本文選題：非酒精性脂肪性肝病 + 糖代謝異常�。� 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：1背景與目的 非酒精性脂肪性肝病(NAFLD)及2型糖尿�。═2DM）是世界范圍內(nèi)的常見(jiàn)病、多發(fā)病,其發(fā)病率在近幾十年來(lái)有了顯著的增加。估計(jì)我國(guó)現(xiàn)有NAFLD患者約1.5億[1]，已經(jīng)達(dá)到了流行病的程度。NAFLD的發(fā)生與代謝綜合征（MS）、糖耐量異常、T2DM有密不可分的聯(lián)系。循證醫(yī)學(xué)研究顯示，NAFLD是T2DM和動(dòng)脈粥樣硬化相關(guān)疾病的高危因素, T2DM患者中約80%患者合并NAFLD，是加重肝臟和外周胰島素抵抗、導(dǎo)致糖尿病進(jìn)展和惡化的重要原因[2]。因此NAFLD的篩查將有助于預(yù)測(cè)T2DM和心血管疾病的發(fā)生，對(duì)NAFLD的預(yù)防和治療也能幫助有效地防治T2DM。 但目前體檢人群中往往只關(guān)注空腹血糖（FBG）的水平，可能會(huì)漏診FBG正常的糖代謝異常。本研究通過(guò)調(diào)查在我院體檢的行政機(jī)關(guān)工作人員中NAFLD的患病率，了解其具體發(fā)病趨勢(shì)。進(jìn)一步于FBG正常的NAFLD患者中行OGTT試驗(yàn)、胰島素釋放試驗(yàn)，以便觀察NAFLD患者中糖代謝異常的患病率，并同時(shí)觀察了體檢人群中肥胖、高血壓病、高甘油三酯血癥、高膽固醇血癥、高LDL-C血癥的患病率，探討NAFLD與糖脂代謝異常及IR的聯(lián)系，為早期干預(yù)提供幫助。 2對(duì)象與方法 2.1分組 共納入2013年1月-2013年7月在鄭州大學(xué)第二附屬醫(yī)院體檢中心體檢的年齡在25-60歲空腹血糖正常的男、女城市居民（行政機(jī)關(guān)單位工作人員）1000例為調(diào)查對(duì)象。在患有NAFLD的人群中，，隨機(jī)招募122例作為NAFLD組，其中男70例，女52例，平均年齡49.20±10.88歲，從非NAFLD人群中隨機(jī)招募88例為正常對(duì)照組，其中男46例,女42例，平均年齡48.02±9.63歲。兩組性別、年齡、病程等一般資料比較無(wú)明顯差異。將122例NAFLD人群按脂肪變嚴(yán)重程度進(jìn)一步分為輕度脂肪肝組、中度脂肪肝組、重度脂肪肝組。 2.2觀測(cè)指標(biāo) 2.2.1體檢人群中肥胖、NAFLD、高血壓病、高甘油三脂血癥、高膽固醇血癥、高LDL-C血癥的患病率； 2.2.2體檢人群中NAFLD與非NAFLD人群肥胖、高血壓病、高甘油三酯血癥、高膽固醇血癥的患病率； 2.2.3NAFLD組及正常對(duì)照組中糖代謝異�；疾÷实谋容^； 2.2.4NAFLD組與正常對(duì)照組各生化指標(biāo)及BMI、腰圍、臀圍、WHR、SBP、DBP相關(guān)性分析。 2.3統(tǒng)計(jì)方法 統(tǒng)計(jì)分析采用SPSS17.0軟件包進(jìn)行，計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差表示，兩組比較采用t檢驗(yàn)，計(jì)數(shù)資料組間比較采用x2檢驗(yàn)，檢驗(yàn)水準(zhǔn)α=0.05,不同程度脂肪肝與各指標(biāo)的關(guān)系分析用spearman相關(guān)分析。 3結(jié)果 3.11000例體檢人群中，代謝性疾病的患病率分別為高血壓34.0%、肥胖12.0%、NAFLD30.1%、高甘油三酯血癥25.4%、高膽固醇血癥15.5%、高LDL-C血癥12.0%; 3.2NAFLD人群中各種代謝性疾病的患病率均高于非NAFLD人群，分別為肥胖7.9%VS4.2%、高血壓病47.6%VS25.7%、高膽固醇血癥22.6%VS18.0%和高甘油三酯血癥51.2%VS14.2%,差異均有顯著性(P＜0.05)； 3.3NAFLD及正常對(duì)照組中糖代謝異常的患病率； 根據(jù)OGTT檢測(cè)結(jié)果，NAFLD組糖代謝異常50例（41.0％），其中合并糖尿病15例（12.3％），糖耐量減退30例（24.6％），空腹血糖調(diào)節(jié)受損5例（4.0％）。正常對(duì)照組糖代謝異常16例（18.2％）。NAFLD比正常對(duì)照組中糖代謝異�；疾÷拭黠@升高，差異有顯著性（P＜0.05）； 3.4NAFLD及正常對(duì)照組各生化指標(biāo)及BMI、腰圍、臀圍、WHR、SBP、DBP的比較； NAFLD組BMI、腰圍、TG、HOMA-IR、FINS、2hINS、HbA1C、PBG、SBP的平均水平均顯著高于正常對(duì)照組，差異有顯著性(P＜0.05)。兩組患者TC、LDL-C、HDL-C、WHR、DBP、臀圍的比較則無(wú)顯著差異(P＞0.05)；3.5不同程度脂肪肝與各生化指標(biāo)及BMI、腰圍、臀圍、WHR、SBP、DBP分析。 不同程度脂肪肝與HOMA-IR、BMI、TG、FINS、2hINS、腰圍、HbA1c和PBG呈正相關(guān)。 4結(jié)論 4.1NAFLD合并肥胖、高血壓病、高甘油三酯血癥、高膽固醇血癥的患病率高于健康人群； 4.2NAFLD患者較健康人群存在明顯的胰島素抵抗及糖脂代謝異常； 4.3NAFLD人群中HOMA-IR、BMI、TG、FINS、2hINS、腰圍、HbA1C、PBG與NAFLD嚴(yán)重程度呈正相關(guān)； 4.4空腹血糖正常的NAFLD患者應(yīng)行OGTT試驗(yàn)以發(fā)現(xiàn)以餐后血糖高為主的糖代謝異常。
[Abstract]:1 Background and Purpose

Non - alcoholic fatty liver disease and type 2 diabetes mellitus ( T2DM ) are common diseases in the world . The incidence of the disease has been significantly increased in recent decades . It is estimated that about 150 million LD patients in our country have reached epidemic proportions . According to the evidence - based medical study , the incidence and metabolic syndrome ( MS ) , impaired glucose tolerance and T2DM are closely related to the disease . Therefore , the screening of naf ld will help to predict the onset of T2DM and cardiovascular disease , and the prevention and treatment of naf ld can also help to effectively prevent T2DM .

In the present study , the prevalence of fasting blood glucose ( FBG ) is usually focused on fasting plasma glucose ( FBG ) , and the abnormal glucose metabolism may be missed . In this study , the prevalence of the abnormal glucose metabolism in the staff of the administrative organ in our hospital is investigated . The prevalence of obesity , hypertension , triglyceride , hypercholesterolemia and high LDL - C in the patients with healthy subjects were investigated .

2 Objects and Methods

2.1 Grouping

A total of 1000 cases of male and female urban residents ( administrative organs ) were enrolled in the physical examination center of the Second Affiliated Hospital of Zhengzhou University from January 2013 to July 2013 . Among them , 122 cases were randomly recruited as control group . Among them , there were 46 males and 42 females , the average age was 48.02 鹵 9.63 years .

2.2 Observation indicators

2.2 . 1 Prevalence of obesity in the physical examination population , NALD , hypertension , hyperlipidemia , hypercholesterolemia , and high LDL - C ;


2.2 . 2 Prevalence of obesity , hypertension , high triglyceride and hypercholesterolemia in the population of the physical examination .


2.2 . 3Comparison of the prevalence of glucose metabolism in the patients with naf LD group and normal control group ;


2.2 . 4Analysis of correlation between the biochemical indexes and BMI , waist circumference , hip circumference , WHR , SBP , DBP and DBP of the healthy control group were analyzed .

2.3 Statistical method

Statistical analysis was carried out with SPSS 17.0 software package , and the measurement data was expressed by mean 鹵 standard deviation . The comparison between the two groups was t - test , and the comparison between the two groups was x2 test , the test level was 偽 = 0.05 , and the relationship between fatty liver and each index was analyzed by the correlation analysis .

3 Results

Among them , the prevalence of metabolic diseases was 34.0 % , 12.0 % in obesity , 30.1 % in LD , 25.4 % in high triglyceride , 15.5 % in hypercholesterolemia , and 12.0 % in high LDL - C , respectively .

3 . The prevalence of various metabolic diseases in the population of the disease was higher than that in the non - naoLD group ( 7.9 % VS4.2 % , 47.6 % VS21.7 % ) , hypercholesterolemia ( 22.6 % ) and high triglyceride ( 51.2 % VS14.2 % ) ( P < 0.05 ) .


3 . The prevalence of glucose metabolism abnormality in the normal control group .


According to the results of OGTT , there were 50 cases ( 41.0 % ) of glucose metabolism abnormality in the patients with diabetes mellitus , including 15 cases of diabetes mellitus ( 12.3 % ) , 30 cases of impaired glucose tolerance ( 24 . 6 % ) , impaired fasting blood glucose regulation ( 4.0 % ) , and abnormal glucose metabolism in normal control group ( 18.2 % ) .


3 . The biochemical indexes and BMI , waist circumference , hip circumference , WHR , SBP and DBP of the patients were compared with those of normal control group .


The average levels of BMI , waist circumference , TG , homeostasis - IR , FBG , 2hINS , HbA1C , pbg and SBP were significantly higher than those in the normal control group ( P < 0.05 ) . There was no significant difference in TC , LDL - C , HDL - C , WHR , DBP and hip circumference in both groups ( P > 0.05 ) .
3.5 Fatty liver and biochemical indexes and BMI , waist circumference , hip circumference , WHR , SBP and DBP were analyzed .

Different levels of fatty liver were positively correlated with BMI , TG , FBG , 2hINS , waist circumference , HbA1c and pbg .

4 Conclusion

4 . The prevalence of high - cholesterol was higher than that in healthy population by combining with obesity , hypertension , triglyceride and hypercholesterolemia .


4 . There were obvious insulin resistance and glycolipid metabolism abnormality in the healthy population of the patients with the disease .


4 . There was a positive correlation between BMI , TG , FBG , 2hINS , waist circumference , HbA1C and PBLD severity among the patients with the disease .


4.4 Patients with normal fasting blood glucose should undergo OGTT test to find the abnormal glucose metabolism based on postprandial blood glucose .

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R587.1

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