摘要
目的探讨血清碱性磷酸酶(ALP)与2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的相关性。方法选取2016年7月—2018年12月于江苏大学附属医院内分泌科住院的599例T2DM患者为研究对象。根据是否合并NAFLD分为NAFLD组(286例)和非NAFLD组(313例),根据腹部超声检查结果将NAFLD患者分为轻度(111例)、中度(105例)、重度(70例)三组,比较各组间一般临床资料的差异。正态分布的计量资料两组间比较采用独立样本t检验,三组间比较采用方差分析;非正态分布计量资料两组间比较采用Mann-Whitney U检验;三组间比较使用Kruskal-Wallis H秩和检验,计数资料组间比较采用χ^(2)检验。采用Pearson相关分析法和Spearman相关分析法分析ALP与临床指标的相关性。Logistic回归分析NAFLD的影响因素。结果NAFLD组高血压病史所占比例、收缩压、舒张压、BMI、腰围(WC)、空腹胰岛素(FIns)、空腹C肽、血尿酸、低密度脂蛋白胆固醇、TG、TC、稳态模型评估胰岛素抵抗指数(HOMA-IR)、ALT、AST、GGT、ALP均高于非NAFLD组(χ^(2)=7.864、t=-2.226、t=-3.800、t=-11.842、t=-9.150、Z=-6.173、t=-5.419、t=-4.957、t=-2.702、Z=-9.376、t=-3.016、Z=-5.794、Z=-6.737、Z=-4.389、Z=-7.764、t=-2.833,P值均<0.05)。NAFLD组年龄、高密度脂蛋白胆固醇均低于非NAFLD组(t=2.184、Z=-5.273,P值均<0.05)。NAFLD脂肪肝的严重程度(轻、中、重)与年龄(rs=0.140)、BMI(rs=0.239)、WC(rs=0.222)、FIns(rs=0.191)、HOMA-IR(rs=0.218)、ALT(rs=0.188)、AST(rs=0.279)、GGT(rs=0.202)、ALP(rs=0.361)呈正相关(P值均<0.05)。在T2DM合并NAFLD患者中,ALP与糖化血红蛋白(r=0.149)、空腹血糖(r=0.146)、HOMA-IR(rs=0.132)、TC(r=0.151)、ALT(rs=0.210)、AST(rs=0.192)、GGT(rs=0.297)呈正相关(P值均<0.05)。Logistic回归分析显示,ALP是T2DM患者发生NAFLD的影响因素(OR=1.013,95%CI:1.004~1.023,P<0.05)。结论血清ALP升高是T2DM合并NFALD的危险因素,且与高血糖、胰岛素抵抗、高血脂密切相关,可能在T2DM和NFALD疾病的发生发展中起一定作用。
Objective To investigate the association between serum alkaline phosphatase(ALP)and type 2 diabetes mellitus(T2DM)with nonalcoholic fatty liver disease(NAFLD).Methods A total of 599 patients with T2DM who were hospitalized in Department of Endocrinology,Affiliated Hospital of Jiangsu University,from July 2016 to December 2018 were enrolled as subjects.According to the presence or absence of NAFLD,the patients were divided into NAFLD group with 286 patients and non-NAFLD group with 313 patients,and according to the results of abdominal ultrasound,the patients with NAFLD were divided into mild group with 111 patients,moderate group with 105 patients,and severe group with 70 patients.General clinical data were compared between groups.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between three groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between three groups;the chi-square test was used for comparison of categorical data between groups.Pearson correlation analysis and Spearman correlation analysis were used to investigate the correlation between ALP and clinical indices,and a logistic regression analysis was used to investigate the influencing factors for NAFLD.ResultsCompared with the non-NAFLD group,the NAFLD group had significantly higher proportion of patients with history of hypertension(χ^(2)=7.864,P<0.05),systolic blood pressure(t=-2.226,P<0.05),diastolic blood pressure(t=-3.800,P<0.05),body mass index(BMI)(t=-11.842,P<0.05),waist circumference(WC)(t=-9.150,P<0.05),fasting insulin(FINS)(Z=-6.173,P<0.05),fasting C-peptide(t=-5.419,P<0.05),serum uric acid(t=-4.957,P<0.05),low-density lipoprotein cholesterol(t=-2.702,P<0.05),triglyceride(Z=-9.376,P<0.05),total cholesterol(TC)(t=-3.016,P<0.05),Homeostasis Model Assessment of Insulin Resistance(HOMA-IR)(Z=-5.794,P<0.05),alanine aminotransferase(ALT)(Z=-6.737,P<0.05),aspartate aminotransferase(AST)(Z=-4.389,P<0.05),gamma-glutamyl transpeptidase(GGT)(Z=-7.764,P<0.05),and ALP(t=-2.833,P<0.05),as well as significantly lower age(t=2.184,P<0.05)and high-density lipoprotein cholesterol(Z=-5.273,P<0.05).The severity of NAFLD(mild,moderate or severe)was positively correlated with age(rs=0.140,P<0.05),BMI(rs=0.239,P<0.05),WC(rs=0.222,P<0.05),FINS(rs=0.191,P<0.05),HOMA-IR(rs=0.218,P<0.05),ALT(rs=0.188,P<0.05),AST(rs=0.279,P<0.05),GGT(rs=0.202,P<0.05),and ALP(rs=0.361,P<0.05).In the patients with T2DM and NAFLD,ALP was positively correlated with HbAlc(r=0.149,P<0.05),fasting plasma glucose(r=0.146,P<0.05),HOMA-IR(rs=0.132,P<0.05),TC(r=0.151,P<0.05),ALT(rs=0.210,P<0.05),AST(rs=0.192,P<0.05),and GGT(rs=0.297,P<0.05).The logistic regression analysis showed that ALP was an influencing factor for NAFLD in patients with T2DM(odds ratio=1.013,95%confidence interval:1.004-1.023,P<0.05).Conclusion Elevated serum ALP is a risk factor for T2DM with NAFLD and is closely associated with hyperglycemia,insulin resistance,and hyperlipemia,and ALP may play a role in the development and progression of T2DM and NAFLD.
作者
钱方方
戴梅清
赵丽
邓霞
杨玲
贾珏
王济芳
王东
袁国跃
QIAN Fangfang;DAI Meiqing;ZHAO Li;DENG Xia;YANG Ling;JIA Jue;WANG Jifang;WANG Dong;YUAN Guoyue(Department of Endocrinology,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212000,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2023年第1期83-88,共6页
Journal of Clinical Hepatology
基金
国家自然科学基金(81870548)
江苏省自然科学基金(BK20191222)
江苏省社会发展重点研发项目(BE2018692)。
关键词
非酒精性脂肪性肝病
碱性磷酸酶
糖尿病
2型
Non-alcoholic Fatty Liver Disease
Alkaline Phosphatase
Diabetes Mellitus,Type 2
