不同病程2型糖尿病伴脂肪肝患者代谢参数与胰岛功能的相关性分析

摘要

目的:观察不同病程住院2型糖尿病伴脂肪肝患者代谢参数及β细胞功能的变化情况,分析肝脏脂肪含量(liverfat content,LFC)与胰岛功能之间的相关性.方法:收集2016年1月至2017年3月住院糖尿病患者214例及非糖尿病者65例,采用质子磁共振波谱(1 H-MRS)定量测定其LFC,采用精氨酸试验估测1相胰岛素分泌,并计算稳态模式评估法胰岛素分泌指数(HOMA-β)及胰岛素抵抗指数(HOMA-IR).分析各病程组相关指标的变化情况及指标间的相关性.结果:随着糖尿病病程的延长,1相胰岛素分泌、HOMA-β、LFC等逐渐下降;HOMA-IR无明显变化;血肌酐(SCr)、高密度脂蛋白胆固醇(HDL-c)、尿微量白蛋白逐渐增加.相关分析显示,β细胞功能(包括1相胰岛素分泌及HOMA-β)与LFC、体质指数(BMI)、体质量、腰围、臀围、血尿酸(UA)、天冬氨酸氨基转移酶(AST)、三酰甘油(TG)、丙氨酸氨基转移酶(ALT,仅1相胰岛素分泌)、γ-谷氨酰氨基转移酶(GGT,仅1相胰岛素分泌)、腰臀比(WHR,仅HOMA-β)正相关(P＜0.05);p细胞功能与糖化血红蛋白(HbA1c,1相胰岛素分泌及HOMA-β)、糖尿病病程(仅1相胰岛素分泌)、HDL-c(仅1相胰岛素分泌)负相关(P＜0.01);β细胞功能与性别、年龄、尿素氮(BUN)、SCr、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)无明显相关性.逐步回归分析显示,1相胰岛素分泌与BMI独立正相关;糖尿病患者HOMA-β与HOMA-IR、BMI独立正相关,男女性糖尿病患者HOMA-β与HOMA-IR独立正相关.结论:随着2型糖尿病患者病程的延长,胰岛素抵抗程度变化不大,患者胰岛β细胞功能逐渐减退,LFC逐渐下降.%Objective:To observe the changes of metabolic parameters and islet function,and to explore the relationships between liver fat content (LFC) and islet function in inpatients of type 2 diabetes mellitus patients with different duration.Methods:Totally 214 diabetic patients and 65 non-diabetes patients from January 2016 to March 2017 were collected.LFC was determined by proton magnetic resonance spectrum analysis (1H-MRS),the first-phase insulin secretion was estimated by arginine test,and insulin secretion index (HOMA-β) and insulin resistance index (HOMA-IR) were assesses by homeostasis model assessment.The changes of the parameters and their relationships were analyzed in each group.Results:Along with the course of disease,the first-phase insulin secretion,HOMA-β and LFC decreased gradually,some parameters such as serum creatinine (SCr),high density lipoprotein cholesterol (HDL-c) and microalbuminuria increased gradually,while there was no significant change in HOMA-IR.Correlation analysis demonstrated that the beta cell function (including the firstphase insulin secretion and HOMA-β) was positively associated with LFC,body mass index (BMI),body weight,waist circumference,hip circumference,serum uric acid (UA),aspartate aminotransferase (AST),triglyceride (TG),waist-hip ratio (WHR,only HOMA-β),alanine aminotransferase (ALT,only the first-phase insulin secretion) and glutamyl transferase (GGT,only the first-phase insulin secretion),all P＜0.05,and was negatively associated with glycosylated hemoglobin (HbA1c),the course (only the first-phase insulin secretion),HDL-c (only the first-phase insulin secretion),all P＜0.01.There were no correlations between beta cell function and the other factors including gender,age,urea nitrogen (BUN),SCr,total cholesterol (TC),low density lipoprotein cholesterol (LDL-c).Stepwise regression analysis showed that there was independently positive correlation between the first-phase insulin secretion and BMI.There were independently positive correlations between HOMA-β and HOMA-IR and BMI in diabetic patients.Conclusions:Along with the course of disease,the degree of insulin resistance is not significantly changed,while the beta cell function and LFC decreased gradually.