本文選題：高甘油三酯血癥-腰圍表型　切入點(diǎn)：內(nèi)臟脂肪面積　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本文旨在探討中青年男性2型糖尿病患者合并高甘油三酯血癥-腰圍表型(hypertriglyceridemic-waist circumference phenotype,HTWC)與肝臟脂肪含量(liver fat content,LFC)及內(nèi)臟脂肪面積(visceral fat area,VFA)的關(guān)系,并分析LFC與VFA的相關(guān)性。方法:隨機(jī)選取2015年10月~2016年8月于秦皇島市第一醫(yī)院內(nèi)分泌科住院的男性2型糖尿病患者134例,年齡分布為20-64歲,平均年齡為46.69±10.72歲。入組要求嚴(yán)格遵守2006年世界衛(wèi)生組織修訂的糖尿病診斷標(biāo)準(zhǔn)。將134人分成四組:1)甘油三酯1.7mmol/l、腰圍90cm(A組,30人);2)甘油三酯≥1.7mmol/l、腰圍90cm(B組,32人);3)甘油三酯1.7mmol/l、腰圍≥90cm(C組,33人);4)甘油三酯≥1.7mmol/l、腰圍≥90cm(HTWC表型組,39人)。內(nèi)臟脂肪型肥胖(VFO)診斷標(biāo)準(zhǔn):VFA≥100cm2。被選患者需排除:1)1型糖尿病、特殊類型糖尿病;2)大于5年飲酒史,換算成酒精每周攝入≥140g;3)病毒、自身免疫等因素引起的肝病;4)糖尿病酮癥及酮癥酸中毒;5)入院前應(yīng)用調(diào)脂藥物史、惡性腫瘤史、精神疾患史、近期感染史。所有患者采集信息如下:年齡、身高、體重、腰圍(waist circumference,WC)、VFA、LFC、甘油三酯(triglyceride,TG)、總膽固醇(total cholesterol,TC)、低密度脂蛋白膽固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白膽固醇(high density lipoprotein-cholesterol,HDL-C)、谷丙轉(zhuǎn)氨酶(alanine aminotransferase,ALT)、谷草轉(zhuǎn)氨酶(aspartate aminotransferase,AST)、血小板、白蛋白、空腹血糖(fasting blood glucose,FBG)、糖化血紅蛋白(Hb A1c)。計(jì)算體重指數(shù)(body mass index,BMI)。計(jì)算非酒精性脂肪性肝病纖維化評(píng)分(NAFLD fibrosis score,NFS),NFS=-1.675+0.037×年齡(歲)+0.094×BMI(kg/m2)+1.13×空腹血糖受損/糖尿病(是=1,否=0)+0.99×AST/ALT-0.013×血小板(×109/L)-0.066×白蛋白(g/L)。VFA的測(cè)量方法為生物電阻抗法,使用儀器為我院實(shí)驗(yàn)室生物電阻抗人體成分分析儀(型號(hào)為S10)。LFC的測(cè)量方法為肝臟回聲衰減系數(shù)法,利用imige J軟件對(duì)選取的肝臟超聲圖像進(jìn)行分析,并帶入特定公式進(jìn)行計(jì)算。使用SPSS 17.0軟件進(jìn)行數(shù)據(jù)分析。分析前對(duì)數(shù)據(jù)進(jìn)行正態(tài)性及方差齊性檢驗(yàn)。符合正態(tài)分布的計(jì)量資料采用x±s表示,非正態(tài)分布資料進(jìn)行對(duì)數(shù)轉(zhuǎn)換。組間正態(tài)分布的計(jì)量資料比較采用方差分析,多重比較采用LSD檢驗(yàn),組間非正態(tài)分布的計(jì)量資料采用秩和檢驗(yàn)(Kruskal-Wallis H檢驗(yàn))。單因素相關(guān)分析采用Pearson相關(guān)分析法并逐個(gè)繪制散點(diǎn)圖。計(jì)數(shù)資料比較采用Χ2檢驗(yàn),篩選危險(xiǎn)因素采用Logistic回歸分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1 A、B、C、HTWC組平均VFA分別是72.50±12.07、91.15±18.89、97.11±15.57、121.75±20.2。HTWC組平均VFA明顯高于A、B、C組(P值分別為0.00、0.00、0.00),C組平均VFA明顯高于A組(P=0.00),B組平均VFA明顯高于A組(P=0.006),B、C組間VFA差異無統(tǒng)計(jì)學(xué)意義(P=0.367);2 A、B、C、HTWC組平均LFC分別為12.22±2.16、23.16±5.75、23.53±5.07、32.39±6.78。HTWC組平均LFC明顯高于A、B、C組(P值分別為0.00、0.031、0.025),C組平均LFC明顯高于A組(P=0.004),B組平均LFC明顯高于A組(P=0.008),B、C組間LFC差異無統(tǒng)計(jì)學(xué)意義(P=0.927);3 HTWC表型組平均NFS顯著大于A、B、C組(P值分別為0.002、0.033、0.029),C組平均NFS水平顯著大于A組(P=0.009),B組平均NFS顯著大于A組(P=0.007)。B、C組間NFS差異無統(tǒng)計(jì)學(xué)意義(P=0.397);4 VFA與HDL-C(r=-0.209,P0.05)呈負(fù)相關(guān)。VFA與WC(r=0.457,P0.05)、BMI(r=0.323,P0.05)、LFC(r=0.812,P0.05)、TG(r=0.251,P0.05)、TC(r=0.200,P0.05)、LDL-C(r=0.225,P0.05)呈正相關(guān)。VFA與年齡、AST、ALT、FBG、Hb A1c無相關(guān)性;5 A組、B組、C組、HTWC表型組中,VFA≥100cm2的檢出率分別為16.7%、44%、54.5%、74.4%。以VFA是否大于或等于100cm2為因變量(否=0,是=1),以TG、TC、LDL-C、HDL-C、AST、ALT、BMI、WC、LFC、TG與WC分層(TG1.7mmol/l、WC90cm設(shè)為1;TG≥1.7mmol/l、WC90cm設(shè)為2;TG1.7mmol/l、WC≥90cm設(shè)為3;TG≥1.7mmol/l、WC圍≥90cm設(shè)為4)作為自變量,進(jìn)行Logistic回歸分析,結(jié)果顯示除LFC外,HTWC表型也是中青年男性2型糖尿病合并VFA≥100cm2的危險(xiǎn)因素,校正TG、TC、LDL-C、HDL-C、AST、ALT、BMI、WC、LFC后,HTWC表型組VFA≥100cm2的檢出率仍是A組的12.597倍,(OR=12.597,95%:1.359~116.730)。結(jié)論:1患有2型糖尿病且合并HTWC表型的中青年男性人群中,其VFA及LFC水平明顯上升。HTWC表型是中青年男性2型糖尿病伴VFA升高的危險(xiǎn)因素,可作為初步篩查VFA是否大于或等于100cm2的簡單指標(biāo)。2中青年男性2型糖尿病患者中,VFA與LFC存在明顯的正相關(guān)性�？紤]到肝臟活檢、質(zhì)子磁共振波譜分析等測(cè)量LFC的方法成本高、難以推廣,肝臟回聲衰減系數(shù)法測(cè)量LFC工作量大、耗時(shí)多,而生物電阻抗法測(cè)量VFA操作簡便、成本低廉等原因,可利用生物電阻抗法測(cè)得的VFA水平去判斷LFC的增減趨勢(shì)。3患有2型糖尿病且合并HTWC表型的中青年男性人群中,其NFS明顯上升,較非HTWC表型者更易進(jìn)展為肝纖維化。
[Abstract]:Objective: To study the young and middle-aged male patients with type 2 diabetes and hypertriglyceridemic waist phenotype (hypertriglyceridemic-waist circumference, phenotype, HTWC) and liver fat content (liver fat, content, LFC) and visceral fat area (visceral fat, area, VFA) of the relationship, and to analyze the correlation between LFC and VFA. Methods: 134 cases randomly from October 2015 ~2016 year in August in the Department of endocrinology of Qinhuangdao First Hospital hospitalized male patients with type 2 diabetes, distribution of 20-64 years of age, the average age was 46.69 + 10.72 years old. The group requires strict adherence to the diagnostic criteria for diabetes in 2006. The 134 amendment WHO were divided into four groups: 1) triglyceride 1.7mmol/l, waist 90cm (group A, 30 people) 2); triglycerides than 1.7mmol/l, waist 90cm (group B, 32 people); 3) triglyceride 1.7mmol/l, waist circumference is greater than or equal to 90cm (C, 33); 4) were larger than 1.7mmol/l, waist circumference is greater than or equal to 9 0cm (HTWC phenotype group, 39). Visceral fat obesity (VFO) diagnostic criteria: VFA = 100cm2. was selected to exclude patients with type 1 diabetes: 1), a special type of diabetes; 2) more than 5 years history of drinking alcohol, converted into a weekly intake of more than 140g; 3) virus, caused by autoimmune factors liver disease; 4) diabetic ketosis and ketoacidosis; 5) before admission application of lipid-lowering drug history, history of malignancy, history of psychiatric disorders, recent infection history. All patients collected information as follows: age, height, weight, waist circumference (waist, circumference, WC, VFA, LFC), triglycerides (triglyceride, TG), total cholesterol (total cholesterol, TC), low density lipoprotein cholesterol (low density, lipoprotein-cholesterol, LDL-C), high density lipoprotein cholesterol (high density, lipoprotein-cholesterol, HDL-C), alanine aminotransferase (alanine, aminotransferase, ALT), aspartate aminotransferase (aspartate aminotransferase, AST) , platelet, albumin, fasting blood glucose (fasting blood, glucose, FBG), glycosylated hemoglobin (Hb A1c). Body mass index (body mass index, BMI). The calculation of nonalcoholic fatty liver fibrosis score (NAFLD fibrosis score, NFS, NFS=-1.675+0.037) * age (years old) +0.094 * BMI (+1.13 * kg/m2) impaired fasting glucose / diabetes (=1, =0) +0.99 * AST/ALT-0.013 * -0.066 * (* 109/L) platelet albumin (g/L).VFA measurement method for bioelectrical impedance analysis, the use of instruments for laboratory bio impedance body composition analyzer (model S10).LFC measurement method for liver echo attenuation coefficient method the liver ultrasound image selected, analyzed by IMIGE J software, and into the specific calculation formula. Using the SPSS 17 software was used for data analysis. The data of normality and homogeneity of variance before analysis with the measurement of normal distribution. The data are expressed by X + s, the non normal distribution data of logarithmic transformation. Compared with normal distribution measurement data between groups variance analysis, multiple comparison between groups using LSD test, non normal distribution measurement data using the Wilcoxon rank sum test (Kruskal-Wallis H test). Single factor correlation analysis using Pearson correlation analysis method and by drawing scatter plot. Count data were compared using the x 2 test, screening the risk factors by Logistic regression analysis.P0.05 the difference was statistically significant. Results: 1 A, B, C, HTWC group of average VFA were 72.50 + 12.07,91.15 + 18.89,97.11 + 15.57121.75 + 20.2.HTWC group was significantly higher than the average VFA A, B, C group (P = 0.00,0.00,0.00), C group average VFA was significantly higher than A group (P=0.00), B group average VFA was significantly higher than A group (P=0.006), B VFA C, there was no significant difference between groups (P=0.367); 2 A, B, C, HTWC group average LFC was 12.22 + 2.16,23.16 + 5. 75,23.53鹵5.07,32.39鹵6.78.HTWC緇勫鉤鍧嘗FC鏄庢樉楂樹簬A,B,C緇，

本文編號(hào)：1601271