2型糖尿病合并非酒精性脂肪性肝病患者血浆脂肪细胞特异性脂肪酸结合蛋白水平的分析

【】　目的　研究2型糖尿病（type2diabetesmellitus，T2DM）合并非酒精性脂肪性肝病（non-alcoholicfattyliverdisease，NAFLD）患者血浆脂肪细胞特异性脂肪酸结合蛋白（adipocyte-specificfattyacid-bindingprotein，A-FABP）的水平及其相关因素。　方法　2009年10月―2010年10月选取T2DM合并NAFLD组（A组）60例，未合并NAFLD组56例（B组）为研究对象。测定体质量指数（bodymassindex，BMI），检测血脂、糖化血红蛋白（hemoglobinA1c，HbA1c）等生化指标。放射免疫法测定空腹胰岛素（fastinginsulin，FINS），空腹C肽水平（fastingC-peptide，FCP），计算胰岛素抵抗指数（homeostasismodelofassessment-insulinresistance，HOMA-IR）、胰岛素敏感指数（insulinsensitivityindex，ISI），测定A-FABP、C反应蛋白（C-reactionprotein，CRP）及肿瘤坏死因子-α（tumornecrosisfactor-α，TNF-α）。　结果　与B组患者相比，A组患者其血浆A-FABP水平、BMI、腰围、腰臀比、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、CRP、TNF-α、FCP、FINS、总胆固醇、甘油三酯、Ln（HOMA-IR）升高，Ln（ISI）降低，差异有统计学意义（P0.05）。A-FABP水平变化与TNF-α、HOMA-IR、CRP呈正相关，与ISI呈负相关。　结论　T2DM伴NAFLD中，A-FABP升高与胰岛素抵抗是并存的，且存在明显相关关系，二者在疾病的发生发展中均可能具有重要的作用。【Abstract】　Objective　Toanalyzetheserumlevelofadipocyte-specificfattyacid-bindingprotein(A-FABP)inpatientswithtype2diabetesmellitus(T2DM)complicatedwithnon-alcoholicfattyliverdisease(NAFLD),anditsrelatedfactors.　Methods　FromOctober2009toOctober2010,112patientswithT2DMwerecategorizedintotwogroupsthegroupwithNAFLD(groupA)with60patients,andthegroupwithoutNAFLD(groupB)with56patients.Bodymassindex(BMI),alanineaminotransferase(ALT),aspartateaminotransferase(AST),totalcholesterol(TC),triglyceride(TG),highdensitylipoproteincholesterol(HDL-C),lowdensitylipoproteincholesterol(LDL-C),andhemoglobinA1c(HbA1c)weredetected.Radioimmunoassaywascarriedouttomeasurefastinginsulin(FINS)andfastingC-peptide(FCP),andhomeostasismodelofassessment-insulinresistance(HOMA-IR)andinsulinsensitivityindex(ISI)werecalculated.Atthesametime,A-FABP,C-reactionprotein(CRP)andtumornecrosisfactor-α(TNF-α)werealsodetected.　Results　ComparedwithpatientsingroupB,plasmalevelsofA-FABP,BMI,waistline,waisttohipratio,ALT,AST,TG,TC,HDL-C,LDL-C,CRP,FCP,FINS,andHOMA-IRforpatientsingroupAwereallhigher,whileISIwaslower;andthedifferencesintheabove-mentionedparameterswerestatisticallysignificant(P0.05).ThechangeofA-FABPlevelwaspositivelycorrelatedwithTNF-α,HOMA-IRandCRP,whileitwasnegativelycorrelatedwithISI.　Conclusions　InpatientswithT2DMwithNAFLD,thereisanobviouscorrelationbetweenthecoexistingA-FABPriseandinsulinresistance.Bothofthemplayedcriticalrolesintheonsetanddevelopingofthedisease.