發(fā)布時間：2018-06-17 06:20

  本文選題：肥胖 + 非酒精性脂肪肝　； 參考：《南京大學(xué)》2017年碩士論文

【摘要】：目的:探究肥胖患者非酒精性脂肪肝病(NAFLD)與糖代謝的關(guān)系。方法:研究人群一:納入170例肥胖(體重指數(shù)≥28kg/m^2)患者,根據(jù)腹部彩超有無NAFLD分為NAFLD組(134例)及非NAFLD組(36例),行75g葡萄糖口服糖耐量(OGTT)或150克饅頭餐糖耐量試驗(yàn)檢測空腹血糖(FBG)及餐后2h血糖(PBG)、胰島素釋放試驗(yàn)檢測空腹胰島素(F-INS)、餐后2h胰島素(2h-INS)、空腹C肽(F-CP)及餐后2hC肽(2h-CP),并計算胰島素抵抗指數(shù)(HOMA-IR)等,同時檢測糖化血紅蛋白(HbA1c)及谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、甘油三酯(TG)、總膽固醇(CH)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)等生化指標(biāo)。研究人群二:80例經(jīng)肝臟病理證實(shí)有NAFLD肥胖患者,根據(jù)肝臟病理肝臟脂肪含量分為輕度脂肪肝組(F1組,28例)和中重度脂肪肝組(F2-3組,52例),行75g葡萄糖口服糖耐量(OGTT)或150克饅頭餐檢測四點(diǎn)血糖(FBG、0.5h-BG、1h-BG、PBG)、胰島素釋放試驗(yàn)檢測四點(diǎn)胰島素(F-INS、0.5h-INS、1h-INS、2h-INS)及 C 肽(F-CP、0.5h-CP、1h-CP、2h-CP),并計算HOMA-IR等,檢測HbA1c及AST、ALT、谷酰轉(zhuǎn)肽酶(γ-GT)、堿性磷酸酶(AKP)、TG、CH、HDL-C、LDL-C、血尿酸(UA)等生化指標(biāo)。分析NAFLD與糖代謝的關(guān)系。結(jié)果:非NAFLD及NAFLD組患者2型糖尿病(T2DM)患病率分別為47.2%和76.1%(P0.05);NAFLD組患者較非NAFLD組患者BMI更高(P0.05);NAFLD 患者 FBG、PBG 及 HbA1c 均較非 NAFLD 組升高(P0.05);NAFLD組患者較非NAFLD組患者ALT、AST及TG水平高(0.05)。F1組及F2-3組T2DM患病率分別為42.6%和51.93%;F2-3組較F1組年齡輕,BMI更高、腰圍更大(P0.05);F2-3組患者OGTT或饅頭餐四點(diǎn)血糖及HbA1c較F1組有升高趨勢(P0.05);F2-3組較F1組F-INS及F-CP水平高(P0.05),胰島素抵抗顯著(P0.05);胰島素敏感性(ISIm)及2h處置指數(shù)(DI 120)顯著偏低(P0.05);F2-3 組較 F1 組 ALT、AST 及 γ-GT 水平高(P0.05),血UA水平高(P0.05)。二元邏輯回歸提示HOMA-IR為中重度脂肪肝的獨(dú)立危險因素。結(jié)論:肥胖患者合并NAFLD糖代謝紊亂加重,隨著肝臟脂肪含量增加,其胰島素抵抗加重,糖代謝紊亂加重,肝損傷加重,更容易發(fā)展為T2DM。目的:探究肥胖2型糖尿病(T2DM)患者代謝術(shù)后早期動態(tài)血糖變化。方法:14例代謝手術(shù)肥胖T2DM患者于術(shù)前及術(shù)后3月行動態(tài)血糖監(jiān)測(CGM),同時記錄身高、體重、體重指數(shù)(BMI)、腰圍,予150克饅頭餐糖耐量實(shí)驗(yàn)測定空腹血糖(FBG)、餐后2小時血糖(PBG),胰島素釋放實(shí)驗(yàn)測定空腹胰島素(F-INS)、空腹C肽(F-CP)、餐后2小時胰島素(2h-INS)、餐后2小時C肽(2h-CP),測定糖化血紅蛋白(HbA1c)及甘油三酯(TG)、總膽固醇(CH)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)及尿酸(UA)等生化指標(biāo),計算胰島素抵抗指數(shù)(HOMA-IR)及胰島β細(xì)胞功能(HOMA-β),觀察代謝術(shù)后3月動態(tài)血糖變化及糖脂代謝及胰島功能變化。結(jié)果:術(shù)后3月患者CGM指標(biāo)平均血糖(MBG)、血糖最高值(BGmax)、血糖最低值(BGmin)均較術(shù)前顯著下降(P0.01),血糖≥ 7.8mmol/L及≥ 11.1 mmol/L時間百分比(%)及高血糖指數(shù)(HBGI)較術(shù)前顯著降低(P0.01),血糖3.9mmol/L時間百分比及低血糖指數(shù)(LBGI)較術(shù)前顯著升高(P0.05),反應(yīng)血糖波動的指標(biāo)如平均血糖標(biāo)準(zhǔn)差(SDBG)、最大血糖波動范圍(LAGE)、平均血糖波動范圍(MAGE)無明顯變化(P0.05)�；颊叽x術(shù)后3月體重、BMI、腰圍較術(shù)前顯著下降(P0.05),FBG、PBG、HbAlc較術(shù)前顯著下降(P0.01),F-INS、F-CP 及 HOMA-IR 較術(shù)前顯著下降(P0.05),HOMA-β 無明顯改變(P0.05)�；颊咝g(shù)后TG、CH及UA水平較術(shù)前顯著降低(TGP0.05,CH、UAP0.01)。結(jié)論:代謝術(shù)后早期患者體重即明顯下降,糖代謝及胰島素抵抗明顯改善。
[Abstract]:Objective: To explore the relationship between nonalcoholic fatty liver disease (NAFLD) and glucose metabolism in obese patients. Methods: study population 1: 170 cases of obesity (body mass index more than 28kg/m^2) were included in group NAFLD (134 cases) and non NAFLD group (36 cases) based on abdominal color Doppler ultrasound (NAFLD), and the test of oral glucose tolerance (OGTT) or 150 grams of steamed bread tolerance test was carried out. Fasting blood glucose (FBG) and postprandial 2H blood glucose (PBG). Insulin release test was used to detect fasting insulin (F-INS), postprandial 2H insulin (2h-INS), fasting C peptide (F-CP) and postprandial 2hC peptide (2h-CP), and to calculate the insulin resistance index (HOMA-IR) and so on, and the glycosylated hemoglobin (HbA1c) and glutamic pyruvidase (glutamic acid), triglyceride, triglyceride, and glycosyltransferase were also detected. Total cholesterol (CH), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and other biochemical indicators. Two: 80 cases of NAFLD obese patients were confirmed by liver pathology. The liver pathological liver fat content was divided into mild fatty liver group (F1 group, 28 cases) and moderate and severe fatty liver group (group F2-3, 52 cases), and 75g glucose was taken orally. The glucose tolerance (OGTT) or 150 grams of steamed bread meal tests four points of blood glucose (FBG, 0.5h-BG, 1h-BG, PBG). The insulin release test was used to detect four points of insulin (F-INS, 0.5h-INS, 1h-INS, 2h-INS) and C peptides. The relationship between NAFLD and glucose metabolism was analyzed. Results: the prevalence rates of type 2 diabetes (T2DM) in the non NAFLD and NAFLD groups were 47.2% and 76.1%, respectively (P0.05), and in the NAFLD group, the BMI was higher than that in the non NAFLD group (P0.05), and the NAFLD FBG was higher than that in the non NAFLD group. The prevalence rate of T2DM in group TG (0.05).F1 and F2-3 group was 42.6% and 51.93%, and in group F2-3, the age was lighter, BMI was higher, and the waist circumference was larger (P0.05); OGTT or steamed bread was higher in group F2-3 and HbA1c than that in F1 group. Im) and 2H treatment index (DI 120) were significantly lower (P0.05), F2-3 group was higher than F1 group ALT, AST and gamma -GT level (P0.05), and the blood UA level was high (P0.05). The two yuan logical regression suggested an independent risk factor for moderate and severe fatty liver. Aggravation, aggravation of glucose metabolism, aggravation of liver injury, and more likely to develop into T2DM. Objective: To explore the early dynamic blood glucose changes in obese type 2 diabetes mellitus (T2DM) patients after metabolism. Methods: 14 cases of obese T2DM patients underwent dynamic blood glucose monitoring (CGM) before and after the operation in March, and recorded height, weight, body mass index (BMI), waist circumference, and 150 grams. The steamed bread meal test measured fasting blood glucose (FBG), 2 hours postprandial blood glucose (PBG), fasting insulin (F-INS), fasting C peptide (F-CP), 2 hours postprandial insulin (2h-INS), and 2 hours C peptide (2h-CP) after meal, determination of glycosylated red egg white (HbA1c) and triglyceride (TG), total cholesterol (CH), and high-density lipoprotein cholesterol (HDL-C). The biochemical indexes such as low density lipoprotein cholesterol (LDL-C) and uric acid (UA) were used to calculate the insulin resistance index (HOMA-IR) and islet beta cell function (HOMA- beta). The changes of glucose and lipid metabolism and islet function in March were observed. Results: the average blood glucose (MBG), the highest blood sugar (BGmax) and the lowest blood sugar (B) in the patients in March after the operation were observed. Gmin) was significantly lower than preoperative (P0.01), the percentage of blood sugar > 7.8mmol/L and > 11.1 mmol/L time (%) and hyperglycemia index (HBGI) were significantly lower than before operation (P0.01), the percentage of 3.9mmol/L time and the index of hypoglycemia (LBGI) were significantly higher than before operation (P0.05). The index of blood glucose fluctuation, such as the mean blood glucose standard deviation (SDBG), and the maximum blood sugar The range of fluctuation (LAGE), the average blood glucose fluctuation range (MAGE) had no obvious change (P0.05). The body weight, BMI, waist circumference decreased significantly in March after the operation (P0.05), FBG, PBG, HbAlc decreased significantly (P0.01), F-INS, F-CP, and HOMA-IR were significantly lower than before the operation. It was significantly lower before treatment (TGP0.05, CH, UAP0.01). Conclusion: the body weight of the patients in early stage of metabolism was significantly decreased, and glucose metabolism and insulin resistance were improved significantly.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1;R589.2;R575.5
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本文編號：2030045