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目的:探讨新诊断的2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)的代谢特征及与视黄醇结合蛋白4(retinol binding protein 4,RBP4)的关系。方法:收集新诊断的T2DM住院患者216例,根据是否合并NAFLD分为T2DM伴有NAFLD组144例和T2DM不伴NAFLD组72例。测量两组患者血压、体质指数(body mass index,BMI)、血脂[总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholestorol,LDL-C)、脂蛋白a(lipoprotein a,Lp-a)]、空腹血糖(fasting blood glucose,FBG)、空腹胰岛素(fasting insulin,FINS)、糖化血红蛋白(HbA1c)、血尿酸(uric acid,UA)、肝功能[γ-谷氨酰转肽酶(γ-glutamyl transpeptidase,γ-GGT)、丙氨酸转氨酶(alanine transarninase,ALT)、天门冬氨酸转氨酶(aspartate transarninase,AST)]及RBP4,比较上述指标在两组间有无差异,并对相关指标做Logistic回归或Pearson相关分析。结果:新诊断的T2DM伴有NAFLD患者的BMI、收缩压、舒张压均高于T2DM不伴NAFLD组,较正年龄、性别、BMI后,T2DM伴NAFLD患者的TG、TC、FINS、胰岛素抵抗指数、γ-GGT、ALT、UA、RBP4显著高于T2DM不伴NAFLD组(P<0.05)。2组FBG、HbA1c、HDL-C、LDL-C、Lp-a、AST在较正年龄、性别、BMI后差异无统计学意义(P>0.05)。Logistic回归分析发现RBP4、BMI、ALT是新诊断的T2DM合并NAFLD的独立危险因素。T2DM合并NAFLD组的RBP4与胰岛素抵抗指数、HbA1c、FINS、γ-GGT、UA显著相关(P<0.05)。结论:新诊断的T2DM伴有NAFLD较不伴NAFLD患者存在明显的胰岛素抵抗,并与代谢综合征组分(肥胖、高血压、高脂血症、高尿酸血症)相伴发生;RBP4及BMI、ALT在预测T2DM合并NAFLD风险方面有重要临床价值。
Objective: To investigate the metabolic characteristics of newly diagnosed type 2 diabetes mellitus (T2DM) complicated with nonalcoholic fatty liver disease (NAFLD) and its relationship with retinol binding protein 4 (RBP4) Relationship. Methods: A total of 216 newly diagnosed T2DM patients were enrolled. According to whether they had NAFLD or not, there were 144 cases of T2DM with NAFLD and 72 cases of T2DM without NAFLD. Blood pressure, body mass index (BMI), total cholesterol (TC), triglyceride (TG) and high density lipoprotein cholesterol (HDL-C , Low density lipoprotein cholestorol (LDL-C), lipoprotein a (Lp-a), fasting blood glucose (FBG), fasting insulin (FINS) Glycosylated hemoglobin (HbA1c), uric acid (UA), liver function, γ-glutamyl transpeptidase (γ-GGT), alanine transaminase (ALT) Aspartate transaminase (AST)] and RBP4. The differences of the above indexes between the two groups were compared. Logistic regression or Pearson correlation analysis was performed on the related indexes. Results: The BMI, systolic blood pressure and diastolic blood pressure of newly diagnosed T2DM patients with NAFLD were higher than that of T2DM patients without NAFLD. The positive rates of TG, TC, FINS, insulin resistance index , Γ-GGT, ALT, UA, RBP4 were significantly higher than T2DM without NAFLD group (P <0.05). The FBG, HbA1c, HDL-C, LDL-C, Lp-a and AST in the two groups had no significant difference after adjusting for age, sex and BMI (P> 0.05). Logistic regression analysis found that RBP4, BMI and ALT were independent risk factors for newly diagnosed T2DM with NAFLD. RBP4 was significantly associated with insulin resistance index, HbA1c, FINS, γ-GGT and UA in T2DM with NAFLD (P <0.05). Conclusions: The newly diagnosed T2DM with NAFLD has obvious insulin resistance compared with non-NAFLD patients and is associated with metabolic syndrome components (obesity, hypertension, hyperlipidemia, hyperuricemia); RBP4 and BMI, ALT has important clinical value in predicting the risk of T2DM with NAFLD.