2型糖尿病合并非酒精性脂肪肝的危險因素研究

劉瑜 王星 代萌

摘 要：目的 探討2型糖尿病合并非酒精性脂肪肝的危險因素。方法 選擇2017年1月～12月在我院住院的T2DM患者138例，根據(jù)是否合并NAFLD分為兩組，合并NAFLD的86例患者設(shè)為觀察組，52例單純T2DM設(shè)為對照組。比較兩組一般臨床資料及生化指標(biāo)，采用回歸分析判定其中的獨(dú)立相關(guān)的主要危險因素和（或）保護(hù)性因素。結(jié)果 兩組患者BMI、收縮壓、糖化血紅蛋白、甘油三酯、高密度脂蛋白、低密度脂蛋白、尿酸、同型半胱氨酸、胰島素抵抗指數(shù)等指標(biāo)比較，差異有統(tǒng)計學(xué)意義（P≤0.05）；將上述有差異指標(biāo)進(jìn)行二元Logistic回歸分析發(fā)現(xiàn)，BMI、TG、SUA、HbA1c、HOMA-IR與T2DM合并NAFLD呈正相關(guān)（OR>1，P<0.05），HDL-C與T2DM合并NAFLD呈負(fù)相關(guān)（OR<1，P≤0.05）。結(jié)論 T2DM合并NAFLD相當(dāng)常見，BMI、HOMA-IR、HbA1c、TG、SUA是其危險因素，HDL-C 是其保護(hù)因素。胰島素抵抗在并發(fā)NAFLD的T2DM者中更加明顯。

關(guān)鍵詞：2型糖尿病；非酒精性脂肪肝；危險因素；甘油三酯；高密度脂蛋白；低密度脂蛋白

中圖分類號：R587.1；R575.5 文獻(xiàn)標(biāo)識碼：A DOI：10.3969/j.issn.1006-1959.2018.23.029

文章編號：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.

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）是最常見的肝臟疾病，影響了60%～70%的肥胖人群，NAFLD包括各種程度及各種表現(xiàn)的肝臟病理損傷，從單純性的肝硬化到肝細(xì)胞性肝炎、干細(xì)胞壞死、肝組織纖維化等，代謝綜合征的常見表現(xiàn)如胰島素抵抗、肥胖以及高血糖癥和高脂血癥是發(fā)展為NAFLD的高危險特征[1]。NAFLD和2型糖尿病（type 2 diabetes mellitus，T2DM）有著密切的關(guān)系，且T2DM合并NAFLD者肝硬化及肝病相關(guān)的死亡風(fēng)險均有顯著的增加[2，3]，極大地危害了人類健康。本研究主要討論T2DM合并NAFLD的相關(guān)因素，為早期發(fā)現(xiàn)、及時干預(yù)此類疾病提供思路。

1 對象與方法

1.1研究對象 選擇江蘇省南京市棲霞區(qū)婦幼保健院2017年1月～12月收治的確診為T2DM的患者138例。納入標(biāo)準(zhǔn)：①T2DM診斷標(biāo)準(zhǔn)符合美國糖尿病協(xié)會（ADA）糖尿病專家委員會于2017年診療標(biāo)準(zhǔn)[4]；②……