Chen Mingyun, Li Tingting, Zhang Rong, Li Lianxi, Lu Junxi, Bao Yuqian, Jia Weiping
Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China.
Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China; Email:
Zhonghua Yi Xue Za Zhi. 2015 Nov 24;95(44):3575-8.
To investigate the clinical features of non-alcoholic fatty liver disease (NAFLD) and its relationship with serum C-peptide levels in patients with latent autoimmune diabetes in adults (LADA).
A total of 155 patients with LADA who had no drinking history and were hospitalized in department of endocrinology and metabolism from January 2007 to June 2009 were divided into two groups, including patients with LADA but without NAFLD and patients with both LADA and NAFLD, according to Chinese medical association's guidelines of NAFLD and hepatic ultrasound result. Their clinical data and results of laboratory examinations were collected and analyzed, including medications, blood pressure, weight, height, waist circumference, hip circumference, fasting plasma glucose, 2 h postprandial plasma glucose, fasting C-peptide, 2 h postprandial C-peptide, hemoglobin A1c, renal function, liver function, blood lipid and C-reactive protein. The clinical features between two groups were compared and the relationship between serum C-peptide and NAFLD were also analyzed.
Compared to the patients with LADA but without NAFLD, patients with both LADA and NAFLD had higher alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (γ-GT) (all P<0.01), but the serum total bilirubin (TBI) and direct bilirubin (DBI) level had no significant inter-group difference (P>0.05). The patients with both LADA and NAFLD had higher fasting C-peptide [0.62(0.33-0.93) vs 0.17 (0.05-0.50) nmol/L, P<0.001], 2 h postprandial C-peptide [1.57(0.78-1.88) vs 0.42(0.06-1.01) nmol/L, P<0.001] and more severe insulin resistance [0.8(1.0-2.5) vs 0.6(0.2-1.3), P<0.001]. Logistic regression analysis showed that there was a significant association between fasting C-peptide and the presence of NAFLD after controlling other confounding factors in patients with LADA.
The patients with both LADA and NAFLD had more severe metabolic disorders and insulin resistance. Serum fasting C peptide was independently associated with the presence of NAFLD in patients with LADA.
探讨成人隐匿性自身免疫性糖尿病（LADA）患者非酒精性脂肪性肝病（NAFLD）的临床特征及其与血清C肽水平的关系。
选取2007年1月至2009年6月在我院内分泌代谢科住院的155例无饮酒史的LADA患者，根据中华医学会NAFLD诊疗指南及肝脏超声检查结果，将其分为LADA无NAFLD组和LADA合并NAFLD组。收集并分析两组患者的临床资料及实验室检查结果，包括用药情况、血压、体重、身高、腰围、臀围、空腹血糖、餐后2小时血糖、空腹C肽、餐后2小时C肽、糖化血红蛋白、肾功能、肝功能、血脂及C反应蛋白。比较两组患者的临床特征，并分析血清C肽与NAFLD的关系。
与LADA无NAFLD组相比，LADA合并NAFLD组患者的丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）及γ-谷氨酰转移酶（γ-GT）水平更高（均P<0.01），但血清总胆红素（TBI）及直接胆红素（DBI）水平组间差异无统计学意义（P>0.05）。LADA合并NAFLD组患者的空腹C肽[0.62(0.33 - 0.93) vs 0.17(0.05 - 0.50) nmol/L，P<0.001]、餐后2小时C肽[1.57(0.78 - 1.88) vs 0.42(0.06 - 1.01) nmol/L，P<0.001]水平更高，胰岛素抵抗更严重[0.8(1.0 - 2.5) vs 0.6(0.2 - 1.3)，P<0.001]。Logistic回归分析显示，在控制LADA患者其他混杂因素后，空腹C肽与NAFLD的存在显著相关。
LADA合并NAFLD患者存在更严重的代谢紊乱及胰岛素抵抗。血清空腹C肽与LADA患者NAFLD的存在独立相关。
