2型糖尿病合并非酒精性脂肪肝的危险因素研究(1)
摘 要：目的 探讨2型糖尿病合并非酒精性脂肪肝的危险因素。方法 选择2017年1月～12月在我院住院的T2DM患者138例，根据是否合并NAFLD分为两组，合并NAFLD的86例患者设为观察组，52例单纯T2DM设为对照组。比较两组一般临床资料及生化指标，采用回归分析判定其中的独立相关的主要危险因素和(或)保护性因素。结果 两组患者BMI、收缩压、糖化血红蛋白、甘油三酯、高密度脂蛋白、低密度脂蛋白、尿酸、同型半胱氨酸、胰岛素抵抗指数等指标比较，差异有统计学意义(P≤0.05)；将上述有差异指标进行二元Logistic回归分析发现，BMI、TG、SUA、HbA1c、HOMA-IR与T2DM合并NAFLD呈正相关(OR>1，P<0.05)，HDL-C与T2DM合并NAFLD呈负相关(OR<1，P≤0.05)。结论 T2DM合并NAFLD相当常见，BMI、HOMA-IR、HbA1c、TG、SUA是其危险因素，HDL-C 是其保护因素。胰岛素抵抗在并发NAFLD的T2DM者中更加明显。
关键词：2型糖尿病；非酒精性脂肪肝；危险因素；甘油三酯；高密度脂蛋白；低密度脂蛋白
, 百拇医药
中图分类号：R587.1；R575.5 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.23.029
文章编号：1006-1959(2018)23-0108-03
Abstract：Objective To investigate the risk factors of type 2 diabetes mellitus with non-alcoholic fatty liver disease.Methods 138 T2DM patients in our hospital from January to December 2017 were selected and divided into two groups， depending on whether the NAFLD is combined，86 patients combined with NAFLD were treated as observation group and 52 patients with T2DM as control group.Two groups of general clinical data and biochemical indicators were compared， and the main independent risk factors and / or protective factors were determined by regression analysis.Results BMI， systolic blood pressure， glycosylated hemoglobin， triglyceride， high density lipoprotein， low density lipoprotein， uric acid， homocysteine and insulin resistance index were compared between the two groups，the difference was statistically significant (P≤0.05).The results of binary Logistic regression analysis showed that there was a positive correlation between BMI，TG，SUA，HbA1c，HOMA-IR and T2DM combined with NAFLD (OR>1， P<0.05).There was a negative correlation between HDL-C and T2DM combined with NAFLD (OR<1，P≤0.05).Conclusion T2DM combined with NAFLD is common and BMI，HOMA-IR，HbA1c，TG，SUA is the risk factor.HDL-C is the protective factor.Insulin resistance was more pronounced in T2DM patients combined with NAFLD.
, http://www.100md.com
Key words：Type 2 diabetes mellitus；Non-alcoholic fatty liver；Risk factors；Triglyceride；High-density lipoprotein；Low-density lipoprotein
非酒精性脂肪肝(nonalcoholic fatty liver disease，NAFLD)是最常见的肝脏疾病，影響了60%～70%的肥胖人群，NAFLD包括各种程度及各种表现的肝脏病理损伤，从单纯性的肝硬化到肝细胞性肝炎、干细胞坏死、肝组织纤维化等，代谢综合征的常见表现如胰岛素抵抗、肥胖以及高血糖症和高脂血症是发展为NAFLD的高危险特征[1]。NAFLD和2型糖尿病(type 2 diabetes mellitus，T2DM)有着密切的关系，且T2DM合并NAFLD者肝硬化及肝病相关的死亡风险均有显著的增加[2，3]，极大地危害了人类健康。本研究主要讨论T2DM合并NAFLD的相关因素，为早期发现、及时干预此类疾病提供思路。
, http://www.100md.com
1 对象与方法
1.1研究对象 选择江苏省南京市栖霞区妇幼保健院2017年1月～12月收治的确诊为T2DM的患者138例。纳入标准：①T2DM诊断标准符合美国糖尿病协会(ADA)糖尿病专家委员会于2017年诊疗标准[4]；②根据中华医学会肝脏病分会脂肪肝和酒精性肝病组制订的《NAFLD诊疗指南》[5](2010版)中的诊断标准来定义NAFLD。排除标准：①各种有明确病因所致的肝脏损害：如各型肝炎病毒、药物、自身免疫、肝豆状核变性、全肠外营养等；②患者酗酒史超过5年，饮酒量折合成酒精量，男性≥40 g/d，女性≥20 g/d；③排除严重的糖尿病急慢性并发症，如酮症酸中毒、尿毒症等；④肿瘤病史或精神病患者。根据是否合并NAFLD分为两组，合并NAFLD的86例患者设为观察组，52例单纯T2DM设为对照组。, 百拇医药(刘瑜 王星 代萌)
关键词：2型糖尿病；非酒精性脂肪肝；危险因素；甘油三酯；高密度脂蛋白；低密度脂蛋白
, 百拇医药
中图分类号：R587.1；R575.5 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.23.029
文章编号：1006-1959(2018)23-0108-03
Abstract：Objective To investigate the risk factors of type 2 diabetes mellitus with non-alcoholic fatty liver disease.Methods 138 T2DM patients in our hospital from January to December 2017 were selected and divided into two groups， depending on whether the NAFLD is combined，86 patients combined with NAFLD were treated as observation group and 52 patients with T2DM as control group.Two groups of general clinical data and biochemical indicators were compared， and the main independent risk factors and / or protective factors were determined by regression analysis.Results BMI， systolic blood pressure， glycosylated hemoglobin， triglyceride， high density lipoprotein， low density lipoprotein， uric acid， homocysteine and insulin resistance index were compared between the two groups，the difference was statistically significant (P≤0.05).The results of binary Logistic regression analysis showed that there was a positive correlation between BMI，TG，SUA，HbA1c，HOMA-IR and T2DM combined with NAFLD (OR>1， P<0.05).There was a negative correlation between HDL-C and T2DM combined with NAFLD (OR<1，P≤0.05).Conclusion T2DM combined with NAFLD is common and BMI，HOMA-IR，HbA1c，TG，SUA is the risk factor.HDL-C is the protective factor.Insulin resistance was more pronounced in T2DM patients combined with NAFLD.
, http://www.100md.com
Key words：Type 2 diabetes mellitus；Non-alcoholic fatty liver；Risk factors；Triglyceride；High-density lipoprotein；Low-density lipoprotein
非酒精性脂肪肝(nonalcoholic fatty liver disease，NAFLD)是最常见的肝脏疾病，影響了60%～70%的肥胖人群，NAFLD包括各种程度及各种表现的肝脏病理损伤，从单纯性的肝硬化到肝细胞性肝炎、干细胞坏死、肝组织纤维化等，代谢综合征的常见表现如胰岛素抵抗、肥胖以及高血糖症和高脂血症是发展为NAFLD的高危险特征[1]。NAFLD和2型糖尿病(type 2 diabetes mellitus，T2DM)有着密切的关系，且T2DM合并NAFLD者肝硬化及肝病相关的死亡风险均有显著的增加[2，3]，极大地危害了人类健康。本研究主要讨论T2DM合并NAFLD的相关因素，为早期发现、及时干预此类疾病提供思路。
, http://www.100md.com
1 对象与方法
1.1研究对象 选择江苏省南京市栖霞区妇幼保健院2017年1月～12月收治的确诊为T2DM的患者138例。纳入标准：①T2DM诊断标准符合美国糖尿病协会(ADA)糖尿病专家委员会于2017年诊疗标准[4]；②根据中华医学会肝脏病分会脂肪肝和酒精性肝病组制订的《NAFLD诊疗指南》[5](2010版)中的诊断标准来定义NAFLD。排除标准：①各种有明确病因所致的肝脏损害：如各型肝炎病毒、药物、自身免疫、肝豆状核变性、全肠外营养等；②患者酗酒史超过5年，饮酒量折合成酒精量，男性≥40 g/d，女性≥20 g/d；③排除严重的糖尿病急慢性并发症，如酮症酸中毒、尿毒症等；④肿瘤病史或精神病患者。根据是否合并NAFLD分为两组，合并NAFLD的86例患者设为观察组，52例单纯T2DM设为对照组。, 百拇医药(刘瑜 王星 代萌)