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| 2型糖尿病患者中ZJU指数定义的非酒精性脂肪性肝病与血清25-羟维生素D水平的关系 |
| 陈重阳1,潘斌晶1,闫俊新1,蔡静1,赵平平1,赵阳婷1,吕小羽1,李凯1,王亚雯1,刘靖芳1,2* |
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(1. 兰州大学第一临床医学院, 兰州 730000;
2. 兰州大学第一医院内分泌科, 兰州 730000
*通信作者) |
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| 摘要: |
| 目的 探讨2型糖尿病（T2DM）患者中ZJU指数定义的非酒精性脂肪性肝病（NAFLD）与血清25-羟维生素D［25（OH）D］水平的相关性。方法 收集2016年4月至2020年10月兰州大学第一医院内分泌科确诊的917例T2DM住院患者的临床资料。ZJU指数＜32.0时排除NAFLD，为32.0～38.0时不确定，＞38.0时诊断为NAFLD，分析3组患者血清25（OH）D水平的差异。采用广义线性模型分析25（OH）D水平与ZJU指数定义的NAFLD的相关性。结果 917例T2DM患者中ZJU指数定义的NAFLD患者共有570例（62.16%）；超声诊断为脂肪肝的412例T2DM患者中ZJU指数定义为NAFLD的患者有336例（81.55%）。合并高血压、高脂血症、超重或肥胖的T2DM患者NAFLD的患病率分别高于无高血压、无高脂血症、体重正常的T2DM患者［64.92%（396/610） vs 56.68%（174/307），68.18%（480/704） vs 42.25%（90/213），76.83%（315/410）、99.08%（108/109） vs 38.03%（143/376）；P均＜0.01］。血糖控制不佳的T2DM患者NAFLD的患病率高于血糖控制良好者［69.33%（495/714） vs 36.95%（75/203），P＜0.001］。25（OH）D水平正常的T2DM患者NAFLD的患病率高于25（OH）D不足、缺乏者［79.90%（163/204）vs 56.99%（367/644）、57.97%（40/69），P＜0.001］。调整年龄、空腹血糖、餐后2 h血糖、糖化血红蛋白（HbA1c）、BMI、收缩压、舒张压、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）等混杂因素后，协方差分析显示男性、女性患者中，NAFLD组和非NAFLD组之间血清25（OH）D水平差异均无统计学意义（P＝0.065、0.197）。广义线性模型分析显示，BMI、餐后2 h血糖、HbA1c、稳态模型胰岛素抵抗指数、甘油三酯、ALT/AST是ZJU指数定义的NAFLD的危险因素（OR＝2.754、1.499、1.341、1.067、2.871、22.346），而血清25（OH）D水平与ZJU指数无关（P＝0.802）。结论 ZJU指数对于T2DM患者合并NAFLD的诊断有一定的应用价值。血糖控制不佳或合并高血压、高脂血症、超重、肥胖的T2DM患者ZJU指数定义的NAFLD的患病率较高，但血清25（OH）D水平与NAFLD无关。 |
| 关键词: 2型糖尿病 非酒精性脂肪性肝病 胰岛素抵抗 25-羟维生素D ZJU指数 |
| DOI：10.16781/j.CN31-2187/R.20220309 |
| 投稿时间：2022-04-16修订日期：2022-09-02 |
| 基金项目:国家自然科学基金（81960155），甘肃省自然科学基金（20JR10RA690）. |
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| Correlation between non-alcoholic fatty liver disease defined by ZJU index and serum 25-hydroxyvitamin D levels in patients with type 2 diabetes mellitus |
| CHEN Chong-yang1,PAN Bin-jing1,YAN Jun-xin1,CAI Jing1,ZHAO Ping-ping1,ZHAO Yang-ting1,LÜ Xiao-yu1,LI Kai1,WANG Ya-wen1,LIU Jing-fang1,2* |
(1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China;
2. Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the relationship between non-alcoholic fatty liver disease (NAFLD) defined by ZJU index and serum 25-hydroxyvitamin D levels in patients with type 2 diabetes mellitus (T2DM). Methods The clinical data of 917 T2DM patients diagnosed in Department of Endocrinology, First Hospital of Lanzhou University from Apr. 2016 to Oct. 2020 were collected. The patients were divided into non-NAFLD group (ZJU index＜32.0), uncertain group (ZJU index 32.0-38.0) and NAFLD group (ZJU index＞38.0), and the serum 25-hydroxyvitamin D levels of the 3 groups were compared. The association between 25-hydroxyvitamin D levels and NAFLD defined by ZJU index was analyzed by generalized linear model. Results There were 570 NAFLD patients (62.16%) defined by ZJU index in 917 T2DM patients. The ZJU index defined 336 (81.55%) patients as NAFLD in 412 T2DM patients who were diagnosed with fatty liver by ultrasound. The prevalence rates of NAFLD in T2DM patients with hypertension, hyperlipidemia, overweight or obesity were significantly higher than those in T2DM patients without hypertension, hyperlipidemia or with normal weight (64.92% ［396/610］ vs 56.68% ［174/307］, 68.18% ［480/704］ vs 42.25% ［90/213］, and 76.83% ［315/410］ and 99.08% ［108/109］ vs 38.03% ［143/376］; all P＜0.01). The prevalence of NAFLD in T2DM patients with poor glycemic control was significantly higher than that with good glycemic control (69.33% ［495/714］ vs 36.95% ［75/203］, P＜0.001). The prevalence of NAFLD in T2DM patients with normal 25-hydroxyvitamin D levels was significantly higher than that with 25-hydroxyvitamin D inadequacy or deficiency (79.90% ［163/204］ vs 56.99% ［367/644］ and 57.97% ［40/69］, P＜0.001). After adjusting for confounding factors such as age, fasting blood glucose, blood glucose 2 h after meals, glycosylated hemoglobin (HbA1c), body mass index (BMI), systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), analysis of covariance showed that there were no significant differences in 25-hydroxyvitamin D levels between male and female NAFLD groups and non-NAFLD groups in either male or female patients (P＝0.065 and 0.197). The generalized linear model suggested that BMI, blood glucose 2 h after meals, HbA1c, homeostasis model of assessment for insulin resistance index, triglyceride and ALT/AST were the risk factors for NAFLD defined by ZJU index (OR＝2.754, 1.499, 1.341, 1.067, 2.871, and 22.346). There was no correlation between serum 25-hydroxyvitamin D level and ZJU index (P＝0.802). Conclusion ZJU index has application value in the diagnosis of NAFLD in T2DM patients. The prevalence of NAFLD defined by ZJU index is higher in T2DM patients with poor glycemic control, hypertension, hyperlipidemia, overweight or obesity, but serum 25-hydroxyvitamin D level is not associated with NAFLD. |
| Key words: type 2 diabetes mellitus non-alcoholic fatty liver disease insulin resistance 25-hydroxyvitamin D ZJU index |
