2型糖尿病患者非酒精性脂肪性肝病与性激素水平的关系
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摘要
目的了解2型糖尿病(T2DM)患者非酒精性脂肪性肝病(NAFLD)与性激素水平的关系。方法选取2010年3月—2013年10月在绍兴市中心医院内分泌科住院的T2DM患者256例,根据是否合并NAFLD分为NAFLD组和非NAFLD组,比较两组患者性激素和糖脂代谢指标水平差异,采用多因素Logistic回归模型分析T2DM患者NAFLD患病的影响因素。结果 256例T2DM患者的NAFLD检出率为56.25%,男性检出率为59.15%,女性为52.63%,差异无统计学意义(P>0.05)。男性患者中,NAFLD组睾酮(T)水平为(3.78±1.13)ng/m L,低于非NAFLD组的(4.61±1.55)ng/m L(P<0.05);NAFLD组雌二醇(E2)水平为(22.24±12.88)pg/m L,高于非NAFLD组的(17.84±8.72)pg/m L(P<0.05)。女性患者中,NAFLD组E2水平为(19.83±8.61)pg/m L,低于非NAFLD组的(26.32±16.85)pg/m L(P<0.05)。多因素Logistic回归分析结果显示,T(OR=0.660,95%CI:0.495~0.880)和E2(OR=0.958,95%CI:0.922~0.996)水平分别是男、女性T2DM患者患NAFLD的保护因素,而E2(OR=1.042,95%CI:1.001~1.085)水平是男性T2DM患者患NAFLD的危险因素。结论 T2DM合并NAFLD患者存在性激素紊乱;T和E2分别是男、女T2DM患者患NAFLD的保护因素。
Objective To explore the association between non-alcoholic fatty liver disease(NAFLD) and the levels of sex hormones among patients with type 2 diabetes mellitus(T2DM).Methods The prevalence of NAFLD in 256 patients in Shaoxing Central Hospital from Match 2010 to October 2013 with type 2 diabetes were calculated.According to with or without NAFLD,the T2 DM patients were divided into NAFLD group and non-NAFLD group.The levels of sex hormones,glucose and lipid were detected.The difference between the two groups was compared and the relationship between NAFLD and sex hormone were explored.Results The prevalence rate of NAFLD in patients with type 2 diabetes was 56.25%,but the prevalence of NAFLD was not different between different genders.Patients with NAFLD have obvious sex hormone disorder,and testosterone(T) in NAFLD group were lower than those in non-NAFLD group and estradiol(E2) in NAFLD group were higher than those in non-NAFLD group among males.E2 in NAFLD group were lower than those in non-NAFLD group among females.Further logisitic regression analysis showed that T and E2 were protective factors of NAFLD in males and females,while E2 was the risk factors of NAFLD in males.Conclusion For patients with NAFLD in type 2diabetes,the dominant sex hormone is a protective factor for the formation of NAFLD.
Objective To explore the association between non-alcoholic fatty liver disease(NAFLD) and the levels of sex hormones among patients with type 2 diabetes mellitus(T2DM).Methods The prevalence of NAFLD in 256 patients in Shaoxing Central Hospital from Match 2010 to October 2013 with type 2 diabetes were calculated.According to with or without NAFLD,the T2 DM patients were divided into NAFLD group and non-NAFLD group.The levels of sex hormones,glucose and lipid were detected.The difference between the two groups was compared and the relationship between NAFLD and sex hormone were explored.Results The prevalence rate of NAFLD in patients with type 2 diabetes was 56.25%,but the prevalence of NAFLD was not different between different genders.Patients with NAFLD have obvious sex hormone disorder,and testosterone(T) in NAFLD group were lower than those in non-NAFLD group and estradiol(E2) in NAFLD group were higher than those in non-NAFLD group among males.E2 in NAFLD group were lower than those in non-NAFLD group among females.Further logisitic regression analysis showed that T and E2 were protective factors of NAFLD in males and females,while E2 was the risk factors of NAFLD in males.Conclusion For patients with NAFLD in type 2diabetes,the dominant sex hormone is a protective factor for the formation of NAFLD.
引文
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[12]周丽荣,马艳.2型糖尿病合并非酒精性脂肪性肝病患者的胰岛功能变化[J].医学综述,2016,22(16):3263-3266.
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[14]范小芬,邓银泉,陈玖,等.非酒精性脂肪性肝病不同中医证型与血清TNF-α、IL-6水平的关系研究[J].西部中医药,2016,29(1):5-7.
[15]王亚东,张英泽,赵彩彦,等.性激素在非酒精性脂肪性肝病发病机制中的作用[J].中华肝脏病杂志,2012,20(5):398-400.
[16]陈艳丽.NAFLD患者肠道菌群改变与膳食因素及血清LPS、IL-18、IL-1β的相关性研究[D].安徽医科大学,2015.
[17]范世宏,毛玉山,麦一峰.2型糖尿病合并非酒精性脂肪肝与血清脂联素的相关性研究[J].预防医学,2016,28(10):973-976.
[18]唐东华,姚起新,亓竹青,等.17β-雌二醇上调去卵巢胰岛素抵抗大鼠骨骼肌中胰岛素受体的表达[J].中华内分泌代谢杂志,2010,26(8):695-698.
[19]王晓琳,章志建,陆炎,等.雌激素在肝脏糖脂代谢中的作用机制研究[C]//中华医学会第十一次全国内分泌学学术会议论文汇编,2012.
[20]邢莉莉,舒静,方素华.雌激素及其受体在能量代谢中的作用[J].中华妇产科杂志,2013,48(7):548-550.
[2]TARGHER G,DAY C P,BONORA E.Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease[J].N Engl J Med,2010,363(14):1341-1350.
[3]MATTIAS EKSTEDT,HANNES HAGSTRM,NASR P,et al.Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up[J].Hepatology,2015,61(5):1547-1554.
[4]张艳,郭传勇.非酒精性脂肪性肝病发病机制及其相关基因研究进展[J].实用肝脏病杂志,2013,16(4):375-377.
[5]艾萍,廖映红.2型糖尿病合并非酒精性脂肪性肝病与血脂代谢紊乱的关系[J].中国老年学杂志,2016,36(2):327-330.
[6]中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南[J].中国肝脏病杂志:电子版,2010,15(3):229-232.
[7]ANSTEE Q M,MCPHERSON S,Day C P.How big a problem is non-alcoholic fatty liver disease?[J].British Medical JournalClinical Research Edition,2011,343(8):d3897.
[8]李勇杰,苏宏业,李圣琦.2型糖尿病患者非酒精性脂肪肝检出率及临床特点[J].广西医学,2012,34(1):86-88.
[9]GUTIERREZ-GROBE Y,PONCIANO-RODRIGUEZ G,RAMOS M H,et al.Prevalence of non-alcoholic fatty liver disease in premenopausal,posmenopausal and polycystic ovary syndrome women.The role of estrogens[J].Ann Hepatol,2010,9(4):402-409.
[10]VOLZKE H,AUMANN N,KREBS A,et al.Hepatic steatosis is associated with low serum testosterone and high serum DHEAS levels in men[J].Int J Androl,2010,33(1):45-53.
[11]江小平,李芳萍.男性2型糖尿病患者伴非酒精性脂肪肝病的性激素变化——附53例报告[J].新医学,2010,41(8):508-510.
[12]周丽荣,马艳.2型糖尿病合并非酒精性脂肪性肝病患者的胰岛功能变化[J].医学综述,2016,22(16):3263-3266.
[13]BASARIA S,MULLER D C,CARDUCCI M A,et al.Hyperglycemia and insulin resistance in men with prostate carcinoma who receive androgen-deprivation therapy[J].Cancer,2006,106(3):581-588.
[14]范小芬,邓银泉,陈玖,等.非酒精性脂肪性肝病不同中医证型与血清TNF-α、IL-6水平的关系研究[J].西部中医药,2016,29(1):5-7.
[15]王亚东,张英泽,赵彩彦,等.性激素在非酒精性脂肪性肝病发病机制中的作用[J].中华肝脏病杂志,2012,20(5):398-400.
[16]陈艳丽.NAFLD患者肠道菌群改变与膳食因素及血清LPS、IL-18、IL-1β的相关性研究[D].安徽医科大学,2015.
[17]范世宏,毛玉山,麦一峰.2型糖尿病合并非酒精性脂肪肝与血清脂联素的相关性研究[J].预防医学,2016,28(10):973-976.
[18]唐东华,姚起新,亓竹青,等.17β-雌二醇上调去卵巢胰岛素抵抗大鼠骨骼肌中胰岛素受体的表达[J].中华内分泌代谢杂志,2010,26(8):695-698.
[19]王晓琳,章志建,陆炎,等.雌激素在肝脏糖脂代谢中的作用机制研究[C]//中华医学会第十一次全国内分泌学学术会议论文汇编,2012.
[20]邢莉莉,舒静,方素华.雌激素及其受体在能量代谢中的作用[J].中华妇产科杂志,2013,48(7):548-550.