-P180) (5.87 + + 2.79) and 50.15 + 1.69 0.16. Logistic regression of the related factors of nonalcoholic fatty liver disease in type 2 diabetes mellitus: using NAFLD as a variable, other suspicious factors as independent variables, first using single factor analysis, screening out 16 statistically significant factors, and then using non strip two classified logistic regression analysis, the results showed BMI, ALT SUA is an independent risk factor for type 2 diabetes mellitus combined with NAFLD, and the difference is statistically significant (P0.05).
Conclusions (1) patients with type 2 diabetes combined with NAFLD were generally earlier than those with type 2 diabetes without NAFLD. (2) patients with type 2 diabetes complicated with NAFLD had more severe lipid metabolic disorders than those without NAFLD. (3) islet sensitivity in type 2 diabetic patients with NAFLD, secretory function and modulation of islet beta cells after glucose load The glucose homeostasis ability decreased, and the degree of blood glucose disorder was more serious after sugar load. (4) the increase of BMI, ALT and SUA could promote the occurrence and development of type 2 diabetes with NAFLD.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.1;R575.5

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