第一临床医学院知识库

目的 本研究旨在通过观察老年2型糖尿病（T2DM）患者合并或不合并非酒精性脂肪性肝病（NAFLD）时，血糖、血压、血脂、肝功、血尿酸、25-OH-D3等指标的变化，探讨老年2型糖尿病患者发生非酒精性脂肪性肝病的相关影响因素及其与25-OH-D3的关系。

方法 收集2015年8月至2016年7月兰州大学第一医院老年病科及内分泌科住院患者201例,年龄在60-87岁，分为老年T2DM合并（103例）或不合并（98例）NAFLD两组。采用离子层析高效液相、酶联免疫、B型超声检测等技术手段，比较两组患者的年龄构成、性别、病程、常见合并症患病情况、体重指数(BMI)、天冬氨酸氨基转移酶 (AST)、丙氨酸氨基转移酶 (ALT)、血尿酸(UA)、甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbAlc)、空腹血糖(FBG)、空腹胰岛素(FINS)、空腹C肽、餐后2小时血糖(2hPBG)、胰岛素抵抗指数(HOMA-IR)、25羟基维生素D3(25-OH-D3)。应用SPSS18.0软件进行统计学分析，探讨老年T2DM患者发生NAFLD的相关危险因素以及与25-OH-D3的关系。

结果（1）老年T2DM合并NAFLD组的患者发生高血压、冠心病、颈动脉粥样硬化的机率均高于老年T2DM不合并NAFLD组的患者，差异具有统计学意义（P＜0.05）。（2）老年T2DM合并NAFLD组的患者，其糖尿病患病病程、BMI、FINS、C肽、UA、TC、TG、SBP、DBP、HOMA-IR均高于老年T2DM不合并NAFLD组患者，差异具有统计学意义（P＜0.05）。HDL-C、25-OH-D3水平低于老年T2DM不合并NAFLD组患者，差异具有统计学意义（P＜0.05）。（3）老年T2DM合并NAFLD组患者的维生素D缺乏及维生素D不足发生的比例明显高于老年T2DM不合并NAFLD组患者，差异具有统计学意义（P＜0.05）。（4）老年T2DM合并NAFLD组患者的25-OH-D3水平与年龄、FBG、HbAlc、2hPBG、TG、TC、LDL-C、HOMA-IR呈负相关，差异均具有统计学意义（P＜0.05）。（5）多因素logistic回归分析，结果显示，BMI（OR=1.188，P＜0.05）、TG（OR=1.660，P＜0.05）、HOMA-IR（OR=1.660，P＜0.001）是老年T2DM 患者NAFLD发生的危险因素，HDL-C、25-OH-D3则为老年T2DM患者NAFLD发生的保护因素。

结论（1）老年T2DM合并NAFLD的患者较老年T2DM不合并NAFLD的患者具有更多的心、脑血管合并症发病的危险因素，其发生心、脑血管系统并发症的机率明显升高。（2）老年T2DM合并NAFLD的患者较老年T2DM不合并NAFLD的患者25羟基维生素D3的水平明显降低。25羟基维生素D3的缺乏会使非酒精性脂肪性肝病的患病率增加。探讨25羟基维生素D3与非酒精性脂肪性肝病的关系，对提早发现心、脑血管并发症，并及时进行干预和治疗具有重要的临床意义。

Objective  This study was designed to observe the changes about blood glucose, blood pressure, blood lipid , liver function, blood uric acid, 25-OH-D3 and other indicators in the elderly type 2 diabetes mellitus (T2DM) patients with or without nonalcoholic fatty liver disease (NAFLD), and to investigate the related factors of nonalcoholic fatty liver disease in elderly patients with type 2 diabetes mellitus and its relationship with 25-OH-D3.

Subjective and methods  From August 2015 to July 2016, 201 cases of elderly patients in the Department of geriatrics and Department of endocrinology of First Hospital Affiliated to Lanzhou University were selected, aged 60-87 years, were divided into two groups ，type 2 diabetes with NAFLD group (n = 103)and type 2 diabetes without NAFLD group (n = 98). Using ion chromatography, HPLC, ELISA, B type ultrasonic detection technology, comparing the two groups of patients with age, sex, course of disease, the common complication incidence, body mass index, aspartate aminotransferase, alanine aminotransferase, serum uric acid, serum total cholesterol, three glycerol ester, high density lipoprotein cholesterol, low density lipoprotein cholesterol, fasting blood glucose, 2 hour postprandial blood glucose, fasting insulin, fasting C peptide, glycosylated hemoglobin, insulin resistance index, 25 hydroxy vitamin D3. SPSS18.0 software was used to analyze the risk factors of NAFLD in elderly patients with T2DM and the relationship with 25 hydroxy vitamin D3.

Results(1) The incidence of hypertension, coronary heart disease and carotid atherosclerosis in elderly T2DM patients with NAFLD group was higher than that of elderly T2DM patients without NAFLD group, the difference was statistically significant (P < 0.05).(2) The elderly T2DM patients with NAFLD, course of disease, body mass index, fasting insulin, fasting C peptide, uric acid, total cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure and insulin resistance index were higher than that of elderly T2DM patients without NAFLD group , the difference was statistically significant (P < 0.05). The levels of high density lipoprotein cholesterol and 25- hydroxy vitamin D3 were lower than of elderly T2DM patients without NAFLD group , the difference was statistically significant (P < 0.05).(3) The incidence of vitamin D deficiency in the elderly T2DM patients with NAFLD group was significantly higher than that in elderly T2DM patients without NAFLD group, the difference was statistically significant (P < 0.05).(4) The 25 hydroxyvitamin D3 levels which in elderly T2DM patients with NAFLD group was negatively correlated with age, fasting blood glucose, 2 hour postprandial blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride, low density lipoprotein cholesterol, insulin resistance index, the differences were statistically significant (P < 0.05).(5) The results of multivariate logistic regression analysis showed that, BMI (OR=1.188, P < 0.05), TG (OR=1.660, P < 0.05), HOMA-IR (OR=1.660, P < 0.001) were risk factors for elderly patients with T2DM combined with NAFLD. HDL and 25-OH-D3 are protective factors of T2DM in elderly patients with NAFLD.

Conclusions(1) Elderly patients with T2DM combined with NAFLD had more risk factors of cardiovascular and cerebrovascular complications in elderly patients with T2DM than those with NAFLD, and the incidence of cardiovascular and cerebrovascular complications was significantly higher.(2) Compared with the elderly T2DM patients without NAFLD, the levels of vitamin D3 were significantly lower in patients with NAFLD. 25 vitamin D3 deficiency may increase the prevalence of nonalcoholic fatty liver disease .Objective to investigate the relationship between 25 hydroxy vitamin D3 and nonalcoholic fatty liver disease, and to find out the early complications of heart and cerebrovascular disease, and to intervene and treat it in time.