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目的探讨2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者血浆同型半胱氨酸与胰岛素抵抗的关系。方法选择2011年3月至2012年3月上海复旦大学附属中山医院青浦分院内分泌科住院治疗的156例T2DM患者。按病史和B超结果分为NAFLD组(DM+N)组和非NAFLD组(DM组),另选取健康体检者65名为对照(NC)组,测定3组空腹血糖(FPG)、胰岛素(FINS)及同型半胱氨酸(HCY)等,计算胰岛素抵抗指数(HOMA-IR指数)。结果与NC组相比,DM+N及DM组空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、体重指数(BMI)、丙氨酸转氨酶(ALT)、HOMA-IR指数及HCY均升高(P<0.05或P<0.01)。与DM组比较,DM+N组ALT、TG、FPG、FINS、HOMA-IR指数及HCY均升高(P<0.05或P<0.01)。HOMA-IR和TG是HCY的独立危险因素。结论 T2DM合并非酒精性脂肪肝患者血浆同型半胱氨酸升高,与胰岛素抵抗存在明显相关性。
Objective To investigate the relationship between plasma homocysteine and insulin resistance in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD). METHODS: From March 2011 to March 2012, 156 patients with T2DM admitted to Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University in Shanghai were enrolled. According to the history and the result of B-ultrasound, the subjects were divided into two groups: NAFLD group (DM + N) and non-NAFLD group (DM group), and 65 healthy subjects were selected as control group (NC) .Fasting fasting blood glucose (FPG), insulin FINS) and homocysteine (HCY) were calculated. The insulin resistance index (HOMA-IR index) was calculated. Results Compared with NC group, the levels of fasting blood glucose (FPG), fasting insulin (FINS), HbA1c, triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol LDL-C, BMI, ALT, HOMA-IR index and HCY were increased (P <0.05 or P <0.01). Compared with DM group, ALT, TG, FPG, FINS, HOMA-IR index and HCY in DM + N group were all increased (P <0.05 or P <0.01). HOMA-IR and TG are independent risk factors for HCY. Conclusions Plasma homocysteine level is elevated in T2DM patients with non-alcoholic fatty liver disease, which is significantly correlated with insulin resistance.