目的: 探讨血清中脂肪因子Metrnl水平与2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪肝(nonalcoholic fatty liver disease, NAFLD)患者糖脂代谢及肝功能的相关性。方法: 选取2021年1月-2022年12月在内蒙古科技大学包头医学院第一附属医院老年科住院和体检的研究对象160例,根据是否符合NAFLD、T2DM诊断标准分为单纯T2DM组(n=57例),T2DM合并NAFLD组(n=38例),对照组(n=65例)。均记录人体学参数,测定空腹血糖(fasting blood glucose, FBG)、空腹胰岛素(fasting insulin, FINS)、谷丙转氨酶(glutamic-pyruvic transaminase, AST)、谷草转氨酶(glutamic oxaloacetic transaminase, ALT)、γ-谷氨酰转肽酶(γ-glutamyl transpeptadase, GGT)、白蛋白、总胆固醇(total cholesterol, TC)、三酰甘油(triglyceride, TG)、低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol, HDL-C)、糖化血红蛋白(glycated hemoglobin Ah, HbA1C)、尿酸(uric acid,UA)、脂肪因子Metrnl,比较组间差异,观察T2DM合并NAFLD患者Metrnl与糖脂代谢及肝功能的相关性。结果: 单纯T2DM组Metrnl、白蛋白水平低于对照组(P＜0.05),单纯T2DM组FBG、TC、HbA1c水平高于对照组(P＜0.05);T2DM合并NAFLD组Metrnl、白蛋白水平低于对照组(P＜0.05),T2DM合并NAFLD组AST、ALT、GGT、TG、LDL-C、FBG、HbA1c水平高于对照组(P＜0.05);T2DM合并NAFLD组Metrnl水平低于T2DM组,T2DM合并NAFLD组AST、GGT水平高于T2DM组(P＜0.05)。相关性分析显示Metrnl与GGT(r=-0.288)、FBG(r=-0.714)、HbA1c(r=-0.513)、TG(r=-0.2)呈负相关(P＜0.05)。多元Logistic分析结果显示Metrnl、FBG、LDL-C、白蛋白均为T2DM合并NAFLD发生的独立危险因素(P＜0.05)。结论: NAFLD患者体内Metrnl水平低于对照组,Metrnl水平与FBG、HbA1c、TG、GGT水平呈负相关,Metrnl水平降低是T2DM合并NAFLD发生的独立危险因素,提示Metrnl是一种保护性因子,或许可以改善T2DM合并NAFLD患者体内的糖脂代谢紊乱,为疾病的治疗提供新的思路。
Objective: To investigate the correlation between the level of serum adipokines Metrnl and the metabolism of glucose, lipid and liver function in type 2 diabetes mellitus (T2DM) patients with nonalcoholic fatty liver disease (NAFLD). Methods: A total of 160 study subjects who were hospitalized and underwent physical examinations in the geriatric department of the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from January 2021 to December 2022 were selected. They were divided into a simple T2DM group (n=57 cases), a T2DM combined with NAFLD group (n=38 cases), and a control group (65 cases) based on whether they met the diagnostic criteria for NAFLD and T2DM. The anthropometric parameters were recorded, and fasting blood glucose (FBG), fasting insulin (FINS), glutamic transaminase (AST), glutamic transaminase (ALT), γ- Glutamyl transpeptidase (GGT), albumin, total cholesterol (TC), total cholesterol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin Ah (HbA1C), uric acid (UA), and fat factor Metrnl were compared between groups. The correlation between Metrnl, glucose and lipid metabolism, and liver function in patients with T2DM combined with NAFLD were observed. Results: The levels of Metrnl and albumin in the pure T2DM group were lower than those in the control group (P＜0.05), while the levels of FBG, TC, and HbA1c in the pure T2DM group were higher than those in the control group (P＜0.05); The levels of Metrnl and albumin in the T2DM combined with NAFLD group were lower than those in the control group (P＜0.05), while the levels of AST, ALT, GGT, TG, LDL-C, FBG, and HbA1c in the T2DM combined with NAFLD group were higher than those in the control group (P＜0.05); The Metrnl levels in the T2DM combined with NAFLD group were lower than those in the T2DM group, while the AST and GGT levels in the T2DM combined with NAFLD group were higher than those in the T2DM group (P＜0.05). Correlation analysis showed that Metrnl was negatively correlated with GGT (r=-0.288), FBG (r=-0.714), HbA1c (r=-0.513), and TG (r=-0.2) (P＜0.05). The results of multiple logistic analysis showed that Metrnl, FBG, LDL-C, and albumin were all independent influencing factors for the occurrence of T2DM combined with NAFLD (P＜0.05). Conclusion: The levels of Metrnl in NAFLD patients are lower than those in the control group, and there is a negative correlation between Metrnl levels and FBG, HbA1c, TG, GGT levels. The decrease in Metrnl levels is an independent risk factor for the occurrence of T2DM combined with NAFLD, suggesting that Metrnl is a protective factor that may improve glucose and lipid metabolism disorders in T2DM combined with NAFLD patients and provide new ideas for disease treatment.
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