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投稿时间：2020-10-22 网络发布日期：2021-04-20
投稿时间：2020-10-22 网络发布日期：2021-04-20
中文摘要: 目的 探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者肝纤维化与胰岛素抵抗(IR)的关系。方法 收集2018年12月至2020年1月就诊于兰州大学第二医院的T2DM患者298例,依据腹部超声检查结果,分为单纯T2DM组(n=81)及T2DM合并NAFLD组(n=217)。收集两组病史资料及馒头餐糖耐量试验结果,计算稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素动态分泌敏感性评估指数(ISImatsuda)及胰岛素敏感指数(ISI)。依据NAFLD肝纤维化评分(NFS)将T2DM合并NAFLD患者分为排除纤维化亚组(n=69)、不确定亚组(n=86)及纤维化亚组(n=62),比较各组间IR程度。应用Logistic回归分析影响肝纤维化发展的因素。ROC曲线分析HOMA-IR、ISImatsuda对患者肝纤维化的诊断价值。结果 相比于单纯T2DM组,合并NAFLD组患者的HOMA-IR升高,ISImatsuda、ISI则下降(P均<0.01);合并NAFLD患者中,肝纤维化亚组HOMA-IR(11.96±4.66)高于不确定亚组(9.74±4.16)和排除纤维化亚组(6.21±2.99),ISImatsuda、ISI低于其他两组,差异均有统计学意义(P均<0.01)。 Logistic回归分析显示,高HOMA-IR是影响T2DM合并NAFLD患者肝维化的危险因素(P<0.01),而高ISImatsuda为延缓肝纤维化的保护性因素(P<0.05)。ROC曲线分析提示HOMA-IR取最佳截断值为9.895时,诊断T2DM合并NAFLD患者发生肝纤维化的敏感度为75.8%,特异度为71.6%,ROC曲线下面积为0.738。结论 IR是促进肝纤维化进展的危险因素,改善胰岛素敏感性可能是延缓肝纤维化的治疗靶标。
Abstract:Objective To explore the relationship between liver fibrosis and insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD).
Methods A total of 298 patients with T2DM admitted to the Second Hospital of Lanzhou University from December 2018 to January 2020 were selected and divided into simple T2DM group (T2DM group,n=81) and T2DM combined with NAFLD group (T2DM plus NAFLD group,n=217) according to the results of abdominal ultrasound examination.The medical history data and the results of steamed bread meal sugar-tolerance test were collected to analyze Homeostasis model assessment-insulin resistance index (HOMA-IR),insulin dynamic secretion index (ISImatsuda) and insulin sensitivity index (ISI).According to NAFLD fibrosis score (NFS),T2DM patients with NAFLD were divided into fibrosis excluded subgroup (n=69),uncertainty fibrosis subgroup (n=86) and fibrosis subgroup (n=62).The degree of IR was compared among the groups.Logistic regression analysis was used to explore the influencing factors of liver fibrosis progression.Receiver operation curve (ROC) analysis was used to define the diagnostic value of HOMA-IR and ISImatsuda in liver fibrosis.
Results Compared with T2DM group,HOMA-IR increased,while ISImatsuda and ISI decreased in T2DM plus NAFLD group (all P<0.01).In the T2DM patients with NAFLD,HOMA-IR in liver fibrosis subgroup(11.96±4.66)was higher than those in uncertain subgroup(9.74±4.16)and fibrosis exclusion subgroup(6.21±2.99),and ISImatsuda and ISI were statistically lower than those in uncertain fibrosis subgroup and fibrosis excluded subgroup (all P<0.05).Logistic regression analysis showed that high HOMA-IR was an independent risk factor of liver fibrosis in patients with T2DM and NAFLD (P<0.01),while high ISImatsuda had a protective effect on delaying liver fibrosis(P<0.05).ROC curve suggested that when the best cut-off value of HOMA-IR was 9.895,the sensitivity for diagnosing liver fibrosis in patients with T2DM and NAFLD was 75.8%,the specificity was 71.6%,and the area under ROC curve was 0.738.
Conclusion IR is a risk factor for the progression of liver fibrosis,and improving insulin sensitivity may be a therapeutic target for delaying liver fibrosis.
keywords: Type 2 diabetes mellitus Nonalcoholic fatty liver disease Liver fibrosis Insulin resistance
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附件
| Author Name | Affiliation |
| LIU Jiao,REN Cai-qin,FENG Ya-li,HE Ji-rui | Department of Geriatrics,the Second Hospital of Lanzhou University,Lanzhou,Gansu 730000,China |
引用文本：
刘佼,任彩琴,冯亚莉,何继瑞.2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化与胰岛素抵抗的关系[J].中国临床研究,2021,34(4):443-448.
刘佼,任彩琴,冯亚莉,何继瑞.2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化与胰岛素抵抗的关系[J].中国临床研究,2021,34(4):443-448.