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目的研究2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者血清颗粒蛋白前体水平的变化及其临床意义。方法采用横断面研究,随机选取T2DM患者116例,其中合并NAFLD组(68例),未合并NAFLD组(48例)。检测两组血清颗粒蛋白前体水平并测定糖化血红蛋白(HbA1c)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(AKP)、尿酸(UA)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、空腹胰岛素(FINS)水平,计算稳态模型胰岛素抵抗指数(HOMA-IR);同时测量身高、体质量、腰围、臀围,计算体质量指数(BMI)和腰臀比。应用多元逐步回归分析方法分析血清颗粒蛋白前体与上述指标的相关性,应用Logistic回归分析T2DM合并NAFLD的影响因素。结果 (1)T2DM合并NAFLD组与未合并NAFLD组相比,BMI、腰围、臀围、腰臀比、FINS、HOMA-IR、TG、ALT、AST水平明显升高(P<0.05),HDL-C水平降低(P<0.05)。(2)血清颗粒蛋白前体水平在T2DM合并NAFLD组显著高于未合并NAFLD组(P<0.01)。(3)多元逐步回归分析结果提示BMI、HOMA-IR、TG分别作为独立危险因素影响血清颗粒蛋白前体水平。(4)Logistic回归分析显示颗粒蛋白前体、BMI及ALT为T2DM患者发生NAFLD的独立影响因素。结论 T2DM合并NAFLD患者血清颗粒蛋白前体水平明显升高,高水平的颗粒蛋白前体是T2DM合并NAFLD的独立影响因素,可能成为评估T2DM合并NAFLD的重要血清学指标。
Objective To study the changes and clinical significance of serum granulogranin precursor in patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD). Methods A total of 116 patients with T2DM were randomly selected from a cross-sectional study, including NAFLD group (n = 68) and NAFLD group (n = 48). Serum levels of granulocyte precursors were measured and serum levels of HbA1c, ALT, AST, AKP, UA, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG) and fasting insulin (FINS) Resistance index (HOMA-IR); height, body mass, waist circumference and hip circumference were measured at the same time. Body mass index (BMI) and waist-hip ratio were calculated. Logistic regression analysis was used to analyze the influencing factors of T2DM combined with NAFLD by using multiple stepwise regression analysis to analyze the correlation between serum granulocyte precursor and the above indexes. Results (1) The levels of BMI, waistline, hip circumference, WHR, FINS, HOMA-IR, TG, ALT and AST in T2DM with NAFLD group were significantly higher than those in NAFLD group (P < C level decreased (P <0.05). (2) Serum progranulin levels were significantly higher in T2DM with NAFLD than those without NAFLD (P <0.01). (3) The results of multivariate stepwise regression analysis suggested that serum BMI, HOMA-IR, and TG, as independent risk factors, respectively, affected the level of serum progranulin. (4) Logistic regression analysis showed that granule precursor, BMI and ALT were independent influencing factors of NAFLD in T2DM patients. Conclusions Serum progranulin levels are significantly elevated in patients with T2DM and NAFLD. High levels of progranulin are independent predictors of T2DM with NAFLD and may be important serological markers for assessing T2DM with NAFLD.