Endocrinology Unit, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
Diabetologia. 2011 Mar;54(3):641-7. doi: 10.1007/s00125-010-2009-0. Epub 2010 Dec 12.
AIMS/HYPOTHESIS: Non-alcoholic fatty liver disease (NAFLD) is common in type 2 diabetes but it is unknown whether NAFLD is prevalent in European women at risk of type 2 diabetes. We studied the prevalence of, and risk factors for, NAFLD in European women with previous gestational diabetes (GDM) at high risk of type 2 diabetes.
A total of 110 women with previous GDM and 113 without previous GDM, with non-diabetic glucose tolerance were recruited retrospectively from antenatal databases. Participants underwent liver ultrasound scan examination, anthropometry and blood sampling for liver function tests and to determine levels of fasting lipids, NEFA and insulin and glucose concentrations in order to derive insulin sensitivity and insulin secretion indices (HOMA%S and HOMA%B, respectively).
There was no significant difference in BMI in women with previous GDM compared with those without previous GDM (28.9 ± 0.6 vs. 27.9 ± 0.6 kg/m(2), respectively; p = 0.12). Women with previous GDM had higher fasting and 2 h glucose concentrations following a 75 g OGTT ([mean ± SEM] fasting glucose 5.3 ± 0.1 vs. 5.1 ± 0.1 mmol/l, p = 0.02; 2 h glucose 6.8 ± 0.2 vs. 5.8 ± 0.3 mmol/l, p = 0.02), dyslipidaemia (LDL-cholesterol 3.3 ± 0.1 vs. 2.8 ± 0.1 mmol/l; HDL-cholesterol [median {interquartile range}] 1.3 [1.2-1.6] vs. 1.8 [1.5-1.9] mmol/l; triacylglycerol 1.3 [0.9-1.6] vs. 1.0 [0.7-1.7] mmol/l, all p ≤ 0.03), higher insulin secretion and lower insulin sensitivity. NAFLD prevalence was greater in women with previous GDM compared with those without previous GDM: 38% (95% CI 28-47%) vs. 17% (95% CI 10-24%), p = 0.001. In multiple logistic regression analysis, lower insulin sensitivity and raised serum alanine transaminase concentrations were associated with NAFLD.
CONCLUSIONS/INTERPRETATION: NAFLD is prevalent in European women with previous GDM. Impaired insulin sensitivity and increased liver transaminase activity are closely associated with NAFLD in these women.
目的/假设：非酒精性脂肪性肝病（NAFLD）在 2 型糖尿病患者中很常见，但欧洲 2 型糖尿病高危女性中 NAFLD 的患病率尚不清楚。我们研究了既往有妊娠期糖尿病（GDM）且有 2 型糖尿病高危的欧洲女性中 NAFLD 的患病率和相关危险因素。
我们回顾性地从产前数据库中招募了 110 名既往有 GDM 且糖耐量正常的女性和 113 名既往无 GDM 的女性。所有参与者均接受了肝脏超声检查、人体测量学检查和血液采样，以进行肝功能检查，并确定空腹血脂、NEFA 和胰岛素水平，以计算胰岛素敏感性和胰岛素分泌指数（HOMA%S 和 HOMA%B）。
与既往无 GDM 的女性相比，既往有 GDM 的女性的 BMI 无显著差异（分别为 28.9±0.6kg/m2 和 27.9±0.6kg/m2，p=0.12）。既往有 GDM 的女性在口服葡萄糖耐量试验（OGTT）后空腹和 2 小时血糖浓度更高（[均值±SEM]空腹血糖 5.3±0.1mmol/L 与 5.1±0.1mmol/L，p=0.02；2 小时血糖 6.8±0.2mmol/L 与 5.8±0.3mmol/L，p=0.02），血脂异常（LDL-胆固醇 3.3±0.1mmol/L 与 2.8±0.1mmol/L；HDL-胆固醇[中位数{四分位数范围}]1.3[1.2-1.6]mmol/L 与 1.8[1.5-1.9]mmol/L；三酰甘油 1.3[0.9-1.6]mmol/L 与 1.0[0.7-1.7]mmol/L，均 p≤0.03），胰岛素分泌更高，胰岛素敏感性更低。既往有 GDM 的女性 NAFLD 患病率高于既往无 GDM 的女性：38%（95%CI 28-47%）与 17%（95%CI 10-24%），p=0.001。在多因素逻辑回归分析中，胰岛素敏感性降低和血清丙氨酸氨基转移酶浓度升高与 NAFLD 相关。
结论/解释：NAFLD 在欧洲既往有 GDM 的女性中很常见。这些女性中，胰岛素敏感性降低和肝转氨酶活性升高与 NAFLD 密切相关。
