摘要
目的分析2型糖尿病患者肝脏脂肪含量（1iver fat content，LFC）随糖尿病病程的变化，探讨其与肝病结局的关系。方法采集435例住院2型糖尿病患者的病史资料、生化指标、肝脏质子磁共振波谱（1H—MRS），计算非酒精性脂肪性肝病（NAFLD）纤维化评分（NFS）。结果在新诊断2型糖尿病（NT2DM）患者NAFLD检出率显著高于已诊断2型糖尿病（VP2DM）患者（92．7％对82．2％，P〈0．05），并有更高的LFC[（27．97±16．88对19．44±15．54）％，P〈0．01]。LFC随糖尿病病程的增加而减少，校正性别、年龄、体重指数（BMI）、口服降糖药、降脂药、注射胰岛素等因素后，LFC与糖尿病病程呈线性负相关（rs=-0．233，P〈0．01）；多元线性逐步回归分析显示，LFC与BMI、白蛋白、谷丙转氨酶呈线性正相关，与糖尿病病程线性负相关。NT2DM患者中可排除进展性纤维化（NFS〈-1．455）的NAFLD比例显著高于PT2DM患者（26．3％对15．5％，P〈0．05）；而进展性纤维化的NAFLD患者（NFS〉0．676）中PT2DM所占比例显著高于NT2DM（79．2％对20．8％，P〈0．05）；NFS与糖尿病病程呈正相关（rs=0．236，P〈0．01）。发生进展性肝纤维化的NAFLD患者的LFC显著降低，且LFC与NFS呈线性负相关关系（rs=-0．164，P〈0．叭）。结论糖尿病病程是2型糖尿病患者LFC的独立影响因素，随着糖尿病病程的延长，肝脏脂肪含量的减少与NAFLD向进展性纤维化发展相关，预示不良肝病结局。
Objective To investigate the effects of diabetic duration on liver fat content （LFC） in patients with type 2 diabetes, and to explore its relationship with the outcome of liver disease. Methods A total of 435 hospitalized patients with type 2 diabetes were recruited. The history data, results of laboratory tests, and hepatic H-MRS were collected, and nonalcoholic fatty liver disease （NAFLD） fibrosis score （NFS） was calculated. Results The prevalence of NAFLD in newly-diagnosed type 2 diabetes mellitus （ NT2DM ） group was higher than that in previously-diagnosed type 2 diabetes mellitus （ PT2DM ） group （92.7% vs 82.2% , P 〈 0.05 ）, with higher LFC [ （ 27.97 ± 16.88 vs 19.44 ±15.54） %, P〈0. 01 ]. The LFC was reduced with prolonged duration of diabetes. Partial correlation analysis showed that LFC was negatively correlated with duration of diabetes （ r = -0. 233, P〈0.01 ） after adjustment for gender, age, body mass index （BMI） , oral anti-diabetic drugs, lipid-lowering drugs, and insulin treatment. Multiple linear regression analysis showed that LFC was positively correlated with BMI, albumin, and alanine aminotransferase while negatively correlated with duration of diabetes. The proportion of patients without advanced fibrosis （NFS〈-1. 455 ） was significantly higher in NT2DM group than that in PT2DM group （26.3% vs 15.5% ,P〈0.05）, and the proportion of PT2DM in patients with advanced fibrosis （ NFS〉0. 676） was significantly higher than that of NT＇2DM （ 79.2% vs 20.8%, P〈0.05 ）. NFS was positively correlated with the duration of diabetes （r = 0. 236,P〈0.01 ）. The liver fat content in patients with advanced liver fibrosis decreased significantly, and the LFC was negatively correlated with NFS （ re = -0. 164, P〈0.01 ）. Conclusions The duration of diabetes is an independent influencing factor of LFC. With the extension of the duration of diabetes, the decreased LFC in type 2 diabetic patients with NAFLD is related to the development of a
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2014年第1期3-7,共5页
Chinese Journal of Endocrinology and Metabolism
基金
973计划项目（2012CB524906）
卫生部2011年国家临床重点专科建设项目[卫办医政函（2011）873号文]
上海申康医院发展中心项目（SHDC12012201）
上海市卫生局新三年卫生行动计划（12GWZX0103）
上海市科委重点项目（10411956400）
关键词
糖尿病
2型
非酒精性脂肪性肝病
纤维化
Diabetes mellitus, type 2
Nonalcoholic fatty liver disease
Fibrosis
