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目的探讨老年2型糖尿病(T2DM)患者并发非酒精性脂肪肝(NAFLD)与颈动脉粥样硬化的关系。方法将150例老年T2DM患者分为合并NAFLD 76例(T2DM+NAFLD组)与未合并NAFLD 74例(T2DM组),比较两组各项生物化学指标、颈动脉内膜中层厚度(CIMT),观察斑块形成和动脉狭窄情况。结果老年T2DM+NAFLD组体质量指数(BMI)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、三酰甘油(TG)、空腹胰岛素(FINS)、空腹C肽(FCP)、餐后2h C肽(2hCP)、胰岛素抵抗指数(HOMA-IR)、CIMT明显高于老年T2DM组(P<0.05)。老年T2DM+NAFLD组高密度脂蛋白(HDL)低于老年T2DM组(P<0.05)。老年T2DM+NAFLD组颈动脉粥样硬化患病率、斑块形成率、动脉狭窄率均高于老年T2DM组(P<0.05)。CIMT与糖尿病病程、年龄、TG、总胆固醇(TC)、空腹血糖(FPG)、餐后2h血糖(2hPG)、FINS、餐后2h胰岛素(2hINS)相关。结论老年T2DM并发NAFLD与血脂代谢紊乱、胰岛素抵抗有关,且易于发生颈动脉粥样硬化。
Objective To investigate the relationship between non-alcoholic fatty liver (NAFLD) and carotid atherosclerosis in elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 150 elderly T2DM patients were divided into two groups: 76 patients with NAFLD (T2DM + NAFLD group) and 74 patients without NAFLD (T2DM group). All the biochemical indexes and carotid artery intima-media thickness (CIMT) Plaque formation and stenosis. Results The body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), fasting insulin (FINS) (2hCP), insulin resistance index (HOMA-IR) and CIMT in post-prandial 2h group were significantly higher than those in T2DM group (P <0.05). High-density lipoprotein (HDL) in T2DM + NAFLD group was lower than that in T2DM group (P <0.05). The prevalence of carotid atherosclerosis, plaque formation rate and stenosis rate in elderly T2DM + NAFLD group were higher than those in T2DM group (P <0.05). CIMT was associated with duration of diabetes, age, TG, total cholesterol (TC), fasting blood glucose (FPG), 2h postprandial blood glucose (2hPG), FINS and 2hINS after meal. Conclusions Elderly patients with T2DM complicated with NAFLD are associated with dyslipidemia, insulin resistance and carotid atherosclerosis.