非酒精性脂肪性肝病合并2型糖尿病患者血清抵抗素和黄醇结合蛋白4水平及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2022.02.020

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)血清抵抗素和黄醇结合蛋白4(RBP4)水平变化及其临床意义。方法 2017年10月～2021年1月我院诊治的NAFLD合并T2DM患者106例和NAFLD患者106例,检测空腹血糖(FBG),采用化学发光法检测空腹胰岛素(FINS) 水平,计算HOMA-β指数和胰岛素抵抗指数(HOMA-IR),采用ELISA法检测血清抵抗素、RBP4、肿瘤坏死因子(TNF-α)和白介素(IL-6)水平。结果合并T2DM患者血清TC和HDL-C水平分别为(4.7±0.5)mmol/L和(1.1±0.2)mmol/L,显著低于NAFLD患者【分别为(5.6±0.6)mmol/L和(1.4±0.3)mmol/L,P<0.05】;合并T2DM患者血清GGT水平(102.3±15.5)U/L,显著高于NAFLD患者【(71.6±4.6),P<0.05】,而两组血清ALT、AST和ALP水平无显著性差异(P>0.05);合并T2DM患者血清FBG、FINS和HOMA-IR水平分别为(7.7±0.8)mmol/L、(6.7±1.2)mU/L和(2.3±0.5),显著高于NAFLD患者【分别为(5.7±0.7)mmol/L、(5.5±2.3)mU/L和(1.4±0.2),P<0.05】,而HOMA-β水平为(3.7±0.4),显著低于NAFLD患者【(5.0±0.5),P<0.05】;合并T2DM患者血清抵抗素、RBP4、TNF-α和IL-6水平分别为(3.2±0.4)ng/mL、(57.3±12.3)mg/L、(376.2±36.7)pg/mL和(76.3±8.2)ng/L,显著高于NAFLD患者【分别为(1.2±0.2)ng/mL、(32.7±7.1)mg/L、(340.3±38.2)pg/mL和(68.4±7.6)ng/L,P<0.05】。结论 NAFLD合并T2DM患者糖代谢指标、血清抵抗素和RBP4等水平与NAFLD患者存在显著性差异,这些指标的变化可能有助于临床医生及早识别合并存在的糖尿病而给予及时的诊治。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 抵抗素, 黄醇结合蛋白4, 血清

Abstract: Objective The aim of this study was to explore the implication of serum resistin and retinol-binding protein 4 (RBP4) in patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods 106 patients with NAFLD and T2DM and 106 patients with NAFLD were enrolled in our hospital between October 2017 and January 2021,and blood lipid and fasting blood glucose (FBG) levels were detected by full-automatic biochemical analyzer. Serum fasting insulin (FINS) level was detected by chemiluminescence, and the pancreatic β-cell function was assessed by HOMA-β. The insulin resistance (IR) was assessed by homeostasis model assessment (HOMA-IR). Serum resistin, RBP4, tumor necrosis factor (TNF-α) and interleukin (IL-6) levels were detected by ELISA. Results Total serum cholesterol and high-density lipoprotein cholesterol levels in patients with NAFLD and T2DM were (4.7±0.5)mmol/L and (1.1±0.2)mmol/L, significantly lower than [(5.6±0.6)mmol/L and (1.4±0.3)mmol/L, respectively, P<0.05] in patients with NAFLD; serum gamma-glutamyl transferase level in patients with NAFLD and T2DM were (102.3±15.5)U/L, significantly higher than [(71.6±4.6), P<0.05] in patients with NAFLD, while there were no significant differences as respect to serum alanine aminotransferase, aspartate aminotransferase and aLkaline phosphatase levels between the two groups (P>0.05); the FBG, FINS and HOMA-IR in patients with NAFLD and T2DM were (7.7±0.8)mmol/L, (6.7±1.2)mU/L and (2.3±0.5), significantly higher than [(5.7±0.7)mmol/L, (5.5±2.3)mU/L and (1.4±0.2), respectively, P<0.05], while the HOMA-β was (3.7±0.4), significantly lower than [(5.0±0.5), P<0.05] in patients with NAFLD; serum resistin, RBP4, TNF-α and IL-6 levels in patients with NAFLD and T2DM were(3.2±0.4)ng/mL, (57.3±12.3)mg/L, (376.2±36.7)pg/mL and (76.3±8.2) ng/L, significantly higher than [(1.2±0.2)ng/mL, (32.7±7.1)mg/L,(340.3±38.2)pg/mL and (68.4±7.6)ng/L, respectively, P<0.05] in patients with NAFLD. Conclusion There are differences in liver function indexes, glucose metabolism indexes, resistin , RBP4 and cytokine levels between patients with NAFLD and T2D and those with NAFLD alone, which might help distinguish the two entity in clinical practice.

Key words: Non-alcoholic fatty liver diseases, Type 2 diabetes mellitus, Resistin, Retinol-binding protein 4, Sera

莫超艳, 杨有强, 钟嫄, 肖友雪. 非酒精性脂肪性肝病合并2型糖尿病患者血清抵抗素和黄醇结合蛋白4水平及其临床意义探讨^*[J]. 实用肝脏病杂志, 2022, 25(2): 231-234.

Mo Chaoyan, Yang Youqiang, Zhong Yuan, et al. Implication of serum resistin and retinol-binding protein 4 in patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus[J]. Journal of Practical Hepatology, 2022, 25(2): 231-234.

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非酒精性脂肪性肝病合并2型糖尿病患者血清抵抗素和黄醇结合蛋白4水平及其临床意义探讨^*

Implication of serum resistin and retinol-binding protein 4 in patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus

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