摘要
目的:分析老年人初发2型糖尿病脂肪肝的发生及其相关因素情况。方法:选择2001-01/2006-01在徐州医学院附属医院老年医学科就诊治疗的老年人初发2型糖尿病患者53例,根据肝胆彩色B超检查结果,将其分为脂肪肝组37例,无脂肪肝组16例。入院行常规检查,并记录有关参数:①血压、体质量指数和腰臀比值。②空腹血糖、餐后2h血糖、总胆固醇、三酰甘油、谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶。③空腹胰岛素、餐后2h胰岛素。④肝脏超声检查结果。结果:纳入糖尿病患者53例,均进入结果分析。①16例无脂肪肝患者中伴肥胖者4例,伴血脂异常8例,肝功能谷草转氨酶、谷丙转氨酶无一例异常,谷氨酰转肽酶异常2例。37例脂肪肝患者中伴肥胖者21例,与非脂肪肝组比较差异有显著性意义(P<0.05),伴血脂异常32例,与非脂肪肝组比较差异有非常显著性意义(P<0.01),谷草转氨酶异常8例,谷丙转氨酶异常9例,谷氨酰转肽酶异常15例,与非脂肪肝组比较差异有显著性意义(P<0.05)。②脂肪肝组患者体质量指数、腰臀比值、餐后2h胰岛素、总胆固醇、舒张压和三酰甘油水平明显高于非脂肪肝组[分别为(26.15±4.61),(22.34±3.12)kg/m2;0.99±0.04,0.95±0.09;(70.52±8.02),(42.36±9.42)mU/L;(5.78±2.21),(4.33±1.72)mmol/L;(86±10),(79±9)mmHg,P<0.05;(3.02±1.26),(1.65±0.95)mmol/L,P<0.01],经Kendall相关分析和t检验结果表明,以上指标与糖尿病脂肪肝明显正相关(P<0.05)。而两组空腹血糖、餐后2h血糖、空腹胰岛素和收缩压水平差异无显著性意义(P>0.05),与糖尿病脂肪肝无明显相关性(P>0.05)。③Logistic回归分析显示腰臀比值、三酰甘油水平升高是老年人初发2型糖尿病患者脂肪肝的主要危险因子(分别为OR=1.384,OR的95%CI=1.081～1.772;OR=1.603,OR的95%CI=1.214～2.117)。结论:肥胖和血脂异常是老年人初发2型糖尿病患者脂肪肝的独立危险因子;老年人初发2型糖尿病患者易患脂肪肝,而一旦出现脂肪肝,易导致肝功能损害。
AIM： To analyze the prevalence and associated factors of fatty liver in elderly patients with type 2 diabetes of initial period.
METHODS： A total of 53 elderly patients with type 2 diabetes of initial period between January 2001 and January 2006 were selected from the Department of Geriatrics, Affiliated Hospital of Xuzhou Medical College. According to the color B-ultrasound detection of liver and gall, the subjects were divided into fatty liver group （n=37） and without fatty liver group （n=16）. Patients were given routine detection and relevant parameters were recorded.（1）Blood pressure, body mass index （BMI） and waist-to hip ratio. （2） Fasting blood glucose, blood glucose at 2 hours after meal, total cholesterol （TC）, triacylglycerol （TG）, glutamate-pyruvate transaminase （GPT）, glutamic oxalacetic transaminase （GOT） and glutamyhranspeptidase （GT）.（3）Levels of fasting insulin and insulin at 2 hours after meal.（4）Resuhs of ultrasound detection of liver and hall.
RESULTS： A total of 53 diabetic patients were involved in the analysis of resuhs.（1）In 16 diabetic patients without fatty liver, 4 were obese, and 8 were abnormal in blood lipid, no one with abnormal GOT or GPT and 2 were abnormal in GTP. Of 37 patients with fatty liver, 21 were obese, which were significantly different from the group without fatty liver （P 〈 0.05）, 32 were abnormal in blood lipid, which remarkably differed from the group without fatty liver （P 〈 0.01）, 8 patients were abnormal in GOT, 9 patients were abnormal in GPT, and 15 patients were abnormal in GTP, which were significantly different from the group without fatty liver （P 〈 0.05）. （2）The levels of BMI, waist-to-hip ratio, level of insulin at 2 hours after meal, TC, diastolic pressure and TG in patients of fatty liver group were obviously higher than the group without fatty liver[respectively, （26.15±4.61）, （22.34±3.12） kg/m^2. 0.99±0.04,0.95±0.09; （70.52±8.02）, （42.36±9.42） mU/L; （5.78±2.21）, （4.33±1.72） mmol/L; （86±10）, （79 ±9） mm Hg,P 〈 0.05;（3.02±1.26）, （1.65±0.95） mmol/L,P 〈 0.01]. Kendall correlation analysis and t test suggested that above-mentioned indexes were in positive relationship with diabetic fatty liver （P 〈 0.05）, whereas the levels of fasting blood glucose, blood glucose at 2 hours after meal, fasting insulin as well as systolic pressure were not significantly different between two groups （P 〉 0.05）, which has no obvious correlation with the diabetic fatty liver （P 〉 0.05）. （3）Logistic regression analysis suggested that the increase of waist-to-hip ratio and level of TG were main dangerous factors of initial type 2 diabetic patients with fatty liver （OR= 1.384, CI=1.081 - 1.772; OR=1.603, CI= 1.214-2.117）.
CONCLUSION： Obesity and abnormal blood lipid are independent dangerous factors of fatty liver in elderly patients with type 2 diabetes of initial period. The elderly patients with type 2 diabetes of initial period are tending to get fatty liver, which will induce the damages of liver function.
出处
《中国临床康复》
CSCD
北大核心
2006年第40期7-9,共3页
Chinese Journal of Clinical Rehabilitation
