摘要
目的 探讨2型糖尿病患者（T2DM）合并非酒精性脂肪性肝病（NAFLD）的胰岛功能变化。方法 选择2014年1~12月于湖北医药学院附属东风医院接受住院治疗的T2DM患者224例。根据是否有NAFLD分为两组：单纯T2DM组（104例）和T2DM合并NAFLD组（120例）。T2DM合并NAFLD患者依据肝功能检查结果分为肝功能正常组（82例）和肝功能异常组（38例）。检测所有患者的空腹总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、γ-谷氨酰转移酶、丙氨酸转氨酶、天冬氨酸转氨酶、糖化血红蛋白、果糖胺、空腹血糖、餐后2 h血糖,以及利用稳态模型评估法（HOMA）计算出胰岛β细胞功能（HOMA-β）和胰岛素抵抗指数（HOMA-IR）。结果 T2DM合并NAFLD组总胆固醇、三酰甘油、低密度脂蛋白胆固醇、天冬氨酸转氨酶、丙氨酸转氨酶、γ-谷氨酰转移酶显著高于单纯T2DM组[（5.39±1.05）mmol/L比（4.50±0.95）mmol/L,（2.60±0.8）mmol/L比（1.3±0.4）mmol/L,（3.4±0.7）mmol/L比（3.0±0.8）mmol/L,（30±10）U/L比（15±5）U/L,（33±11）U/L比（18±5）U/L,（55±12）U/L比（18±5）U/L],差异有统计学意义（均P〈0.01）。T2DM合并NAFLD组与单纯T2DM组在糖化血红蛋白、果糖胺、餐后2 h血糖和空腹血糖比较差异无统计学意义（P〉0.05）;T2DM合并NAFLD组的HOMA-IR和HOMA-β显著高于单纯T2DM组（5.5±2.3比2.7±0.9,55±15比35±9）,差异有统计学意义（均P〈0.01）;在T2DM合并NAFLD组中,肝功能异常患者HOMA-IR和HOMA-β显著低于肝功能正常患者（3.0±0.8比7.2±2.8,30±10比61±19）,差异有统计学意义（均P〈0.01）。结论 T2DM合并NAFLD患者的胰岛素抵抗明显,胰岛β细胞功能减退;在肝功能正常的NAFLD患者,胰岛素抵抗明显,当肝功能异常时,胰岛β细胞功能明显减退。
Objective To study the islet function recession influenced by non-alcoholic fatty liver dis- ease（NAFLD） in patients with type 2 diabetes mellitus（T2DM）. Methods Total of 224 T2DM patients in Dongfeng Hospital Affiliated to Hubei University of Medicine from Jan. to Dec. 2014 were included in the study. The patients were divided into a simple T2DM goup（ 104 cases） and T2DM with NAFLD group（ 120 cases） according to the existence of NAFLD complication. T2DM with NAFLD patients were further divided into a norms] liver function 8roup（82 cases） and an abnormal liver function group （38 cases） based on the results of liver function tests. The patients were tests with resting total cholesterol, triglycerides, high-density lipoprotein cholesterol, low density lipoprotein cholesterol, γ-glntamyltransferase, alanlne transaminase, glutamic oxalacetic traninese, glycosylated hemoglohin, fructosamine, fasting glucose, 2 hours plasma glucose. The HOMA-IR and HOMA-β were calculated by HOMA methed. Results Total cholesterol,triglycer- ides, low-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransfemse, γ-giutamyl tranderase of T2DM with NAFLD group were heighter than simple T2DM group [ （5.39 ± 1.05） mmol/L vs （ 4. 50± 0. 95 ） mmol/L, （2. 60 ± 0. 8 ） mmol/L vs （ 1.3±0.4） mmol/L, （ 3. 4 ± 0. 7 ） mmo]/L vs （ 3.0±0.8） mmol/L,（30±10）U/L vs （15±5） U/L, （33 ±11） U/L vs （18 ±5） U/L,（55 ±12） U/L vs （ 18 ± 5 ） U/L ], The difference was statisically sisnificant （ P〈0.01 ）.There was no statistically significant difference in I-IbAlc,froctosamine 2 h glucose and fasting plucose and fasting in T2DM with NAFLD group com- pared with the T2DM without NAFLD group（p 〉0. 05）. HQMA-IR and HOMA-β of T2DM with NAFLD group were higher than simple T2DM greup（5. 5±2. 3 vs 2. 7±0.9,55±15 vs 35 ±9） ,the difference was statistically significant（ P 〈0. 01 ）. HOMA-IR and HOMA-IR liver function patients in T2DM with NAFLD group were higher than those with abnormal liver function patients （7. 2 ± 2. 8 vs 3.0 ± 0. 8,61± 19 vs 30 ± 10）, the difference was statistically significant（ P 〈 0. 01 ）. Conclusion The T2DM patients with NAFLD have severer insulin resistance compared with patients without NAFLD and the β-cell function decreases significantly when the liver function is abnormal.
出处
《医学综述》
2016年第16期3263-3266,共4页
Medical Recapitulate
关键词
2型糖尿病
非酒精性脂肪肝
胰岛素抵抗
胰岛Β细胞
胰岛功能
Type 2 diabetes mellitus
Non-alcoholic fatty liver disease
Insulin resistance
Islet [3 cell
Islet function
