新诊断2型糖尿病合并非酒精性脂肪肝临床特征及胰岛素抵抗特点分析

目的探讨新诊断2型糖尿病（T2DM）合并非酒精性脂肪肝（NAFLD）临床特征及胰岛素抵抗（IR）特点。方法将符合标准的新诊断T2DM患者根据有无合并NAFLD分为NAFLD组140例与非NAFLD组60例。记录患者的身高、体质量、血压、血糖、血脂、尿酸、生化、肝酶等。计算患者体质量指数（BMI）、胰岛素抵抗指数（HOMA—IR）、胰岛素C肽指数（HO—MA—C肽）。比较两组指标特点。结果NAFLD组患者的BMI、空腹血糖（FBG）、丙氨酸氨基转移酶（ALT）、谷氨酰基转肽酶（GGT）及血尿酸（UA）、甘油三酯（TG）、低密度脂蛋白（LDL—C）高于非NAFLD组（P＜0．05）；与非NAFLD组比较，NAFLD组患者的空腹血浆胰岛素（FINS）、空腹C肽（FCP）、糖化血红蛋白（HbAlc）及HOMA—IR、HOMA—C肽均明显升高（P＜0．05）；Logistic回归分析发现BMI、TG、GGT、uA是新诊断T2DM合并NAFLD重要的危险因素（P＜0．05，OR值分别为1．82、1．53、1．37、1．09）。结论肥胖、高尿酸血症、高TG血症以及GGT升高是新诊断T2DM发生NAFLD的重要危险因素。当新诊断T2DM同时合并NAFLD时，IR更加严重。

Metabolic characteristic and insulin resistance in newly diagnosed type 2 diabetes patients with nonalcoholic fatty liver disease

Objective To investigate metabolic characteristics and insulin resistance in newly diagnosed type 2 diabetes patients with nonalcoholic fatty liver disease. Methods Two hundred patients with newly diagnosed type 2 diabetes mellitus including 140 with nonalcoholic fatty liver disease （NAFLD） （NAFLD group） and 60 without NAFLD （non-NAFLD group） were recruited. Metabolic characteristic were measured and recorded, homeostasis model assessment insulin resistance （HOMA-IR） index and HOMA-C were used to assess insulin resistance. Results were compared between two groups. Results Compared with non-NAFLD group, body mass index （ BMI）, fasting blood glucose （ FBG）, alanine aminotransferase （ ALT）, gamma-glutamyl transferase （ GGT）, uric acid （UA）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C）, fasting insulin （FINS）, fasting C peptide （FCP）, glycated hemoglobin alc（HbAlc） , HOMA-IR, and HOMA-C were significantly higher in the NAFLD group （ P〈0. 05 ）. Logistics regression analysis showed that BMI, TG, GGT, and UA were risk factors for NAFLD （ P 〈0.05, OR = 1.82, 1.53, 1.37, and 1.09）. Conclusions Compared patients without NAFLD, newly diagnosed type 2 diabetes patients with NAFLD present more metabolic disturbance, and severely insulin resistance. Obesity and the increased level of postprandial UA, triglyceridemia, and GGT might increase the risk of NAFLD in the patients with newly diagnosed type 2 diabetes mellitus.