本文選題：2型糖尿病　切入點：非酒精性脂肪肝　出處：《承德醫(yī)學院》2017年碩士論文

【摘要】：近30年來,我國糖尿病(diabetes mellitus,DM)的患病率顯著升高,2010年的調(diào)查發(fā)現(xiàn)我國18歲以上人群DM的患病率已高達11.6%。同時,我國非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)的發(fā)病率及檢出率也呈逐年增加趨勢。流行病學資料顯示,約34%-74%的2型糖尿病(type 2 diabetes mellitus,T2DM)患者合并NAFLD。T2DM與NAFLD共同的發(fā)病機制是胰島素抵抗(insulin resistance,IR)。T2DM患者常存在IR及脂質(zhì)的代謝障礙,脂毒性是其作用機制之一。血清游離脂肪酸(free fatty acid,FFA)為脂代謝的中間產(chǎn)物,當其水平升高或細胞內(nèi)脂肪的含量增加時,能夠誘發(fā)或加重IR及對胰島β細胞功能的損害,從而促使T2DM的發(fā)生,其主要作用于胰腺、肝臟、肌肉等部位。脂肪組織不單單因為是存儲能量的器官而在人體內(nèi)存在,其也是機體最大的內(nèi)分泌器官。脂肪組織分泌的抵抗素、TNF-a等細胞因子,不僅在炎癥免疫調(diào)節(jié)方面發(fā)揮作用,而且參與機體的代謝調(diào)節(jié)。近些年的研究表明,脂肪組織分泌的抵抗素與IR之間有著密切的聯(lián)系,可通過減弱胰島素信號級聯(lián)反應中多個環(huán)節(jié)的作用而導致IR,參與T2DM及NAFLD等疾病的發(fā)病過程。大量研究表明,T2DM合并NAFLD者心血管等大血管并發(fā)癥的發(fā)生風險增高,且獨立于其他危險因素。T2DM和NAFLD皆為動脈粥樣硬化(atherosclerosis,AS)的獨立危險因素。頸動脈是早期AS常見的發(fā)生部位,在臨床工作中常將頸動脈內(nèi)膜中層厚度(carotid artery intima media thickness,CIMT)作為AS的預測因素。因此,本研究擬通過對138例T2DM患者的臨床資料進行分析,來探討CIMT、FFA、抵抗素與T2DM合并NAFLD的關系。目的:本研究旨在通過觀察T2DM合并不同程度NAFLD患者間CIMT、FFA、抵抗素的差異,探討CIMT、FFA、抵抗素與T2DM合并NAFLD的關系,為臨床上該類人群制定預防控制策略提供臨床依據(jù)。方法:連續(xù)入選承德醫(yī)學院附屬醫(yī)院內(nèi)分泌科2015年3月~2015年10月期間住院的t2dm患者143例,其中138例符合入選標準。收集以下資料:(1)患者一般資料:性別、年齡、血壓、身高、體重、腰圍(wc)等;(2)生化指標:所有患者均于隔夜清晨空腹狀態(tài)下抽取靜脈血,送至檢驗科測定總膽固醇(tch)、甘油三酯(tg)、低密度脂蛋白膽固醇(ldl-c)、高密度脂蛋白膽固醇(hdl-c)、糖化血紅蛋白(hba1c)、空腹血糖(fpg);(3)進行肝臟和頸動脈彩超檢查;(4)計算體質(zhì)量指數(shù)(bmi)。按照超聲檢查回報的結果將研究對象分為t2dm不合并nafld組(a組,n=44)、t2dm合并輕度nafld組(b組,n=39)及t2dm合并中重度nafld組(c組,n=55)。結果:1一般資料比較單因素方差分析結果顯示三組在性別、年齡、血壓方面差異無統(tǒng)計學意義(p0.05)。b組、c組的wc、bmi測定值分別為:(92.77±5.86)cm、(95.69±5.86)cm和(26.25±3.01)kg/m2、(27.53±2.92)kg/m2,均顯著高于a組的(88.02±6.78)cm、(24.60±2.51)kg/m2,差異有統(tǒng)計學意義(p0.05)。與b組相比,c組患者的bmi升高(p0.05)。2糖脂代謝方面比較三組間單因素方差分析結果顯示組間差異在tch差異無統(tǒng)計學意義(p0.05),在fpg、hba1c、tg、hdl-c、ldl-c差異有統(tǒng)計學意義(p0.05)。進一步行兩兩比較顯示:與a組的tg(1.40±0.51)mmol/l、fpg(8.84±2.32)mmol/l、hdl-c(0.89±0.13)mmol/l相比,b組的tg(2.08±0.69)mmol/l、fpg(10.16±3.21)mmol/l和c組的tg(2.13±0.60)mmol/l、fpg(10.50±3.15)mmol/l升高,b組的hdl-c(0.82±0.15)mmol/l、c組的hdl-c(0.81±0.11)mmol/l降低,差異有統(tǒng)計學意義(p0.05)。與b組的ldl-c(2.05±0.75)mmol/l、hba1c(9.03±1.56)%相比,c組的ldl-c(2.37±0.65)mmol/l、hba1c(9.69±1.59)%升高,差異有統(tǒng)計學意義(p0.05)。3ffa、抵抗素、cimt水平比較單因素方差分析結果顯示三組間ffa、抵抗素及cimt差異均有統(tǒng)計學意義(p0.05)。進一步行兩兩比較顯示:與a組的ffa(513.57±238.02)ng/mL、抵抗素(24.56±8.39)ng/mL、CIMT(0.90±0.17)mm相比,C組的FFA(656.59±250.64)ng/mL、抵抗素(29.94±10.98)ng/mL、CIMT(1.03±0.17)mm均升高,差異有統(tǒng)計學意義(P0.05)。B組的FFA(556.94±248.78)ng/mL、抵抗素(28.20±11.21)ng/mL、CIMT(0.94±0.16)mm與A組、C組相比,差異均無統(tǒng)計學意義(P0.05)。4合并NAFLD的程度與各指標的相關性合并NAFLD的程度與WC、BMI、FPG、HbA1c、TG、LDL-C、CIMT、FFA、抵抗素呈正相關關系(r=0.459,0.403,0.208,0.305,0.438,0.231,0.309,0.244,0.198,P0.05),而與HDL-C呈負相關關系(r=-0.252,P0.01)。結論:T2DM合并NAFLD者肥胖及糖脂代謝紊亂狀態(tài)更明顯,血清FFA、抵抗素水平更高,CIMT值更大;并且隨NAFLD嚴重程度的增加而更嚴重。
[Abstract]:In the past 30 years, China's diabetes (diabetes mellitus, DM) significantly increased the prevalence rate, the 2010 survey found that people over the age of 18 the prevalence of DM in China has reached 11.6%. at the same time, China's non alcoholic fatty liver (nonalcoholic fatty liver disease, NAFLD) the incidence and prevalence is also increased trend year by year. Epidemiological data show that type 2 diabetes is about 34%-74% (type 2 diabetes mellitus, T2DM NAFLD.T2DM and NAFLD) with the pathogenesis of patients with common insulin resistance (insulin resistance, IR) metabolic disorders are common in patients with.T2DM IR and lipid, lipid toxicity is one of the mechanisms of serum free fatty acids (free. Fatty acid, FFA) for intermediate products of lipid metabolism, as the increase of the content of elevated levels or intracellular fat, can induce or aggravate IR and damage to the function of islet beta cells, can induce T2DM, as the main In the pancreas, liver, muscle and other parts. The adipose tissue is not only because of the energy storage organs in the human body, which is the body's largest endocrine organ. Adipose tissue secretion of resistin, cytokines such as TNF-a, not only in the inflammatory immune regulation play a role, but also involved in metabolic regulation in recent years. Show that there is a close relationship between resistin and IR secreted by adipose tissue, can be caused by weakening the IR aspects of insulin signaling cascade plays a role in the pathogenesis of T2DM and NAFLD in other diseases. Many studies showed that T2DM and NAFLD in cardiovascular macrovascular complications increased the risk, and independent other risk factors for.T2DM and NAFLD are atherosclerosis (atherosclerosis, AS). The independent risk factors of carotid artery is common occurrence site of early AS, in clinical work The carotid intima-media thickness (carotid artery intima media thickness, CIMT) as predictors of AS. Therefore, this study based on the clinical data of 138 cases of T2DM were analyzed to explore the CIMT, FFA, T2DM and NAFLD and the relationship between resistin. Objective: This study aimed to observe the T2DM with different degree among NAFLD patients CIMT, FFA, resistin differences of CIMT, FFA, T2DM and NAFLD and the relationship between resistin, clinical on the population to develop to provide a clinical basis for the prevention and control strategy. Methods: a total of 143 consecutive patients with T2DM admitted to the Department of endocrinology of Affiliated Hospital of Chengde Medical College during October March 2015 ~2015 cases, including 138 cases of eligible to collect. The following information: (1) patients with general information: gender, age, blood pressure, height, weight, waist circumference (WC); (2): biochemical indexes in all patients were taken in the fasting state overnight 闈欒剦琛，

本文編號：1678847