Zhang J, Li L, Yu H Y, Li Y, Wang F M, Di F S
The Third Central Clinical College of Tianjin Medical University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China.
The First Central Clinical College of Tianjin Medical University, Tianjin 300170, China.
Zhonghua Gan Zang Bing Za Zhi. 2023 Oct 20;31(10):1068-1074. doi: 10.3760/cma.j.cn501113-20230517-00223.
To study the correlation between patients with type 2 diabetes mellitus combined with nonalcoholic steatohepatitis in order to provide theoretical support for the treatment of NAFLD through aerobic exercise performance. 253 cases with T2DM combined with NAFLD were selected. 93 cases consented to undergo a liver biopsy. Among them, 74 cases with liver biopsy successfully passed the symptom-limited cardiopulmonary exercise test (CPET) and respiratory quotient (RQ)≥1.05. Patients were divided into two groups according to the NAFLD activity score (NAS) of the pathological biopsy: the non-NASH group (NAS < 4) and the NASH group (NAS≥4). The differences in general clinical and biochemical indicators and exercise parameters were compared between the two groups. The relevant factors that affect aerobic exercise performance in NAFLD patients were explored by correlation and regression analysis. The peak oxygen uptake [VO2 @ peak, (17.82 ± 5.61) ml·kg(-1)·min(-1) and (23.14 ± 5.86) ml·kg(-1)·min(-1)] and anaerobic threshold [VO2 @ AT, (11.47 ± 3.12) ml·kg(-1)·min(-1) and (13.81 ± 3.53) ml·kg(-1)·min(-1)] were lower in the NASH group than those in the non-NASH group in T2DM patients, with < 0.01, indicating a significant decrease in aerobic exercise performance in NASH patients compared to non-NASH patients. Correlation analysis showed that patients with T2DM combined with NAFLD VO2@peak was positively correlated with RQ, carbohydrate oxidation rate (%CHO), daily carbohydrate energy supply (CHO Kcal/d), high-density lipoprotein cholesterol (HDL-C), and maximal voluntary ventilation (MVV) ( 0.360, 0.334, 0.341, 0.255, 0.294, < 0.05 or < 0.01, respectively) and negatively correlated with NAS score, fat attenuation, liver stiffness, fat oxidation rate (%FAT), daily fat energy supply (FAT Kcal/d), aspartate aminotransferase (AST), alanine aminotransferase (ALT), body mass, and body mass index (BMI) ( -0.558, -0.411, -0.437, -0.340, -0.270, -0.288, -0.331, -0.295, -0.469, < 0.05 or < 0.01, respectively). VO2@AT were positively correlated with RQ, %CHO, total cholesterol (TC), and HDL-C ( 0.351, 0.247, 0.303, 0.380, < 0.05 or < 0.01, respectively), while it was negatively correlated with NAS score, fat attenuation, liver stiffness, %FAT, FAT (Kcal/d), ferritin (Fer), ALT, AST, body weight, and BMI ( -0.330, -0.384, -0.428, -0.270, -0.318, 0.320, -0.404, -0.416, -0.389, -0.520, < 0.05 or < 0.01, respectively). Stepwise multiple regression analyses revealed that BMI, RQ, and NAS scores were independent correlated factors of aerobic exercise performance. Hepatic inflammation and fibrosis affect the aerobic exercise performance of patients with T2DM combined with NAFLD.
研究2型糖尿病合并非酒精性脂肪性肝炎患者之间的相关性，以便为通过有氧运动能力治疗非酒精性脂肪性肝病提供理论支持。选取253例2型糖尿病合并非酒精性脂肪性肝病患者。93例患者同意接受肝活检。其中，74例肝活检成功的患者通过了症状限制性心肺运动试验（CPET）且呼吸商（RQ）≥1.05。根据病理活检的非酒精性脂肪性肝病活动评分（NAS）将患者分为两组：非非酒精性脂肪性肝炎组（NAS<4）和非酒精性脂肪性肝炎组（NAS≥4）。比较两组患者的一般临床和生化指标及运动参数。通过相关性和回归分析探讨影响非酒精性脂肪性肝病患者有氧运动能力的相关因素。非酒精性脂肪性肝炎组2型糖尿病患者的峰值摄氧量[VO2@peak，（17.82±5.61）ml·kg-1·min-1和（23.14±5.86）ml·kg-1·min-1]和无氧阈[VO2@AT，（11.47±3.12）ml·kg-1·min-1和（13.81±开3.53）ml·kg-1·min-1]低于非非酒精性脂肪性肝炎组，P<0.01，表明与非非酒精性脂肪性肝炎患者相比，非酒精性脂肪性肝炎患者的有氧运动能力显著下降。相关性分析显示，2型糖尿病合并非酒精性脂肪性肝病患者的VO2@peak与RQ、碳水化合物氧化率（%CHO）、每日碳水化合物能量供应（CHO Kcal/d）、高密度脂蛋白胆固醇（HDL-C）和最大自主通气量（MVV）呈正相关（分别为r=0.360、0.334、0.341、0.255、0.294，P<0.05或P<0.01），与NAS评分、脂肪衰减、肝脏硬度、脂肪氧化率（%FAT）、每日脂肪能量供应（FAT Kcal/d）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、体重和体重指数（BMI）呈负相关（分别为r=-0.558、-0.411、-0.437、-0.340、-0.270、-0.288、-0.331、-0.295、-0.469，P<0.05或P<0.01）。VO2@AT与RQ、%CHO、总胆固醇（TC）和HDL-C呈正相关（分别为r=0.351、0.247、0.303、0.380，P<0.05或P<0.01），而与NAS评分、脂肪衰减、肝脏硬度、%FAT、FAT（Kcal/d）、铁蛋白（Fer）、ALT、AST、体重和BMI呈负相关（分别为r=-0.330、-0.384、-0.428、-0.270、-0.318、0.320、-0.404、-0.416、-0.389、-0.520，P<0.05或P<0.01）。逐步多元回归分析显示，BMI、RQ和NAS评分是有氧运动能力的独立相关因素。肝脏炎症和纤维化影响2型糖尿病合并非酒精性脂肪性肝病患者的有氧运动能力。
