糖尿病_非胰岛素依赖型；_脂肪肝；

老年2型糖尿病胰岛素抵抗与非酒精性脂肪肝相关分析

http://www.100md.com 《实用老年医学》 2006年第4期

糖尿病,非胰岛素依赖型；,脂肪肝；,胰岛素抗药性；,高脂血症；,老年人,1对象与方法,2结果,3讨论,参考文献

     【摘要】目的探讨老年2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者与肥胖、血脂紊乱及胰岛素抵抗(IR)的关系。方法 115例老年T2DM患者根据B超检查结果,分为糖尿病(DM)合并NAFLD组(DFL组)与DM无脂肪肝组(T2DM组),并收集同期的无DM NAFLD(NASH组)患者50例作为对照。运用稳态模型评估法(homeostasis model assessment，HOMA)及其他相关指标,评价IR。结果 (1)115例T2DM患者合并脂肪肝的发生率为56%;(2)DFL组的危险因素:体质量指数(BMI)、舒张压(DBP)、血尿酸(UA)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDLC)、空腹胰岛素(FINS)、空腹C肽(FC)、餐后胰岛素(PINS)、载脂蛋白B(ApoB)、HOMAIR均有显著升高(P<005～001),载脂蛋白A1(ApoA1)、脂蛋白(a)[Lp(a)]、HOMA胰岛素β细胞分泌指数(IS)、胰岛素敏感指数(ISI)则有显著降低(P<005～001),其中最主要的危险因素是BMI、TG和PINS。(3)DFL组与T2DM组比较,性别、年龄、血糖、病程无显著差异;DFL组与NASH组比较, 血清丙氨酸氨基转移酶水平有显著差异(P<005～001),HOMAIR无显著差异。结论 (1)T2DM合并NAFLD患者存在明显的肥胖、血脂紊乱及IR,尤以TG、BMI和ISI为主要因素,高TG血症反映了IR的程度;(2)虽然性别、年龄、血糖、病程对NASH患者影响显著,但在DM患者中它们的影响不大;(3)老年T2DM患者控制体质量、血糖、血脂，减少IR，对于预防和减少T2DM并发脂肪肝具有重要的意义。

    【主题词】糖尿病，非胰岛素依赖型；脂肪肝；胰岛素抗药性；高脂血症；老年人

    Association between insulin resistance and nonalcoholic fatty liver disease in aged patients with type2 diabetes mellitus

    XIA Jinwei, ZHONG Yuan, ZHANG Xingliang.

    Department of Geriatrics, The Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 200233 China

    【Abstract】 Objective To investigate the relationship of obesity, dyslipidaemia, insulin resistance(IR) with nonalcoholic fatty liver disease in aged patients with type 2 diabetes mellitus. Methods One hundred and fifteen patients with type 2 diabetes were divided into two groups (DFL group and T2DM group) according to whether the patients presented with fatty liver or not. Fifty cases of nondiabetic nonalcoholic fatty liver disease were collected in the same period as NASH group. Homeostasis model assessment (HOMA) was applied to estimating IR. Resukts (1) The prevalence of fatty liver in type 2 diabetic patients was 56%. (2) Risk factors related to DFL including BMI,DBP,UA,TG,LDLC,FINS,FC,PINS ......

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