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目的:探讨2型糖尿病(T2DM)并非酒精性脂肪性肝病(NAFLD)患者血清游离脂肪酸(FFA)和细胞角蛋白18(CK18)的表达及其影响。方法:T2DM患者40例,T2DM并NAFLD患者40例,健康对照组20例。体格检查,测定静脉血空腹血糖(FPG)、胆固醇(TC)、甘油三酯(TG)、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、糖化血红蛋白(HbA1c)、胰岛素(FINS)以及血清FFA和CK18,并行肝脏B超检查。结果:①T2DM组的体质指数(BMI)、FPG、FINS、A1C水平和胰岛素抵抗指数(HOMA-IR)显著高于正常对照组,差异有统计学意义;TC、TG、ALT、AST、GGT水平差异无统计学意义。T2DM并NAFLD患者的BMI、FPG、FINS、TC、TG、ALT、AST、GGT水平和HOMA-IR均显著高于T2DM患者,差异有统计学意义(P<0.001);②T2DM组与正常对照组相比,FFA水平明显增高,差异有统计学意义,CK18水平差异无统计学意义。而T2DM并NAFLD组FFA和CK18水平均高于正常对照组和T2DM组,差异有统计学意义(P<0.001)。结论:与T2DM相比,T2DM并NAFLD患者胰岛素抵抗、代谢紊乱更加显著,肝细胞的凋亡增加,对于进一步研究T2DM并NAFLD的发病机制具有重要的意义。
Objective: To investigate the expression of serum free fatty acid (FFA) and cytokeratin 18 (CK18) in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD). Methods: Forty patients with T2DM, 40 patients with T2DM and NAFLD, and 20 healthy controls. The physical examination was performed to detect the levels of fasting blood glucose (FPG), cholesterol (TC), triglyceride (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyl transpeptidase GGT, HbA1c, FINS and serum FFA and CK18. Results: ① The body mass index (BMI), FPG, FINS, A1C and insulin resistance index (HOMA-IR) in T2DM group were significantly higher than those in normal control group, the difference was statistically significant; the levels of TC, TG, ALT, AST and GGT No statistical significance. The levels of BMI, FPG, FINS, TC, TG, ALT, AST, GGT and HOMA-IR in T2DM and NAFLD patients were significantly higher than those in T2DM patients (P <0.001) FFA levels were significantly higher, the difference was statistically significant, CK18 level difference was not statistically significant. However, the levels of FFA and CK18 in T2DM and NAFLD groups were significantly higher than those in normal controls and T2DM groups (P <0.001). CONCLUSION: Compared with T2DM, insulin resistance, metabolic disorder and hepatocellular apoptosis increase in patients with T2DM and NAFLD, which is of great significance for further study on the pathogenesis of T2DM and NAFLD.