| 摘要: |
| 目的 研究2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者血清颗粒蛋白前体水平的变化及其临床意义。方法 采用横断面研究，随机选取T2DM患者116例，其中合并NAFLD组（68例），未合并NAFLD组（48例）。检测两组血清颗粒蛋白前体水平并测定糖化血红蛋白（HbA1c）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（AKP）、尿酸（UA）、三酰甘油 （TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FBG）、空腹胰岛素（FINS）水平，计算稳态模型胰岛素抵抗指数（HOMA-IR）；同时测量身高、体质量、腰围、臀围，计算体质量指数（BMI）和腰臀比。应用多元逐步回归分析方法分析血清颗粒蛋白前体与上述指标的相关性，应用Logistic回归分析T2DM合并NAFLD的影响因素。结果 （1）T2DM合并NAFLD组与未合并NAFLD组相比，BMI、腰围、臀围、腰臀比、FINS、HOMA-IR、TG、ALT、AST水平明显升高（P<0.05），HDL-C水平降低（P<0.05）。（2）血清颗粒蛋白前体水平在T2DM合并NAFLD组显著高于未合并NAFLD组（P<0.01）。（3）多元逐步回归分析结果提示BMI、HOMA-IR、TG分别作为独立危险因素影响血清颗粒蛋白前体水平。（4）Logistic回归分析显示颗粒蛋白前体、BMI及ALT为T2DM患者发生NAFLD的独立影响因素。结论 T2DM合并NAFLD患者血清颗粒蛋白前体水平明显升高，高水平的颗粒蛋白前体是T2DM合并NAFLD的独立影响因素，可能成为评估T2DM合并NAFLD的重要血清学指标。 |
| 关键词: 2型糖尿病 非酒精性脂肪性肝病 颗粒蛋白前体 胰岛素抵抗 |
| DOI：10.16781/j.0258-879x.2016.08.1033 |
| 投稿时间：2015-09-06修订日期：2016-05-26 |
| 基金项目:上海市科学技术委员会科研计划项目（13ZR1460900），上海市浦东新区卫生系统优秀青年医学人才培养计划（PWRq2013-08），上海市卫生和计划生育委员会青年科研项目（20134Y055）. |
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| Variation of serum progranulin levels in patients with type 2 diabetes and nonalcoholic fatty liver disease |
| MA Jun-hua,SUN Fei,XI Qian,WANG Hong-yan,GU Ming-jun,LIU Lian-yong* |
(Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the changes of serum progranulin in type 2 diabetic (T2DM) patients with nonalcoholic fatty liver disease (NAFLD) and the relevant clinical significance. Methods The clinical data were subjected to cross-sectional analysis. Totally 116 T2DM patients were randomly selected and assigned to the NAFLD group (n=68) and non-NAFLD group (n=48). The levels of serum progranulin, glycosylated hemoglobin A1c(HbA1c),liver enzymes (ALT, AST, AKP), uric acid (UA), lipids(TG, TC, LDL-C, HDL-C),fasting blood-glucose (FBG), and fasting insulin (FINS) were assessed. Homeostasis model assessment of insulin resistance (HOMA-IR)was calculated. The height, weight, waist circumference and hip circumference were measured, and the body mass index(BMI) and waist-to-hip ratio (WHR) were calculated. The multiple stepwise regression analysis was used to detect the association of progranulin with the above metabolic parameters. The logistic regression was used to analyze the factors influencing NAFLD in patients with T2DM. Results (1)Compared with non-NAFLD group, the levels of BMI, waist circumference, hip circumference, WHR and serum FINS, HOMA-IR, TG, ALT, and AST were significantly higher in the NAFLD group (P<0.05), while the level of HDL-C was significantly lower (P<0.05)in NAFLD group. (2)Serum levels of progranulin were significantly higher in patients with NAFLD than in those with non-NAFLD (P<0.01). (3)Multiple stepwise regression analysis suggested that BMI, HOMA-IR and TG were the independent factors influencing serum progranulin level. (4)Logistic regression analysis showed that progranulin, BMI and ALT were the independent risk factors influencing NAFLD in T2DM patients. Conclusion Serum progranulin level is increased in T2DM patients combined with NAFLD. High level of progranulin is an independent risk factor for the presence of NAFLD in T2DM patients. Progranulin might be an important serological marker of NAFLD in T2DM patients. |
| Key words: type 2 diabetes mellitus non-alcoholic fatty liver disease progranulin insulin resistance |
