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目的:探讨血清同型半胱氨酸水平在2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)及高血压患者中的变化。方法:将130例新诊断T2DM患者分为单纯T2DM组22例,T2DM合并高血压(高血压)组32例,T2DM合并NAFLD(NAFLD)组36例,糖尿病合并NAFLD及高血压(NAFLD合并高血压)组40例。测定血清同型半胱氨酸(Hcy)、空腹C肽(FCP)和胰岛素(FINS)、游离脂肪酸(FFA)、血脂谱、尿酸和肌酐等水平,并计算胰岛素抵抗指数(HOMR-IR)及胰岛素敏感指数(ISI)。结果:130例新诊断T2DM患者中,NAFLD占59.2%,高血压占53.8%,NAFLD合并高血压占30.0%。NAFLD组与NAFLD合并高血压组患者血清甘油三酯和尿酸水平均高于单纯T2DM组患者(P<0.05),NAFLD组与NAFLD合并高血压组患者血清FFA和Hcy水平高于单纯T2DM组与高血压组患者(P<0.01)。NAFLD组与NAFLD合并高血压组患者LnHOMA-IR高于单纯T2DM组与高血压组患者(P<0.05),但是前者的LnISI却小于后者(P<0.05)。结论:Hcy、甘油三酯、FFA及胰岛素抵抗是2型糖尿病患者合并NAFLD和高血压的危险因素;T2DM合并NAFLD患者血清Hcy水平高于T2DM合并高血压的患者,而且胰岛素抵抗更为明显。
Objective: To investigate the changes of serum homocysteine levels in patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD) and hypertension. Methods: Thirty-two newly diagnosed T2DM patients were divided into two groups: T2DM alone, 32 patients with T2DM complicated with hypertension (hypertension), 36 patients with T2DM complicated with NAFLD (NAFLD), NAFLD with diabetes mellitus and hypertension (NAFLD with hypertension ) Group of 40 cases. Serum levels of homocysteine (Hcy), fasting C-peptide (FCP) and insulin (FINS), free fatty acids (FFA), blood lipid profile, uric acid and creatinine were measured and insulin resistance index (HOMR-IR) and insulin Sensitive Index (ISI). Results: Of 130 newly diagnosed T2DM patients, NAFLD accounted for 59.2%, hypertension 53.8%, NAFLD combined hypertension 30.0%. The levels of serum triglyceride and uric acid in NAFLD and NAFLD patients with hypertension were significantly higher than those in patients with T2DM alone (P <0.05). The levels of serum FFA and Hcy in NAFLD and NAFLD patients with hypertension were significantly higher than those in patients with T2DM alone Blood pressure group patients (P <0.01). The LnHOMA-IR of patients with NAFLD and NAFLD complicated with hypertension was higher than that of patients with simple T2DM and hypertension (P <0.05), but LnISI of the former was less than the latter (P <0.05). Conclusions: Hcy, triglyceride, FFA and insulin resistance are risk factors for NAFLD and hypertension in type 2 diabetic patients. Serum Hcy level is higher in type 2 diabetic patients with T2DM and NAFLD than in type 2 diabetic patients with hypertension, and insulin resistance is more obvious.