| 2型糖尿病患者肝功能损害特征以及原因分析 |
| 投稿时间：2017-01-16 修订日期：2017-02-23 点此下载全文 |
| 引用本文：程艳冬,杨东辉,许碧云,沈山梅,毕艳,周乙华,朱大龙.2型糖尿病患者肝功能损害特征以及原因分析[J].医学研究杂志,2017,46(10):76-80,83 |
| DOI：
10.11969/j.issn.1673-548X.2017.10.020 |
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| 基金项目:江苏省医学重点学科基金资助项目（XK201105） |
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| 中文摘要:目的 探讨2型糖尿病患者肝功能异常特征和原因。方法 共纳入533例2型糖尿病住院患者，男性285例、女性248例，年龄13~90岁，平均年龄58.2±14.7岁，其中85例为病程<6个月的新诊断患者。肝功能主要包括丙氨酸转氨酶（ALT）、门冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（AKP）和乳酸脱氢酶（LDH）和总胆红素（TBIL），以笔者医院正常参考值为标准，任何1项或多项指标超过正常范围，即为异常。结果 共227例（42.6%）患者为1项或多项肝功能指标异常，GGT升高最常见（30.0%），其次为ALT升高（15.2%），AKP升高最低（1.7%），绝大多数为轻度异常。男性异常率高于女性（48.1% vs 36.3%，P=0.006），以GGT和TBIL为主。新诊断患者ALT异常率高于非新诊断患者（25.9% vs 13.2%，P<0.01）；病程<10年患者ALT和GGT的异常率高于病程长者；血糖≥ 7mmol/L的患者ALT和GGT异常率均明显高于血糖<7mmol/L患者。41例ALT>50 U/L病例中，34例（82.9%）确诊脂肪肝；49例GGT>60 U/L病例中，37例（75.5%）存在脂肪肝。结论 2型糖尿病患者肝功能总体异常率较高，以GGT升高为主，但绝大多数程度轻，主要与脂肪肝有关。本研究结果提示糖尿病不直接引起肝功能损害。以GGT升高为主的肝功能异常者是否易发生糖尿病，有待深入研究。 |
| 中文关键词:2型糖尿病 肝功能异常 脂肪肝 |
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| Characterization and Analysis of Causes for Abnormal Liver Functions in Patients with Type 2 Diabetes Mellitus |
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| Abstract:Objective To characterize the abnormal liver functions in patients with patients with type 2 diabetes mellitus (T2DM). Methods This investigation enrolled 533 hospitalized patients with T2DM, including 85 newly diagnosed ones, with 285 males and 248 females and the average age of 58.2±14.7 (13-90 years). Liver function tests included alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alkaline phosphatase (ALP), and total bilirubin (TBIL). Based on the reference levels in our hospital, any item exceeding the upper normal limit was considered abnormal. Results Overall, 227 (42.6%) patients had one or more abnormal liver function items. The elevation of GGT (30.0%) was the most common, followed by increased ALT (15.2%), while the elevation of AKP was the lowest (1.7%). The vast majority of abnormality was mild. The prevalence of elevated levels was higher in male than in female patients (48.1% vs 36.3%, P=0.006), mainly on the elevation of GGT and TBIL. The prevalence of ALT elevation was higher in newly diagnosed than non-newly diagnosed patients (25.9% vs 13.2%, P=0.003), and patients with <10 years duration of T2DM had higher abnormal rates of ALT and GGT than those with >10 years duration. The abnormal rates of ALT and GGT were higher in the patients with fasting blood glucose ≥ 7mmol/L than those with <7mmol/L. Of patients with ALT >50U/L (n=41) and GGT>60U/L (n=49), 34 (82.9%) and 37 (75.5%) had fatty liver respectively. Conclusion The patients with T2DM have high prevalence of abnormal liver functions, mainly with the elevation of GGT, yet the abnormalities are mild. The main reason for the abnormal liver functions is associated with fatty liver. The data suggest that T2DM does not directly cause liver injury. Whether the elevation of GGT is a risk factor for T2DM remains further investigation. |
| keywords:Type 2 Diabetes mellitus Abnormal liver functions Fatty liver |
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