目的: 探讨非酒精性脂肪肝(nonalcoholic fatty liver disease, NAFLD)与2型糖尿病(type 2 diabetes mellitus, T2DM)相关代谢指标的相关性。方法: 选取2020年3月至2021年6月在内蒙古科技大学第一附属医院内分泌科住院且有完整记录的704例T2DM患者,包括T2DM伴NAFLD和不伴NAFLD,根据体质量指数分为肥胖组(BMI ≥28 kg/m2)、超重组(24 kg/m2≤ BMI ＜28 kg/m2)和正常组(BMI ＜24 kg/m2),分别比较不同体质量指数的T2DM合并NAFLD和T2DM不伴NAFLD各组人群的一般资料和各生化指标水平差异,并计算胰岛素抵抗指数(HOMA-IR)。结果: (1)三组不同体质量指数T2DM合并NAFLD患者组内比较:VFA、ApoB、DBil、ALT、AST、UA、FCP、FINS、HOMA-IR等指标差异均有统计学意义(P＜0.05);(2)T2DM伴有NAFLD患者的BMI、VFA、TG、TC、ALT、AST、γ-GGT、DBil、IDBil、UA、FPG、HbA1c、FCP、FINS、HOMA-IR等水平明显高于不伴NAFLD患者,但年龄、HDL-c前组更小,差异有统计学意义(P＜0.05);(3)糖尿病病程、性别差异、高血压患病情况对此次研究无影响,各组差异无统计学意义(P＞0.05);(4)应用多因素Logistic回归分析得出BMI、VFA、HbA1c、FCP、HOMA-IR、TG、ApoB、ALT、γ-GGT、UA是发生NAFLD的独立危险因素。结论: 肥胖、糖脂代谢紊乱及胰岛素抵抗(IR)是导致T2DM患者发生NAFLD的因素,且发病人群逐渐年轻化。此外,该类人群也更易发展为其他代谢综合征。
Objective: To explore the correlation of metabolic indexes between nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods: From March 2020 to June 2021, 704 patients who were hospitalized in the Department of Endocrinology, First Affiliated Hospital of Inner Mongolia University of Science and Technology and had complete records were selected, including type 2 diabetes patients with NAFLD and those without NAFLD, which are divided into the obesity group (BMI≥28 kg/m2), overweight group (24 kg/m2≤BMI<28 kg/m2) and normal weight group (BMI<24 kg/m2) according to different body mass indexes. The general data of different groups of T2DM with NAFLD and T2DM without NAFLD were compared and the insulin resistance indexes (HOMA-IR) were calculated. Results: There were significant differences in VFA, ApoB, DBIL, ALT, AST, UA, FCP, FINS and HOMA-IR among the three groups of T2DM patients complicated with NAFLD of different body mass indexed and (P＜0.05). The levels of BMI, VFA, TG, TC, ALT, AST, γ-GGT, DBIL, IBIL, UA, FPG, HbA1c, FCP, FINS and HOMA-IR in T2DM patients complicated with NAFLD were significantly higher than those without NAFLD, but the ages and HDL in T2DM patients complicated with NAFLD were smaller, and the differences were statistically significant (P＜0.05). The course of diabetes, gender differences and the prevalence of hypertension in each group had no significant influence on NAFLD, and the differences were not statistically significant (P＞0.05). Multivariate Logistic regression analysis showed that BMI, VFA, HbA1c, FCP, HOMA-IR, TG, APOB, ALT, γ-GGT and UA were independent risk factors for NAFLD. Conclusion: Obesity and metabolic disorder of glucose and lipid are the initiators of NAFLD, and these patients are getting younger. In addition, this kind of people is also more likely to develope other metabolic syndromes
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