摘要
目的探讨成人隐匿性自身免疫性糖尿病（LADA）伴非酒精性脂肪肝（NAFLD）的临床特点及其与血清C肽水平的关系。方法选取2007年1月至2009年6月在上海交通大学附属第六人民医院内分泌代谢科住院的无饮酒史的LADA患者155例，采用中华医学会NAFLD诊断指南，依据超声检查结果将患者分为LADA不伴NAFLD组（117例）与LADA伴NAFLD组（38例），收集患者临床资料，包括用药史、血压、体质量、身高、腰围、臀围；空腹血糖和空腹C肽、餐后2h血糖和餐后2hC肽、糖化血红蛋白（HbA1c）、肾功能、肝功能、血脂、C反应蛋白水平，比较两组患者临床特征并分析血清C肽水平与NAFLD间的关系。结果LADA伴NAFLD组较LADA不伴NAFLD组丙氨酸转氨酶（ATJT）、天冬氨酸转氨酶（AST）与γ-谷氨酰转移酶（γ—GT）表达水平显著提高（均P〈0．01），两组血清总胆红素（TBI）与直接胆红素（DBI）水平差异均无统计学意义（均P〉0．05）；LADA伴NAFLD组较LADA不伴NAFLD组有较高的空腹C肽[0．62（0．33—0．93）比0．17（0．05～0．50）nmol／L，P〈0．001]、餐后2hC肽水平[1．57（0．78～1．88）比0．42（0．06—1．01）nmol／L，P〈0．001]及胰岛素抵抗指数[0．8（1．0～2．5）比0．6（0．2—1．3），P〈0．001]；多因素logistic回归校正其他变量后，空腹C肽水平与LADA患者NAFLD的发生密切相关（P〈0．05）。结论LADA伴NAFLD患者有更加严重的代谢紊乱及胰岛素抵抗。空腹c肽水平与LADA患者发生NAFLD存在独立相关关系。
Objective To investigate the clinical features of non-alcoholic fatty liver disease （NAFLD） and its relationship with serum C-peptide levels in patients with latent autoimmune diabetes in adults （LADA）. Methods A total of 155 patients with LADA who had no drinking history and were hospitalized in department of endocrinology and metabolism from January 2007 to June 2009 were divided into two groups, including patients with LADA but without NAFLD and patients with both LADA and NAFLD, according to Chinese medical association＇s guidelines of NAFLD and hepatic ultrasound result. Their clinical data and results of laboratory examinations were collected and analyzed, including medications, blood pressure, weight, height, waist circumference, hip circumference, fasting plasma glucose, 2 h postprandial plasma glucose, fasting C-peptide, 2 h postprandial C-peptide, hemoglobin A1 c, renal function, liver function, blood lipid and C-reactive protein. The clinical features between two groupswere compared and the relationship between serum C-peptide and NAFLD were also analyzed. Results Compared to the patients with LADA but without NAFLD, patients with both LADA and NAFLD had higher alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and gamma-glutamyl transferase （γ-GT） （all P 〈 0. 01 ）, but the serum total bilirubin （TBI） and direct bilirubin （DBI） level had no significant inter-group difference （ P 〉 0. 05 ）. The patients with both LADA and NAFLD had higher fasting C-peptide [ 0. 62 （0. 33 - 0. 93 ） vs 0. 17 （0.05 - 0. 50 ） nmol/L, P 〈 0. 001 ], 2 h postprandial C-peptide [ 1.57 （0. 78 - 1.88 ） vs 0.42 （0. 06 - 1.01 ） nmol/L, P 〈 0. 001 ] and more severe insulin resistance [ 0. 8 （ 1.0 - 2. 5） vs 0. 6 （0. 2 - 1.3 ）, P 〈 0. 001 ]. Logistic regression analysis showed that there was a significant association between fasting C-peptide and the presence of NAFLD after controlling other confounding factors in patients with LADA. Conclusions The patients with both LADA and NAFLD had more severe metabolic disorders and insulin resistance. Serum fasting C peptide was independently associated with the presence of NAFLD in patients with LADA.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第44期3575-3578,共4页
National Medical Journal of China
基金
国家自然科学基金（81170759）
上海市科学技术委员会资助项目（15411960600）
