2型糖尿病合并脂肪肝患者同单纯性脂肪肝患者比较.doc

2型糖尿病合并脂肪肝患者同单纯性脂肪肝患者比较 　【关键词】 2型糖尿病；非酒精性脂肪肝；胰岛素抵抗；血糖；载脂蛋白A1 　　［摘要］ 目的：比较初诊2型糖尿病(T2DM)合并脂肪肝患者和单纯性脂肪肝患者的生化指标的差异。方法：选择56例合并单纯性脂肪肝的初诊T2DM患者，进行临床指标血压、腹围的测定，并行75 g OGTT测定空腹及餐后2 h血糖(BG)，放免法测定胰岛素(INS)、C肽(CP),采用McAuley指数、稳态模型胰岛素抵抗指数(HOMAIR)和空腹胰岛素(FINS)评价胰岛素抵抗(IR)，并于18例非DM 的单纯性脂肪肝患者(NAFLD组)比较。结果：T2DM组与单纯性脂肪肝组比较：两组的体重指数(BMI)、血脂均高于正常值，两者之间差异无显著性；餐后INS、CP较脂肪肝组显著降低(P lt;0.01、P lt;0.05)；空腹载脂蛋白A1(Apoa1)显著降低(P lt;0.05)；计算HOMAIR显著升高(P lt;0.001)，McAuley指数降低(P lt;0.05)；Logistic逐步回归分析显示在脂肪肝患者中，2 h INS的降低、HOMAIR的增加同T2DM的发生呈正相关。结论：单纯性脂肪肝的人群已经存在超重、高脂血症，而合并糖尿病的脂肪肝患者IR更明显,餐后INS分泌功能下降。 　　［关键词］ 2型糖尿病；非酒精性脂肪肝；胰岛素抵抗；血糖；载脂蛋白A1 　　The Clinical Comparison Between the DM and NonDM Parients with Nonalcoholic Fatty Liver Disease 　　Abstract: Objective To evaluate the metabolic disorder between the DM and nonDM parients with nonalcoholic fatty liver disease. McAuley index ,homeostasis model assessment insulin resistance index(HOMAIR) and fasting insulin (FINS) were applied to assess the status of insulin resistance. Methods We studied blood concentrations of glucose, lipid ,Cpeptide, insulin, measured during a 75g oral glucose tolerance test (OGTT) in the fiftysix newly diagnosed type 2 diabetic patients with nonalcoholic fatty liver disease and eighteen nonalcoholic fatty liver disease patients. Results Adjusted with age,sex,body mass index(BMI) and lipid, HOMAIR were significantly higher in dabitec patients than those in controls(P lt;0.001), 2 h insulin,cp,apoA1, McAuley index were significantly lower than those in controls(P lt;0.01,P lt;0.05, P lt;0.05, P lt;0.05).Logistic regression analysis showed that 2 h inslin and HOMAIR were the main risk factors forming type 2 Diabetes mellitus. Conclusion It showed that the independent risk factors for forming type 2 diabetes mellitus in nonalcoholic fatty liver patients are a increasing Insulin resistance and a despaired postprandial Insulin action. 　　Key words:Diabetes mellitus type 2; Nonalcoholic fatty liver;Insulin resistance;Blood glucose ;ApoA1 　　非