[1]张莉莉,翁孝刚,姚姝帆.血糖波动与2型糖尿病合并代谢相关脂肪性肝病的相关性[J].新乡医学院学报,2023,40(5):427-431.[doi:10.7683/xxyxyxb.2023.05.005]
　ZHANG Lili,WENG Xiaogang,YAO Shufan.Relationship between glycemic variability and type 2 diabetes mellitus combined with metabolic associated fatty liver disease[J].Journal of Xinxiang Medical University,2023,40(5):427-431.[doi:10.7683/xxyxyxb.2023.05.005]
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血糖波动与2型糖尿病合并代谢相关脂肪性肝病的相关性
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年5
页码:
427-431
栏目:
临床研究
出版日期:
2023-05-05

文章信息/Info

Title:
Relationship between glycemic variability and type 2 diabetes mellitus combined with metabolic associated fatty liver disease
作者:
张莉莉; 翁孝刚; 姚姝帆
（新乡医学院第三临床学院，河南　新乡　453003）
Author(s):
ZHANG Lili; WENG Xiaogang; YAO Shufan
（The Third Clinical College of Xinxiang Medical University,Xinxiang 453003,Henan Province,China）
关键词:
血糖波动; 2型糖尿病; 代谢相关脂肪性肝病; 血糖
Keywords:
glucose variability; type 2 diabetes mellitus; metabolic associated fatty liver disease; blood glucose
分类号:
R587.2
DOI:
10.7683/xxyxyxb.2023.05.005
文献标志码:
A
摘要:
目的　探讨血糖波动与2型糖尿病（T2DM）合并代谢相关脂肪性肝病（MAFLD）的相关性。
方法　选择2021年1月至2021年10月新乡医学院第三附属医院内分泌科收治的T2DM患者230例为研究对象，根据是否合并MAFLD分为单纯T2DM组（n=77）和T2DM合并MAFLD组（n=153）。收集所有患者的性别、年龄、身高、体质量指数（BMI）等一般临床资料；抽取患者空腹肘静脉血 5 mL，应用生物化学仪检测空腹血糖（FPG）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、总胆红素、结合胆红素、未结合胆红素、白蛋白（ALB）、丙氨酸转氨酶（ALT）及天门冬氨酸氨基转移酶（AST）水平，全自动糖化血红蛋白分析仪测定糖化血红蛋白（HbA1c），全自动化学发光免疫分析仪测定空腹胰岛素（FINS）、空腹C肽（FC-P），并计算稳态模型胰岛素抵抗指数（HOMA-IR）；每日进行7次指尖血糖监测，并计算血糖水平标准差（SDBG）、餐后血糖波动幅度（PPGE）、最大血糖波动幅度（LAGE）。比较单纯T2DM组与T2DM合并MAFLD组患者各指标的差异，分析血糖波动与T2DM合并MAFLD的相关性。
结果　T2DM合并MAFLD组患者的BMI、舒张压、总胆红素、结合胆红素、未结合胆红素、ALB、ALT、AST、FPG、TG、FINS、FC-P、HOMA-IR、SDBG、PPGE、LAGE显著高于单纯T2DM组，年龄、病程显著低于单纯T2DM组（P<0.05）。SDBG正常组和SDBG异常组患者MAFLD患病率分别为51.1%（23/45）、70.3%（130/185），SDBG正常组患者MAFLD患病率显著低于SDBG异常组（χ2=5.970，P<0.05）；PPGE正常组和PPGE异常组患者MAFLD患病率分别为52.4%（22/42）、69.7%（131/188），PPGE正常组患者MAFLD患病率显著低于PPGE异常组（χ2=4.610，P<0.05）；LAGE正常组和LAGE异常组患者MAFLD患病率分别为43.5%（10/23）、69.1%（143/207），LAGE正常组患者MAFLD患病率显著低于LAGE异常组（χ2=6.090，P<0.05）。多因素logistic回归分析显示，病程、BMI、总胆红素、TG、FINS、SDBG是T2DM患者并发MAFLD的独立危险因素（OR=0.955、1.232、1.072、1.771、1.013、1.671，P<0.05）。
结论　血糖波动与T2DM患者合并MAFLD密切相关，控制血糖波动可能对防治MAFLD有积极作用。
Abstract:
Objective　To investigate the relationship between glycemic variability and type 2 diabetes mellitus（T2DM）combined with metabolic associated fatty liver disease (MAFLD).
Methods　A total of 230 patients with T2DM admitted to the Department of Endocrinology,the Third Affiliated Hospital of Xinxiang Medical University From January to October 2021 were selected as the research subjects.According to the patients whether combined with MAFLD,they were divided into simple T2DM group（n=77）and T2DM combined with MAFLD group（n=153).The general clinical data such as gender,age,height,and body mass index (BMI) of all patients were collected.A total of 5 mL of fasting elbow vein blood of patients was extracted,and the levels of fasting blood glucose (FPG),total cholesterol (TC),triacylglycerol (TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),total bilirubin,conjugated bilirubin,unconjugated bilirubin,albumin (ALB),alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured using a biochemical instrument;the glycosylated hemoglobin (HbA1c) was measured with a fully automatic glycosylated hemoglobin analyzer;the levels of fasting insulin (FINS) and fasting C-peptide (FC-P) were measured with a fully automatic chemiluminescence immunoassay analyzer,and the homeostasis model insulin resistance index (HOMA-IR) was calculated;the fingertip blood glucose monitoring was conducted for 7 times a day,and the standard deviation of mean blood glucose (SDBG),postprandial glucose excursions (PPGE) and large amplitude of glycemic excursions (LAGE) were calculated.The differences in various indicators of patients between the simple T2DM group and T2DM combined with MAFLD group were compared,and the correlation between glucose variability and T2DM combined with MAFLD was analyzed.
Results　The BMI,diastolic blood pressure,total bilirubin,conjugated bilirubin,unconjugated bilirubin,ALB,ALT,AST,FPG,TG,FINS,FC-P,HOMA-IR,SDBG,PPGE and LAGE of patients in the T2DM combined with MAFLD group were significantly higher than those of patients in the simple T2DM group,while the age and course of disease were significantly lower than those of patients in the simple T2DM group (P<0.05).The prevalence of MAFLD in patients with normal SDBG and abnormal SDBG was 51.1%(23/45) and 70.3%(130/185),respectively;the prevalence of MAFLD in patients with normal SDBG was significantly lower than that in patients with abnormal SDBG (χ2=5.970,P<0.05).The prevalence of MAFLD in patients with normal PPGE and abnormal PPGE was 52.4% (22/42) and 69.7% (131/188),respectively;the prevalence of MAFLD in patients with normal PPGE was significantly lower than that in patients with abnormal PPGE (χ2=4.610,P<0.05).The prevalence of MAFLD in patients with normal LAGE and abnormal LAGE was 43.5% (10/23) and 69.1% (143/207),respectively;the prevalence of MAFLD in patients with normal LAGE was significantly lower than that in patients with abnormal LAGE (χ2=6.090,P<0.05).Multivariate logistic regression analysis showed that the course of disease,BMI,total bilirubin,TG,fasting insulin and SDBG were independent risk factors for MAFLD in patients with T2DM (OR=0.955,1.232,1.072,1.771,1.013,1.671;P<0.05).
Conclusion　Glucose variability is closely related to MAFLD in T2DM patients,controlling glycemic variability may play a positive role in the prevention and treatment of MAFLD.

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更新日期/Last Update: 2023-05-05