2型糖尿病并发非酒精性脂肪肝患者证素分析

作者	单位
陈筑红	中国中医科学院西苑医院内分泌科
夏城东	中国中医科学院西苑医院内分泌科
黄佳娜	中国中医科学院西苑医院内分泌科
韦玮	中国中医科学院西苑医院内分泌科
胡国庆	中国中医科学院西苑医院内分泌科
魏子孝	中国中医科学院西苑医院内分泌科

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中文摘要:

目的探讨2型糖尿病合并非酒精性脂肪肝的主要危险因素及中医的主要证型和病机。方法采用病例对照研究的方法观察180例2型糖尿病并发脂肪肝和无脂肪肝患者的年龄、身高、体重、体重指数、空腹血糖、C肽、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白(LDL-C)、餐后2h C肽等指标。根据2型糖尿病中医证素分型,统计合并脂肪肝患者所占类型比例。结果2型糖尿病并发脂肪肝组与无脂肪肝组年龄、身高、空腹血糖、HbA1c、TC、LDL-C比较,差异无统计学意义(P>0.05);脂肪肝组体重〔(73.4±11.7)kg〕、BMI(26.0±3.67)、空腹C肽〔(4.09±2.40)μg/L〕和餐后2h C肽〔(6.38±5.46)μg/L〕、TG〔(2.81±2.33)mmol/L〕、HDL-C〔(1.07±0.06)mmol/L〕与无脂肪肝组体重〔(61.4±10.1)kg〕、BMI(22.8±3.23)、空腹C肽〔(2.47±1.74)μg/L〕和餐后2h C肽〔(4.35±2.92)μg/L〕、TG〔(1.93±1.92)mmol/L〕、HDL-C〔(1.19±0.32)mmol/L〕比较,差异均有统计学意义(P<0.01,P<0.05);合并脂肪肝组患者更易出现痰湿证。结论肥胖、胰岛素抵抗(insulin resistance,IR)及脂质代谢紊乱在2型糖尿病并发脂肪肝患者中多见,痰湿是2型糖尿病并发脂肪肝的主要病机。

英文摘要:

Objective To explore the risk factors and the main TCM syndrome types associated with the diabetes mellitus type 2(DM2)patients complicated with non-alcoholic fatty liver(FL).Methods Adopted controlled trial method,the age,stature,body weight,and body mass index(BMI)of 180 DM2 patients were compared with those complicated with or without FL.And some related laboratory indexes,including the age,stature,body weight,BMI,fasting blood glucose(FBG),C-peptide(CP),glycosylated hemoglobin(HbAlc),triglyceride(TG),total cholesterol(TC),high and low density lipoprotein cholesterol(HDL-C and LDL-C),and 2 h post-prandial CP(2 h CP),were compared as well.Moreover,patients’ TCM syndrome types were classified.Results No significant differences were found between DM2 patients complicated with or without FL in aspects of FBG,HbAlc,TC,LDL-C and age,stature(P>0.05),but significant difference did show between them in aspects of CP(4.09±2.40 μg/L vs 2.47±1.74 μg/L),2h CP(6.38±5.46 μg/L vs 4.35±2.92 μg/L),TG(2.81±2.33 mmol/L vs 1.93±1.92 mmol/L),HDL-C(1.07±0.06 mmol/L vs 1.19±0.32 mmol/L)as well as in body weight(73.4±11.7 kg vs 61.4±10.1 kg)and BMI(26.0±3.67 vs 22.8±3.23),respectively(P<0.05 or P<0.01).Moreover,phlegm-dampness type was more liable to appear in DM2 patients complicated FL.Conclusions Obesity,insulin resistance and lipid metabolism disorder are the chief risk factors in DM2 patients complicated with FL and phlegm-dampness is the chief pathogenesis.

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