ADA2013：同濟(jì)大學(xué)醫(yī)學(xué)院曲伸發(fā)現(xiàn)NAFLD影響葡萄糖代謝

?

非酒精性脂肪肝病（NAFLD）和2型糖尿病（T2DM）常常并存，并與彼此的不良結(jié)局有關(guān)。為了描繪出NAFLD和T2DM患者之間代謝異常的差異，來(lái)自同濟(jì)大學(xué)醫(yī)學(xué)院的曲伸教授及其團(tuán)隊(duì)進(jìn)行了一項(xiàng)研究，該研究發(fā)現(xiàn)伴有T2DM和NAFLD患者和僅有T2DM患者之間有葡萄糖代謝有差異。

該研究中，患者被分為兩組：挑選26例伴有NAFLD的T2DM患者（通過(guò)磁共振波譜診斷）和26例性別、年齡和BMI匹配的僅有T2DM的患者。對(duì)患者進(jìn)行75g口服葡萄糖耐量試驗(yàn)，測(cè)量他們基線和服用葡萄糖后30min、60min、120min的血清胰島素和血清C肽水平。

該研究結(jié)果表明，伴有T2DM和NAFLD患者和僅有T2DM患者血糖水平相似。與僅有T2DM患者相比，在伴有T2DM和NAFLD患者中觀察到更明顯的β細(xì)胞分泌亢進(jìn)。與僅有T2DM的患者相比，伴有T2DM和NAFLD患者的早時(shí)相和晚時(shí)相C肽水平顯著增加（△C肽0-30min P＜0.05；AUCC-p/PG30-120min比P＜0.01；C肽30-120min AUC P＜0.01）。OGTT期間，在伴有T2DM和NAFLD患者和僅有T2DM的患者之間，肝源性胰島素抵抗和額外的肝源性胰島素抵抗沒(méi)有統(tǒng)計(jì)學(xué)差異。在伴有T2DM和NAFLD患者中，肝臟胰島素敏感性單獨(dú)導(dǎo)致OGTT的早時(shí)相（0-30min），然而，在僅有T2DM患者中，晚時(shí)相胰島素分泌顯著缺乏單獨(dú)導(dǎo)致30-120min的葡萄糖狀態(tài)。在具有同一水平胰島素抵抗和高血糖的患者中間，伴有T2DM和NAFLD患者比僅有T2DM患者有更高的血清胰島素水平。高胰島素血癥主要是由β細(xì)胞分泌亢進(jìn)引起。

該研究論證了在伴有T2DM和NAFLD患者和僅有T2DM患者中不同形式嚴(yán)重胰島素抵抗的病理生理學(xué)差異。

Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) usually coexist and are associated with the adverse outcomes of the other. The aim of our study was to figure out the metabolic abnormalities difference between the two groups of patients.

The patients were divided into two groups: 26 T2DM patients with NAFLD (diagnosed by magnetic resonance spectroscopy) and 26 gender age and BMI matched patients with T2DM only were selected. The patients took a 75-g oral glucose tolerance test which measured their serum insulin and serum C-peptide level at baseline(0 min) and 30min 60min 120min after the glucose were taken.

The patients with T2DM and NAFLD or T2DM only had similar level of blood glucose levels more obvious β-cell hypersecretion was observed in the patients with T2DM and NAFLD compared with those patients with T2DM only. Fasting early phase and late phase C-peptide levels were significantly increased in the patients with T2DM and NAFLD compared to the patients with T2DM only (ΔC-peptide 0-30min P< 0.05 AUCC-p / PG 30-120min ratio P< 0.01 and AUC C-peptide 30-120 min P< 0.01). Hepatic origin and extra hepatic origin insulin resistances during OGTT has no significant difference between T2DM and NAFLD patients and the patients with T2DM only. Hepatic insulin sensitivity independently contributed to the early phase (0-30 min) of the OGTT in patients with T2DM and NAFLD whereas a significant deficit in late insulin secretion independently contributed to 30-120min glucose status in the patients with T2DM only. For the patients who have same level of insulin resistances and hyperglycemia among them patients with T2DM and NAFLD have higher serum insulin level than the patients with T2DM only. Hyperinsulinemia is caused mainly by β-cell hypersecretion. This demonstrates the pathophysiological difference of different forms of severe insulin resistance in the patients with T2DM and NAFLD and patients with T2DM only.

?

編輯： 葛根    來(lái)源：丁香園