肥胖患者非酒精性脂肪肝病与糖代谢关系及肥胖2型糖尿病患者代谢术后早期动态血糖研究

发布时间：2018-06-17 06:20

  本文选题：肥胖 + 非酒精性脂肪肝　； 参考：《南京大学》2017年硕士论文

【摘要】：目的:探究肥胖患者非酒精性脂肪肝病(NAFLD)与糖代谢的关系。方法:研究人群一:纳入170例肥胖(体重指数≥28kg/m^2)患者,根据腹部彩超有无NAFLD分为NAFLD组(134例)及非NAFLD组(36例),行75g葡萄糖口服糖耐量(OGTT)或150克馒头餐糖耐量试验检测空腹血糖(FBG)及餐后2h血糖(PBG)、胰岛素释放试验检测空腹胰岛素(F-INS)、餐后2h胰岛素(2h-INS)、空腹C肽(F-CP)及餐后2hC肽(2h-CP),并计算胰岛素抵抗指数(HOMA-IR)等,同时检测糖化血红蛋白(HbA1c)及谷丙转氨酶(ALT)、谷草转氨酶(AST)、甘油三酯(TG)、总胆固醇(CH)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等生化指标。研究人群二:80例经肝脏病理证实有NAFLD肥胖患者,根据肝脏病理肝脏脂肪含量分为轻度脂肪肝组(F1组,28例)和中重度脂肪肝组(F2-3组,52例),行75g葡萄糖口服糖耐量(OGTT)或150克馒头餐检测四点血糖(FBG、0.5h-BG、1h-BG、PBG)、胰岛素释放试验检测四点胰岛素(F-INS、0.5h-INS、1h-INS、2h-INS)及 C 肽(F-CP、0.5h-CP、1h-CP、2h-CP),并计算HOMA-IR等,检测HbA1c及AST、ALT、谷酰转肽酶(γ-GT)、碱性磷酸酶(AKP)、TG、CH、HDL-C、LDL-C、血尿酸(UA)等生化指标。分析NAFLD与糖代谢的关系。结果:非NAFLD及NAFLD组患者2型糖尿病(T2DM)患病率分别为47.2%和76.1%(P0.05);NAFLD组患者较非NAFLD组患者BMI更高(P0.05);NAFLD 患者 FBG、PBG 及 HbA1c 均较非 NAFLD 组升高(P0.05);NAFLD组患者较非NAFLD组患者ALT、AST及TG水平高(0.05)。F1组及F2-3组T2DM患病率分别为42.6%和51.93%;F2-3组较F1组年龄轻,BMI更高、腰围更大(P0.05);F2-3组患者OGTT或馒头餐四点血糖及HbA1c较F1组有升高趋势(P0.05);F2-3组较F1组F-INS及F-CP水平高(P0.05),胰岛素抵抗显著(P0.05);胰岛素敏感性(ISIm)及2h处置指数(DI 120)显著偏低(P0.05);F2-3 组较 F1 组 ALT、AST 及 γ-GT 水平高(P0.05),血UA水平高(P0.05)。二元逻辑回归提示HOMA-IR为中重度脂肪肝的独立危险因素。结论:肥胖患者合并NAFLD糖代谢紊乱加重,随着肝脏脂肪含量增加,其胰岛素抵抗加重,糖代谢紊乱加重,肝损伤加重,更容易发展为T2DM。目的:探究肥胖2型糖尿病(T2DM)患者代谢术后早期动态血糖变化。方法:14例代谢手术肥胖T2DM患者于术前及术后3月行动态血糖监测(CGM),同时记录身高、体重、体重指数(BMI)、腰围,予150克馒头餐糖耐量实验测定空腹血糖(FBG)、餐后2小时血糖(PBG),胰岛素释放实验测定空腹胰岛素(F-INS)、空腹C肽(F-CP)、餐后2小时胰岛素(2h-INS)、餐后2小时C肽(2h-CP),测定糖化血红蛋白(HbA1c)及甘油三酯(TG)、总胆固醇(CH)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及尿酸(UA)等生化指标,计算胰岛素抵抗指数(HOMA-IR)及胰岛β细胞功能(HOMA-β),观察代谢术后3月动态血糖变化及糖脂代谢及胰岛功能变化。结果:术后3月患者CGM指标平均血糖(MBG)、血糖最高值(BGmax)、血糖最低值(BGmin)均较术前显著下降(P0.01),血糖≥ 7.8mmol/L及≥ 11.1 mmol/L时间百分比(%)及高血糖指数(HBGI)较术前显著降低(P0.01),血糖3.9mmol/L时间百分比及低血糖指数(LBGI)较术前显著升高(P0.05),反应血糖波动的指标如平均血糖标准差(SDBG)、最大血糖波动范围(LAGE)、平均血糖波动范围(MAGE)无明显变化(P0.05)。患者代谢术后3月体重、BMI、腰围较术前显著下降(P0.05),FBG、PBG、HbAlc较术前显著下降(P0.01),F-INS、F-CP 及 HOMA-IR 较术前显著下降(P0.05),HOMA-β 无明显改变(P0.05)。患者术后TG、CH及UA水平较术前显著降低(TGP0.05,CH、UAP0.01)。结论:代谢术后早期患者体重即明显下降,糖代谢及胰岛素抵抗明显改善。
[Abstract]:Objective: To explore the relationship between nonalcoholic fatty liver disease (NAFLD) and glucose metabolism in obese patients. Methods: study population 1: 170 cases of obesity (body mass index more than 28kg/m^2) were included in group NAFLD (134 cases) and non NAFLD group (36 cases) based on abdominal color Doppler ultrasound (NAFLD), and the test of oral glucose tolerance (OGTT) or 150 grams of steamed bread tolerance test was carried out. Fasting blood glucose (FBG) and postprandial 2H blood glucose (PBG). Insulin release test was used to detect fasting insulin (F-INS), postprandial 2H insulin (2h-INS), fasting C peptide (F-CP) and postprandial 2hC peptide (2h-CP), and to calculate the insulin resistance index (HOMA-IR) and so on, and the glycosylated hemoglobin (HbA1c) and glutamic pyruvidase (glutamic acid), triglyceride, triglyceride, and glycosyltransferase were also detected. Total cholesterol (CH), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and other biochemical indicators. Two: 80 cases of NAFLD obese patients were confirmed by liver pathology. The liver pathological liver fat content was divided into mild fatty liver group (F1 group, 28 cases) and moderate and severe fatty liver group (group F2-3, 52 cases), and 75g glucose was taken orally. The glucose tolerance (OGTT) or 150 grams of steamed bread meal tests four points of blood glucose (FBG, 0.5h-BG, 1h-BG, PBG). The insulin release test was used to detect four points of insulin (F-INS, 0.5h-INS, 1h-INS, 2h-INS) and C peptides. The relationship between NAFLD and glucose metabolism was analyzed. Results: the prevalence rates of type 2 diabetes (T2DM) in the non NAFLD and NAFLD groups were 47.2% and 76.1%, respectively (P0.05), and in the NAFLD group, the BMI was higher than that in the non NAFLD group (P0.05), and the NAFLD FBG was higher than that in the non NAFLD group. The prevalence rate of T2DM in group TG (0.05).F1 and F2-3 group was 42.6% and 51.93%, and in group F2-3, the age was lighter, BMI was higher, and the waist circumference was larger (P0.05); OGTT or steamed bread was higher in group F2-3 and HbA1c than that in F1 group. Im) and 2H treatment index (DI 120) were significantly lower (P0.05), F2-3 group was higher than F1 group ALT, AST and gamma -GT level (P0.05), and the blood UA level was high (P0.05). The two yuan logical regression suggested an independent risk factor for moderate and severe fatty liver. Aggravation, aggravation of glucose metabolism, aggravation of liver injury, and more likely to develop into T2DM. Objective: To explore the early dynamic blood glucose changes in obese type 2 diabetes mellitus (T2DM) patients after metabolism. Methods: 14 cases of obese T2DM patients underwent dynamic blood glucose monitoring (CGM) before and after the operation in March, and recorded height, weight, body mass index (BMI), waist circumference, and 150 grams. The steamed bread meal test measured fasting blood glucose (FBG), 2 hours postprandial blood glucose (PBG), fasting insulin (F-INS), fasting C peptide (F-CP), 2 hours postprandial insulin (2h-INS), and 2 hours C peptide (2h-CP) after meal, determination of glycosylated red egg white (HbA1c) and triglyceride (TG), total cholesterol (CH), and high-density lipoprotein cholesterol (HDL-C). The biochemical indexes such as low density lipoprotein cholesterol (LDL-C) and uric acid (UA) were used to calculate the insulin resistance index (HOMA-IR) and islet beta cell function (HOMA- beta). The changes of glucose and lipid metabolism and islet function in March were observed. Results: the average blood glucose (MBG), the highest blood sugar (BGmax) and the lowest blood sugar (B) in the patients in March after the operation were observed. Gmin) was significantly lower than preoperative (P0.01), the percentage of blood sugar > 7.8mmol/L and > 11.1 mmol/L time (%) and hyperglycemia index (HBGI) were significantly lower than before operation (P0.01), the percentage of 3.9mmol/L time and the index of hypoglycemia (LBGI) were significantly higher than before operation (P0.05). The index of blood glucose fluctuation, such as the mean blood glucose standard deviation (SDBG), and the maximum blood sugar The range of fluctuation (LAGE), the average blood glucose fluctuation range (MAGE) had no obvious change (P0.05). The body weight, BMI, waist circumference decreased significantly in March after the operation (P0.05), FBG, PBG, HbAlc decreased significantly (P0.01), F-INS, F-CP, and HOMA-IR were significantly lower than before the operation. It was significantly lower before treatment (TGP0.05, CH, UAP0.01). Conclusion: the body weight of the patients in early stage of metabolism was significantly decreased, and glucose metabolism and insulin resistance were improved significantly.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R589.2;R575.5
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本文编号：2030045