Department of Metabolic Diseases, Medical College, Jagiellonian University, University Hospital, Kraków, Poland.
Med Sci Monit. 2013 Dec 16;19:1167-72. doi: 10.12659/MSM.889649.
There is evidence that nonalcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular risk. In this study we examined factors associated with the presence of NAFLD and the prevalence of macroangiopathy in patients with type 2 diabetes.
Subjects were 101 consecutive patients with type 2 diabetes: 72 with NAFLD and 29 free of NAFLD. NAFLD was diagnosed by ultrasonography. Serum lipids were measured enzymatically and glycated hemoglobin HbA1c was measured by HPLC.
The mean age of patients was 53.1 ± 10.4 in the NAFLD group and 44.9 ± 10.9 years in patients without NAFLD (p<0.001). The mean duration of diabetes was 10 ± 6.3 years in patients with NAFLD and 15.1 ± 7.8 years in those without NAFLD (p<0.001). Mean values of glycated hemoglobin A1c were similar in both groups. Patients with NAFLD were characterized by a significantly higher prevalence of coronary angioplasty (20.8% vs. 0%, p=0.008). Overweight and obesity were observed in a higher percentage of patients with NAFLD (p<0.001). Patients with NAFLD were characterized by significantly higher values of alanine transaminase (p=0.033), and lower serum concentrations of HDL-cholesterol (p<0.001) and creatinine (p=0.034). Logistic regression analysis (p<0.001) revealed that NAFLD was positively associated with waist circumference above normal (women >80 cm, men >94 cm) (p=0.0083) and alanine transaminase activity (p=0.0164), and negatively with creatinine concentration (p=0.0226). In a second logistic regression model (p<0.001), waist circumference (p<0.007) and total cholesterol (p<0.008) were positive predictors, while HDL-C (p<0.003) was a negative predictor of NAFLD.
The results of the study suggest that NAFLD is associated with visceral obesity and low HDL-cholesterol in patients with type 2 diabetes.
有证据表明非酒精性脂肪性肝病（NAFLD）与心血管风险增加有关。本研究旨在探讨 2 型糖尿病患者中与 NAFLD 相关的因素和大血管病变的患病率。
本研究共纳入 101 例连续就诊的 2 型糖尿病患者：72 例存在 NAFLD，29 例无 NAFLD。通过超声诊断 NAFLD。用酶法测定血清脂质，高效液相色谱法测定糖化血红蛋白（HbA1c）。
NAFLD 组患者的平均年龄为 53.1±10.4 岁，无 NAFLD 组患者的平均年龄为 44.9±10.9 岁（p＜0.001）。NAFLD 组患者的糖尿病平均病程为 10±6.3 年，无 NAFLD 组患者的糖尿病平均病程为 15.1±7.8 年（p＜0.001）。两组患者的糖化血红蛋白 A1c 平均值相似。NAFLD 组患者接受经皮冠状动脉介入治疗的比例明显更高（20.8% vs. 0%，p=0.008）。NAFLD 组患者超重和肥胖的比例更高（p＜0.001）。NAFLD 组患者的丙氨酸氨基转移酶（p=0.033）明显升高，高密度脂蛋白胆固醇（p＜0.001）和肌酐（p=0.034）浓度明显降低。多因素 logistic 回归分析（p＜0.001）显示，NAFLD 与腰围大于正常值（女性＞80cm，男性＞94cm）（p=0.0083）和丙氨酸氨基转移酶活性（p=0.0164）呈正相关，与肌酐浓度（p=0.0226）呈负相关。在第二个多因素 logistic 回归模型（p＜0.001）中，腰围（p＜0.007）和总胆固醇（p＜0.008）是 NAFLD 的正预测因素，而高密度脂蛋白胆固醇（p＜0.003）是其负预测因素。
研究结果表明，2 型糖尿病患者中 NAFLD 与内脏肥胖和低高密度脂蛋白胆固醇有关。
