Yu T P, Zhao C C, Chen M Y, Lu J X, Li L X, Jia W P
Department of Endocrinology and Metabolism, the Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China.
Zhonghua Yi Xue Za Zhi. 2018 Aug 14;98(30):2398-2402. doi: 10.3760/cma.j.issn.0376-2491.2018.30.006.
To investigate the relationship between non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) in patients with latent autoimmune diabetes in adults (LADA). A total of 223 hospitalized patients were recruited between January 2007 and June 2009 in Department of Endocrinology and Metabolism of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University. Finally, 142 patients with complete clinical data and without history of drinking were included in this study. According to the Chinese Medical Association's Guidelines of NAFLD, based on the result of ultrasound, all subjects were divided into two groups including patients with LADA and NAFLD (=37) and patients with LADA but without NAFLD (=105). Clinical data including diabetes duration, history of smoking and medications, height, weight, blood pressure, blood lipids, blood glucose, C-peptide, and liver and kidney function were collected. The prevalence and components of MetS were compared between two groups. The association between MetS and NAFLD was also explored. After adjusting for age and sex, compared with the subjects without NAFLD, the subjects with NAFLD were older and had higher percentage of hypertension, and had higher body mass index[(26.5±3.7) kg/m(2) vs (21.9±3.1) kg/m(2)], waist-hip ratio(0.92±0.06 vs 0.86±0.07), low density lipoprotein cholesterol[(3.26±0.72) mmol/L vs (2.70±0.87) mmol/L], C-reactive protein, fasting C-peptide, 2 h postprandial C-peptide, systolic blood pressure, diastolic blood pressure, alanine aminotransferase and triglyceride (all <0.05). But they had lower high-density lipoprotein cholesterol[(1.17±0.43) mmol/L vs (1.35±0.40) mmol/L]and HbA1c[(8.83±2.14) % vs (10.02±2.79)%](both <0.05). In addition, after adjusting for age and sex, compared with the patients with LADA but without NAFLD, the prevalence of MetS in the patients with LADA and NAFLD was obviously higher (97.3% vs 47.6%, <0.001), and the proportion of the patients with four (32.4% vs 16.2%, <0.001) and five (43.2% vs 5.7%, <0.001) components of MetS in the patients with LADA and NAFLD was also significantly increased than that in the patients with LADA but without NAFLD. Binary regression analysis showed that NAFLD was an independent factor associated with MetS in the patients with LADA after correcting other confounding factors (<0.001). Compared with the patients with LADA but without NAFLD, the prevalence of MetS was obviously higher, and had more serious metabolic disorder in the patients with LADA and NAFLD. The presence of NAFLD was an independent factor associated with MetS in the patients with LADA.
探讨成人隐匿性自身免疫性糖尿病（LADA）患者中非酒精性脂肪性肝病（NAFLD）与代谢综合征（MetS）之间的关系。2007年1月至2009年6月期间，上海交通大学附属第六人民医院内分泌代谢科共招募了223例住院患者。最终，本研究纳入了142例临床资料完整且无饮酒史的患者。根据中华医学会的NAFLD指南，基于超声检查结果，将所有受试者分为两组，包括LADA合并NAFLD患者（n = 37）和LADA但无NAFLD患者（n = 105）。收集临床资料，包括糖尿病病程、吸烟史和用药情况、身高、体重、血压、血脂、血糖、C肽以及肝肾功能。比较两组患者MetS的患病率及组分。同时探讨MetS与NAFLD之间的关联。在调整年龄和性别后，与无NAFLD的受试者相比，有NAFLD的受试者年龄更大，高血压患病率更高，且体重指数更高[（26.5±3.7）kg/m² 对 （21.9±3.1）kg/m²]、腰臀比更高（0.92±0.06 对 0.86±0.07）、低密度脂蛋白胆固醇更高[（3.26±0.72）mmol/L 对 （2.70±0.87）mmol/L]、C反应蛋白、空腹C肽、餐后2小时C肽、收缩压、舒张压、谷丙转氨酶和甘油三酯（均P<0.05）。但他们的高密度脂蛋白胆固醇更低[（1.17±0.43）mmol/L 对 （1.35±0.40）mmol/L]和糖化血红蛋白更低[（8.83±2.14）% 对 （10.02±2.79）%]（均P<0.05）。此外，在调整年龄和性别后，与LADA但无NAFLD的患者相比，LADA合并NAFLD患者的MetS患病率明显更高（97.3% 对 47.6%，P<0.001），且LADA合并NAFLD患者中具有MetS四项（32.4% 对 16.2%，P<0.001）和五项（4
