非酒精性脂肪性肝病与新诊断2型糖尿病关系的病例对照研究

摘要

目的：探讨2型糖尿病（T2DM）的危险因素，研究非酒精性脂肪性肝病（NAFLD）与T2DM的关系，并进行归因危险度评价，为T2DM的防治提供科学依据。方法采用医院为基础的1：1配对病例对照研究，选择2012年1—12月我院内分泌科门诊首次确诊的T2DM患者178例作为病例组，选取同期本院其他科室门诊的非T2DM患者178作为对照组，进行问卷调查。采用χ2检验进行T2DM危险因素的单因素分析，采用非条件Logistic回归分析进行多因素分析，并估算调整人群归因危险度（ PARc%）和综合人群归因危险度（ sPAR%）。结果单因素分析显示：吸烟、饮酒、超重/肥胖、糖尿病家族史、NAFLD病史、高血压病史、高胆固醇（ TC）、高三酰甘油（ TG）、高丙氨酸氨基转移酶（ALT）9项因素在两组间差异有统计学意义（P <0.05）。Logistic 回归分析结果显示：糖尿病家族史、NAFLD病史、高血压病史、超重/肥胖4项因素对T2DM发生的影响有统计学意义（P<0.05），OR值分别为3.036、11.938、1.970、2.534，PARc%分别为18.41%、72.58%、23.79%、41.15%，sPAR%为60.54%。结论 NAFLD是T2DM的独立危险因素，对 T2DM 的发生有影响。针对有遗传家族史的高危人群，控制体质量，早期筛查和干预NAFLD和高血压，可作为T2DM的一级预防措施。%Objective To explore the risk factors for type 2 diabetes(T2DM),study its association with non-alco-holic fatty liver disease( NAFLD)and estimate its population attributable risk so as to provide scientific evidences for prevention and treatment of T2DM. Methods A hospital -based 1:1 pair -matched case -control study was conducted with 178 cases which were newly diagnosed with T2DM in our department of endocrinology and 178 controls visiting other clinic departments at the same time were chosen randomly. Information on demographic,history of disease,life-style was obtained through question-naire.χ2 test was used for single factor analysis and non -conditional logistic regression was used for multiple factors analy-sis. Corrected population attributable risk ( PARc%) and synthesized population attributable risk ( sPAR%) were also esti-mated. Results The single factor analysis showed that the differences of two groups in smoking,drinking,overweight/obesity, family history of diabetes,history of NAFLD,history of hypertension,total cholesterol( TC),high triglyceride( TG),high alanine aminotransferase(ALT)were statistically significant(P<0. 05). The multiple factors analysis showed that family his-tory of diabetes,NAFLD,hypertension and overweight/obesity had statistical influences over T2DM(P<0. 05). The OR value of the four factors was 3. 036,11. 938,1. 970 and 2. 534 respectively,the PARc% was 18. 41%,72. 58%,23. 79%, 41. 15%,respectively and the sPAR% was 60. 54%. Conclusion NAFLD is an independent risk factor of T2DM. Early screen-ing and intervention of NAFLD,with the control of weight and high blood pressure,can be used as the primary preventive meas-ure of T2DM.