2型糖尿病合并非酒精性脂肪性肝病患者血清骨钙素水平的变化及相关影响因素

发布时间：2019-03-19 22:11

【摘要】：目的:随着2型糖尿病(T2DM)的患病率的增高,T2DM合并非酒精性脂肪性肝病(NAFLD)的检出率也逐渐增高。国外的一项研究显示,普通人群的NAFLD患病率为5%,但在肥胖和T2DM患者中可高达25%~75%。骨钙素(OC)是由成骨细胞合成的具有钙调节蛋白属性的结构蛋白,在调节骨矿化、骨成熟及骨重塑方面具有重要作用。但现最新研究表明,OC可能参与能量代谢的调节,可以逆转胰岛素抵抗、高血糖和肥胖,同时还可以降低能量消耗。本研究的目的是研究血清骨钙素在2型糖尿病患者发生非酒精性脂肪性肝病中的作用。方法:选取104名T2DM男性患者为研究对象,通过腹部B超分为NAFLD+T2DM组、T2DM组,同时选取29例健康男性为设为正常对照组。所有研究对象需记录降糖治疗方法、糖尿病病程、身高、体重等临床资料,并测定血清OC浓度、空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、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)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(γ-GT)、体重指数(BMI)等指标。比较三组研究对象之间的OC浓度及相关指标有无显著性差异,并进行OC与所测参数之间的相关性分析。结果:NAFLD+T2DM组TC、TG、LDL-C、FBG、BMI、HbA1c、胰岛素抵抗指数(HOMA-IR)、FINS、ALT高于T2DM组,差异有统计学意义(P0.05),而HDL-C、25-羟基维生素-D3、OC低于T2DM组,差异有统计学意义(P0.05);NAFLD+T2DM组HOMA-IR、BMI、TC与血清OC存在负相关,但T2DM组与正常对照组无此相关性。NAFLD+T2DM组和T2DM组FBG、HbA1c与血清OC水平存在负相关,正常对照组无此相关性。三组间OC与TG均存在负相关,而与FINS、HDL-C、LDL-C、ALT、γ-GT、HOMA-β指数之间却无相关性;多重线性回归分析结果显示,TG(β=-0.029,P=0.000)、HbA1c(β=-0.282,P=0.006)、FBG(β=-0.022,P=0.010)是血清OC的独立危险因素;logistic回归分析结果显示,OC(OR=0.681,95%CI:0.533~0.870)、25-羟基维生素D3(OR=0.904,95%CI:0.851~0.960)是2型糖尿病合并非酒精性脂肪性肝病的保护性因素。结论:2型糖尿病合并非酒精性脂肪性肝病患者血清OC水平较2型糖尿病患者明显降低,OC是2型糖尿病合并非酒精性脂肪性肝病的保护性因素。
[Abstract]:Aim: with the increase of the prevalence of type 2 diabetes mellitus (T2DM), the detection rate of (NAFLD) in T2DM with non-alcoholic fatty liver disease increased gradually. According to a foreign study, the prevalence of NAFLD in the general population is 5%, but it can be as high as 25% and 75% among obese and T2DM patients. Osteocalcin (OC) (osteocalcin) is a calcium-regulated structural protein synthesized by osteoblasts. It plays an important role in the regulation of bone mineralization, bone maturation and bone remodeling. But new research suggests that OC may be involved in the regulation of energy metabolism, reversing insulin resistance, hyperglycemia and obesity, as well as reducing energy expenditure. The purpose of this study was to investigate the role of serum osteocalcin in the development of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. Methods: a total of 104 male patients with T2DM were selected and divided into NAFLD T2DM group and T2DM group by abdominal ultrasound. 29 healthy men were selected as normal control group. All subjects were required to record the clinical data of hypoglycemic therapy, duration, height and weight of diabetes mellitus. Serum OC concentration, fasting blood glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c) and triglyceride (TG), were measured. Total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), 纬-glutamyl transpeptidase (纬-GT), body mass index (BMI) and so on. There was no significant difference in OC concentration and related indexes among the three groups, and the correlation between OC and the measured parameters was analyzed. Results: the insulin resistance index (HOMA-IR) and FINS,ALT of TC,TG,LDL-C,FBG,BMI,HbA1c, in NAFLD T2DM group were significantly higher than those in T2DM group (P0.05), while the levels of HDL-C,25- hydroxyvitamin-D 3 and OC in HDL-C,25- group were lower than those in T2DM group. The difference was statistically significant (P0.05); There was a negative correlation between HOMA-IR,BMI,TC and serum OC in NAFLD T2DM group, but not between T2DM group and normal control group. There was a negative correlation between FBG,HbA1c and serum OC level in NAFLD T2DM group and T2DM group, but not in normal control group. There was a negative correlation between OC and TG, but no correlation between FINS,HDL-C,LDL-C,ALT, 纬-GT,HOMA- 尾 index and FINS,HDL-C,LDL-C,ALT, 纬-GT,HOMA- 尾 index. Multiple linear regression analysis showed that, TG (尾 =-0.029, P = 0.000) and HbA1c (尾 =-0.282, P = 0.006), FBG (尾 =-0.022, P = 0.010) were independent risk factors for serum OC. The results of logistic regression analysis showed that, OC (OR=0.681,95%CI:0.533~0.870, 25-hydroxyvitamin D3 (OR=0.904,95%CI:0.851~0.960) were the protective factors of type 2 diabetes mellitus with non-alcoholic fatty liver disease. Conclusion: the level of serum OC in type 2 diabetic patients with non-alcoholic fatty liver disease is significantly lower than that in type 2 diabetic patients. OC is a protective factor of type 2 diabetes mellitus with non-alcoholic fatty liver disease.
【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;R575.5

【相似文献】