2型糖尿病合并非酒精性脂肪性肝病患者血糖控制水平与氧化应激和早期肝纤维化的关系探讨

doi:10.3969/j.issn.1672-5069.2026.04.011

摘要/Abstract

摘要： 目的探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者血糖控制水平与氧化应激和早期肝纤维化的关系。方法 2022年1月~2024年12月我院诊治的T2DM合并NAFLD患者180例,采用高效液相色谱法检测糖化血红蛋白(HbA1c),采用ELISA法检测血清丙二醇(MDA)、谷胱甘肽过氧化物酶(GSH-PX)和采用全自动生化分析仪检测超氧化物歧化酶(SOD);常规计算肝纤维化4因子指数(FIB-4)。根据HbA1c水平将患者分为血糖达标组(n=84)和未达标组(n=96),根据肝纤维化4因子指数(FIB-4)水平将患者分为肝纤维化低危组(n=64)、中危组(n=80)和高危组(n=36),应用多元线性回归分析血糖控制水平与氧化应激和肝纤维化发病风险程度的影响因素。结果血糖未达标组血清总胆固醇(TC)水平为(2.5±0.3) mmol/L,显著高于血糖达标组【(2.1±0.3) mmol/L,P＜0.001】,甘油三酯(TG)为(4.4±0.5) mmol/L,显著高于血糖达标组【(4.1±0.5) mmol/L,P＜0.001】;血清ALT水平为(40.5±6.5) U/L,显著高于血糖达标组【(36.8±6.2) U/L,P＜0.001】,AST水平为(46.4±7.5) U/L,显著高于血糖达标组【(42.2±6.8) U/L,P＜0.001】;血清MDA水平为(25.1±5.1) μmol/L,显著高于血糖达标组【(20.6±4.6) μmol/L,P＜0.001】,而血清GSH-PX和SOD水平分别为(54.4±6.0) ng/L和(53.2±7.6) U/mL,均显著低于血糖达标组【分别为(60.9±8.3) ng/L和(69.5±10.2) U/mL,P＜0.001】;多元线性回归分析显示,血清AST、HbA1c、MDA、GSH-PX和SOD水平是影响T2DM合并NAFLD患者肝纤维化发病风险的因素(P<0.05)。结论 T2DM合并NAFLD患者血糖水平控制差可能诱发氧化应激反应,并可能促进肝纤维化的发生。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 糖化血红蛋白, 氧化应激, 肝纤维化4因子

Abstract: Objective The purpose of this study was to investigate impact of poorly-controlled blood glucose on oxidative stress and liver fibrosis in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver diseases (NAFLD). Methods A total of 180 patients with T2DM and concomitant NAFLD were encountered in our hospital between January 2022 and December 2024, serum malondialdehyde (MDA), glutathione peroxidase (GSH-PX) were detected by ELISA, suproxide dismulate (SOD) levels was detected by automatic biochemical analyzer. serum glycated hemoglobin (HbA1c) level was routinely obtained and fibrosis index based on the 4 factors (FIB-4) was calculated. Patients were grouped as poorly (n=96)- and well (n=84)-controlled individuals based on HbA1c level, and as low-risk (n=64), medium-risk (n=80) and high-risk subgroup of liver fibrosis (n=36) based on FIB-4 levels. Multivariate linear regression was applied to reveal influencing factors for oxidative stress and liver fibrosis. Results Serum TC level in poorly-controlled blood glucose group was (2.5±0.3) mmol/L, much higher than [(2.1±0.3) mmol/L,P＜0.001], and serum TG level was (4.4±0.5) mmol/L, much higher than [(4.1±0.5) mmol/L,P＜0.001] in well-controlled blood glucose group; serum ALT level was (40.5±6.5) U/L, much higher than [(36.8±6.2) U/L,P＜0.001],and serum AST level was (46.4±7.5) U/L,much higher than [(42.2±6.8) U/L,P＜0.001] in well-controlled blood glucose group; serum MDA level was (25.1±5.1) μmol/L,much higher than [(20.6±4.6) μmol/L,P＜0.001],while serum GSH-PX and SOD levels were (54.4±6.0) ng/L and (53.2±7.6) U/mL,both significantly lower than [(60.9±8.3) ng/L and (69.5±10.2) U/mL,respectivley, P＜0.001] in well-controlled blood glucose group; multivariate linear regression analysis showed that serum AST, HbA1c, MDA, GSH-PX and SOD levels were all the independent impacting factors for liver fibrosis in patients with T2DM and NAFLD (P<0.05). Conclusion Poorly-controlled blood glucose in patients with T2DM and NAFLD might trigger body oxidative stress and lead to liver fibrosis progress.

Key words: Non-alcoholic fatty liver diseases, Type 2 diabetes, Glycated hemoglobin, Oxidative stress, Liver fibrosis factors-4

郭鸿雁, 王蕊, 孙倩. 2型糖尿病合并非酒精性脂肪性肝病患者血糖控制水平与氧化应激和早期肝纤维化的关系探讨[J]. 实用肝脏病杂志, 2026, 29(4): 521-524.

Guo Hongyan, Wang Rui, Sun Qian. Impact of poorly-controlled blood glucose on oxidative stress and liver fibrosis in patients with type 2 diabetes mellitus and non-alcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2026, 29(4): 521-524.

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