2型糖尿病血糖波动致8-异前列腺素 F2α变化对非酒精性脂肪性肝病的影响

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目的:分析2型糖尿病(T2DM)患者血糖波动和8-异前列腺素F2α(8-iso-PGF2α)水平变化对非酒精性脂肪性肝病(NAFLD)的作用。方法选取2012年10月至2013年11月山西医学科学院山西大医院内分泌科住院的单纯T2DM患者(DM组)30例,T2DM合并NAFLD患者(DM+NAFLD组)32例,另选取体检中心查体健康者30例作为正常糖耐量组(NGT组),三组的年龄、性别、病程、血压、体质量指数(BMI)、血脂差异均无统计学意义( P >0.05)。收集患者临床资料,检测血脂、糖化血红蛋白(HbA1c),均行口服葡萄糖耐量试验(OGTT),用葡萄糖氧化酶法测定各点血糖,以餐后血糖波动幅度(PPGE)、血糖水平标准差(SDBG)和平均血糖(MBG)作为评价血糖波动指标,采用酶联免疫吸附法(ELISA)检测血清8-iso-PGF2α评价氧化应激水平,多组比较采用单因素方差分析,对其影响因素进行相关分析。结果⑴DM组和DM+NAFLD组的PPGE[(7.34±2.23)mmol/L,(8.52±2.43)mmol/L]、SDBG[(2.43±0.90)mmol/L,(2.80±0.78)mmol/L]、MBG[(11.06±1.76)mmol/L,(13.65±2.83)mmol/L]、HbA1c[(7.59±1.02)%,(8.05±1.52)%]水平较NGT组显著升高,差异有统计学意义( P <0.05);与DM组相比,DM+NAFLD组的PPGE、SDBG、MBG水平显著升高,差异有统计学意义( P <0.05),但HbA1c差异无统计学意义( P >0.05);⑵三组血清8-iso-PGF2α比较:NGT组[(33.45±8.60)pg/ml]、DM组[(47.33±15.30)pg/ml]及DM+NAFLD组[(56.07±13.10)pg/ml]水平依次升高,差异有统计学意义( P <0.05);⑶Person相关分析:血清8-iso-PGF2α含量与PPGE、SDBG、MBG呈正相关( r =0.796,0.778,0.712, P <0.01)。结论血清8-iso-PGF2α能更好反映机体氧化应激水平,在2型糖尿病患者中随着血糖波动幅度的增大氧化应激水平越高,是导致NAFLD发生的重要机制之一。“,”Objective To investigate the level change of glucose excursion , 8-iso prostaglandin F 2α( 8-iso-PGF2α) in type 2 diabetes mellitus(T2DM), and its effects on nonalcoholic fatty liver disease (NAFLD).Methods A total of 62 inpatients with type 2 diabetes mellitus including T2DM group(DM, 30 cases) and T2DM with NAFLD group(DM+NAFLD, 32 cases) were recruited from October 2012 to November 2013 , normal glucose tolerance group had normal glucose tolerance ( NGT;30 cases ) with normal physical examination results.The age, gender, duration, blood pressure, body mass index (BMI), and blood lipid among three groups were no statistical difference .The clinical data of each patient were collected by professional people .Blood lipids and glycated hemoglobin (HbA1c) were detected.Oral glucose tolerance test (OGTT) were taken in all groups.The Postprandial glucose excursion (PPGE), blood glucose standard deviation (SDBG), mean blood glucose and (MBG) and HbA1c were used to evaluate the glucose excursion.Serum 8-iso-PGF2αwas detected by enzyme-linked immunosorbent (ELISA) to evaluate oxidative stress.Inter-group com-parison was conducted with analysis of variance ( ANOVA) .Correlation analysis was used to evaluate the factors of influence .Results⑴The levels of PPGE[(7.34 ±2.23) mmol/L vs (8.52 ±2.43) mmol/L],SDBG[(2.43 ±0.90) mmol/L vs (2.80 ±0.78) mmol/L], MBG[(11.06 ±1.76) mmol/L vs (13.65 ±2.83) mmol/L], and HbA1c [(7.59 ±1.02)% vs (8.05 ±1.52)%] in T2DM group and T2DM with NAFLD group were significantly higher than that in NGT group (both P <0.05); and that in NAFLD group have significantly rise than that in DM group ( P <0.05), but there was no significant difference in HbA 1c between groups.⑵ The level of serum 8-iso-PGF2αwas gradually increased from NGT group [(33.45 ±8.60) pg/ml], DM group [(47.33 ±15.30) pg/ml], to DM +NAFLD group [(56.07 ±13.10) pg/ml], with statistically significant difference ( P <0.05);⑶The Person corre-lation analysis showed that the content of serum 8-iso-PGF2αwas positively correlated with PPGE, SDBG, and MBG ( r =0.796, 0.778 , 0.712 , P <0.01 ) .Conclusions Serum 8-iso-PGF2αis a better parameter to reflect the status of body oxidative stress .The level of oxidative stress is increased with the increase of glucose excursion in T 2DM, which is the important mechanism of its complica-tions of NAFLD.
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