型糖尿病合并非酒精性脂肪性肝病相关危险因素及并发症分析.docVIP

2型糖尿病合并非酒精性脂肪性肝病的相关危险因素及并发症分析 作者：于江泳 刘晓娜 王东 崔景晶 【摘要】 目的 探讨2型糖尿病（T2DM）患者发生非酒精性脂肪性肝病（NAFLD）的相关危险因素及其与并发症的相关性。方法 将住院的319例T2DM患者按照是否合并NAFLD随机分为NAFLD组（144例）和非NAFLD组（175例）。对比分析两组的体重指数（BMI）、腰臀比（WHR）、空腹C肽（FCP）、餐后2 h C肽、24 h尿白蛋白（24 hUALB)、C反应蛋白（CRP）、血脂及肝肾功能等生化指标；并对脂代谢紊乱、肥胖症、中心性肥胖、糖尿病肾病等并发症发生率进行比较。结果 NAFLD组T2DM患者的BMI、WHR、甘油三酯FCP、24 h UALB及CRP显著高于非NAFLD组（P＜0.01，P＜0.05)；脂代谢紊乱、肥胖症、中心性肥胖、胆囊病变及高血压的发生率均明显增高（P＜0.05），但中枢神经病变、糖尿病肾病等并发症发生率略低于对照组。Logistic回归分析显示，TG和BMI对NAFLD的发生有显著影响（P均＜0.05）。结论 合并NAFLD的T2DM患者有严重的脂代谢紊乱，其发病与胰岛素抵抗有密切关系。NAFLD与糖尿病其他并发症独立存在，是胰岛素抵抗综合征的一种表现。 【关键词】 2型糖尿病 非酒精性脂肪性肝病 危险因素 并发症 【Abstract】 Objective To study the associated risk factors of nonalcoholic fatty liver disease(NAFLD) and relationship with complications in type 2 diabetic patients.Methods Serum lipids,serum glucose and C peptide (fasting and 2hour postprandial),HbA1c，blood pressure,CRP,24 UALB,liver function,renal function,body mass index (BMI) were measured and complications were compared in two groups of type 2 diabetes patients,144 cases with fatty liver and 175 cases without it.Results BMI,WHR,TG,FCP,24 h UALB and CRP of NAFLD group were significantly higher than those of nonNAFLD group (P＜0.01，P＜0.05）.The proportion of obesity,lipid dysmetabolism,centretype obesity,gallbladder disease and hypertension was higher in type 2 diabetes patients with fatty liver than that in without fatty liver.While the proportion of other complications were lower in group of NAFLD (P＞0.05）.Multiple stepwise regression analysis showed that TG and BMI were the mainly risk factors for patients with NAFLD.Conclusion Lipid dysmetabolism is uniformly present in subjects with NAFLD,which is associated with insulin resistance.NAFLD is independent from other complications of diabetes mellitus,and it is a presentation of insulin resistance syndrome. 【Key words】 diabetes mellitus type 2,nonalcoholic fatty liver disease，risk factors，complications 近年来随着人们生活水平提高和生活方式改变，非酒精性脂肪性肝病（nonalcoholic fatty liver disease,NAFLD)发病率日益