| 2型糖尿病、非酒精性脂肪肝与血清胆碱酯酶的关系探讨 |
| 投稿时间：2016-09-10 修订日期：2016-10-08 点此下载全文 |
| 引用本文：周侠,游娜,徐家蓉,缪珩.2型糖尿病、非酒精性脂肪肝与血清胆碱酯酶的关系探讨[J].医学研究杂志,2017,46(5):140-145 |
| DOI：
10.11969/j.issn.1673-548X.2017.05.035 |
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| 中文摘要:目的 探讨2型糖尿病（T2DM）、非酒精性脂肪肝（NAFLD）与血清胆碱酯酶（S-CHE）的关系。方法 随机选取221例T2DM患者，将患者分为T2DM合并NAFLD、未合并NAFLD两组。并随机选取同一时期体检的工人及退休人员206例，分为单纯NAFLD和正常对照组。所有被检者进行餐前和餐后2h血糖、糖化血红蛋白（HbA1c）、肝肾功能、血脂、S-CHE的检测以及肝胆胰脾B超检查；对T2DM患者进行空腹C肽和餐后C肽的测定，并计算胰岛素抵抗指数（HOMA2-IR）、胰岛素敏感度指数（HOMA2-%S）、胰岛β细胞功能（HOMA2-%B）。结果 DM合并NAFLD和单纯NAFLD组的S-CHE水平明显高于T2DM未合并NAFLD组和正常对照组（P均<0.01）；随着T2DM病程的延长，S-CHE、ALT、GGT、TG、TC、空腹C肽、餐后C肽的水平逐渐下降，年龄逐渐增高（P<0.05或P<0.01）；将T2DM患者分为A（S-CHE<8900IU/L）、B（S-CHE≥8900IU/L）两组，B组患者的BMI、脂肪肝百分比、ALT、AST、GGT、TG、TC、LDL-C、HOMA2-IR高于A组，HOMA2-%S低于A组（P<0.05或P<0.01）；Pearson偏相关分析显示，校正年龄、性别、病程、HbA1c、FBG、收缩压、舒张压后，S-CHE与HOMA2-IR、BMI、TG、TC、LDL-C、ALT、GGT水平呈正相关，与HOMA2-%S呈负相关（P<0.05或P<0.01）；多元线性回归分析显示，S-CHE与TC、HOMA2-IR、ALT水平呈正相关（R2=0.281，P均<0.01）。结论 S-CHE的水平在NAFLD患者明显增高，而未合并NAFLD的T2DM患者S-CHE的水平并无增高，S-CHE水平升高主要与脂肪肝、胰岛素抵抗及血脂紊乱相关，常规检测S-CHE可以反映T2DM患者胰岛素抵抗的情况以及早期预测NAFLD的发生。 |
| 中文关键词:2型糖尿病 脂肪肝 胆碱酯酶 胰岛素抵抗 |
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| Relationships between Type 2 Diabetes, Nonalcoholic Fatty Liver Disease and Serum Cholinesterase Concentration |
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| Abstract:Objective To investigate the relationship between type 2 diabetes (T2DM), nonalcoholic fatty liver disease (NAFLD) and serum cholinesterase (S-CHE) concentration. Methods We randomly collected 221 cases of patients with type 2 diabetes, who were divided into T2DM with NAFLD group and without NAFLD group. Meanwhile, 206 workers and retirees for physical examination were selected and divided into simple NAFLD group and healthy control group. All of subjects underwent the examinations of pre-prandial and 2 hour postprandial blood glucose, glycosylated hemoglobin, liver and kidney functions, S-CHE and abdominal ultrasound. T2DM patients were carried the inspection of fasting and postprandial C peptide. The insulin resistance index (HOMA2-IR), insulin sensitivity index (HOMA2-%S) and pancreatic β-cell function (HOMA2-%B) were calculated by HOMA2-Calculator software. Results S-CHE of T2DM patients with NAFLD and simple NAFLD group were obviously higher than that of diabetes unincorporated NAFLD and healthy control group (both P<0.01). With the extension of T2DM duration, S-CHE, ALT, GGT, TG, TC, fasting c-peptide, postprandial c-peptide of T2DM patients declined gradually, age of that increased gradually (P<0.05 or P<0.01). T2DM patients were divided into A(S-CHE<8900 IU/L) and B(S-CHE≥8900 IU/L)groups. The BMI, percentage of fatty liver, ALT, AST, GGT,TG, TC, LDL - C and HOMA2-IR levels of T2DM patients in group B were higher than that of group A, HOMA2-% S level was lower than group A (P<0.05 or P<0.01). Adjusted for age, gender, the duration of T2DM, HbA1c, FBG, systolic pressure and diastolic pressure, the Pearson correlation analysis indicated that S-CHE was positively correlated with HOMA2-IR, BMI, TG, TC, LDL-C, ALT, GGT and negatively correlated with HOMA2-% S (P<0.05 or P<0.01). Multiple linear regression analysis also showed that S-CHE was positively correlated with TC, HOMA2-IR, ALT level (R2=0.281, both P<0.01). Conclusion The level of S-CHE in NAFLD groups was increased significantly, but not in T2DM patients without NAFLD. The high concentration of S-CHE is closely related to fatty liver disease, dyslipidemia and insulin resistance. It is suggested that routine monitoring of serum cholinesterase activities may reveal the condition of the insulin resistance and the onset of nonalcoholic fatty liver disease in T2DM patients. |
| keywords:Type 2 diabetes mellitus Fatty liver Cholinesterase Insulin resistance |
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