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血清25-羟维生素D3与2型糖尿病合并非酒精性脂肪肝患者糖代谢、肝功能及病情进展的相关性

Correlations of serum 25-hydroxyvitamin D3 with glucose metabolism, liver function and disease progression of patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease

    摘要
  • 摘要:
      目的  研究血清25-羟维生素D325-(OH)-D3与2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者糖代谢、肝功能及病情进展的相关性。
      方法  将128例T2DM患者纳为研究对象，根据是否合并NAFLD分为T2DM组(n=41)与NAFLD组(n=87), 同时将50例健康体检者纳为对照组; 根据NAFLD组患者血糖控制情况将其分为A组(血糖控制良好)、B组(血糖控制一般)和C组(血糖控制差); 并根据NAFLD纤维化评分(NFS)将其分为NFS>0.676组、NFS -1.455~0.676组及NFS < -1.455组。分析NAFLD组患者血清25-(OH)-D3水平与糖代谢及肝功能的相关性。
      结果  对照组、T2DM组及NAFLD组甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及血清25-(OH)-D3水平比较，差异有统计学意义(P < 0.05); 不同血糖控制程度NAFLD患者糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、胰岛素抵抗指数(Homa-IR)、胰岛素分泌指数(Homa-β)比较，差异有统计学意义(P < 0.05)。相关性分析提示, NAFLD患者血清25-(OH)-D3水平与Homa-β呈正相关(P < 0.05); 不同NFS得分患者丙氨酸氨基转移酶(ALT)及血清25-(OH)-D3水平比较，差异有统计学意义(P < 0.05)。相关性分析提示, NAFLD患者血清25-(OH)-D3水平与ALT水平呈正相关(P < 0.05)。
      结论  T2DM合并NAFLD患者血清25-(OH)-D3水平与Homa-β及ALT水平均呈正相关，提示维生素D的缺乏可能造成血糖控制不良，并促进肝纤维化进展。此外，血清25-(OH)-D3水平的检测也为NAFLD患者肝功能及纤维化的监测提供了可靠渠道。

     

    Abstract:
      Objective  To investigate the correlations of serum 25-hydroxyvitamin D3 25-(OH)-D3 with glucose metabolism, liver function and disease progression in patients with type 2 diabetes mellitus (T2DM) complicated with nonalcoholic fatty liver disease (NAFLD).
      Methods  A total of 128 T2DM patients were enrolled as subjects and divided into T2DM group (n=41) and NAFLD group (n=87) according to whether they had NAFLD or not, and 50 healthy subjects were enrolled as control group. NAFLD group was divided into group A (good blood glucose control), group B (general blood glucose control) and group C (poor blood glucose control) according to the blood glucose control status. According to the NALFD Fibrosis Score (NFS), patients were divided into NFS>0.676 group, NFS -1.455 to 0.676 group and NFS < -1.455 group. The correlation between serum 25-(OH)-D3 level and glucose metabolism as well as liver function in NAFLD patients were analyzed.
      Results  The levels of triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and serum 25-(OH)-D3 in the control group, the T2DM group and the NAFLD group showed significant differences (P < 0.05). Hemoglobin A1c (HbA1c), fasting plasma glucose(FPG), 2-hour plasma glucose (2 hPG), homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of-β cell function (HOMA-β) of NAFLD patients with different blood glucose control levels had statistical differences (P < 0.05). Correlation analysis showed that serum 25-(OH)-D3 level was positively correlated with HOMA-β in NAFLD patients (P < 0.05); there were significant differences in alanine aminotransferase (ALT) and serum 25-(OH)-D3 levels among patients with different NFS scores (P < 0.05). Correlation analysis showed that ALT level was positively correlated with serum 25-(OH)-D3 level in NAFLD patients (P < 0.05).
      Conclusion  The serum levels of 25-(OH)-D3 in patients with T2DM and NAFLD are positively correlated with the levels of HOMA-β and ALT, suggesting that vitamin D deficiency may cause poor blood glucose control and promote the progression of liver fibrosis. In addition, detection of serum 25-(OH)-D3 level also provides a reliable channel for monitoring liver function and fibrosis in NAFLD patients.

     

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