【摘要】 目的应用超声检测2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者心外膜脂肪组织(EAT)厚度,探讨EAT厚度与NAFLD严重程度的关系。方法选取T2DM患者97例,其中未合并NAFLD者47例(对照组),合并NAFLD者50例。根据脂肪肝二维超声表现将合并NAFLD者分为轻度NAFLD组22例、中度NAFLD组19例及重度NAFLD组9例,测量并比较各组EAT厚度,临床及实验室指标即血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2 h血糖(2hPG)、体质量指数(BMI)、腰围等;应用多重线性回归分析EAT厚度与临床及实验室指标的关系。结果轻度NAFLD组、中度NAFLD组、重度NAFLD组EAT厚度分别为(3.98±0.37)mm、(4.59±0.58)mm、(5.52±0.30)mm,均高于对照组[(3.21±0.35)mm],且中度NAFLD组、重度NAFLD组均高于轻度NAFLD组,重度NAFLD组高于中度NAFLD组,差异均有统计学意义(均P<0.05)。轻度NAFLD组、中度NAFLD组、重度NAFLD组TG、HbA1c及BMI均高于对照组,重度NAFLD组TG和HbA1c高于中度NAFLD组及轻度NAFLD组,差异均有统计学意义(均P<0.05)。中度NAFLD组、重度NAFLD组腰围均高于对照组,重度NAFLD组高于轻度NAFLD组及中度NAFLD组,差异均有统计学意义(均P<0.05)。其余指标组间两两比较差异均无统计学意义。EAT厚度与HbA1c、TG、BMI及腰围均呈正相关(r=0.679、0.649、0.601、0.564,均P<0.05)。多重线性回归分析显示,HbA1c、TG、BMI是EAT厚度的独立预测因子。结论 T2DM患者合并NAFLD时,其EAT明显增厚,且EAT随着NAFLD严重程度的增加而增厚;超声检查可以客观地评价T2DM合并NAFLD患者EAT的异常改变,具有重要的临床意义。更多还原

【Abstract】 ObjectiveTo investigate the correlation between the severity of non-alcoholic fatty liver disease(NAFLD)and epicardium adipose tissue(EAT)thickness in patients with type 2 diabetes mellitus(T2 DM).MethodsA total of 50 T2 DM patients with NAFLD were enrolled,and 47 T2 DM patients without NAFLD were selected as the control group.Ultrasonography and transthoracic echocardiography were performed in the two groups.NAFLD participants were further divided into mild NAFLD group(n=22),moderate NAFLD group(n=19)and severe NAFLD group(n=9)according to the 2-dimensional ultrasonography.EAT thickness were obtained at the same time.Total cholesteroi(TC),triglyceride(TG),low-density lipoprotein(LDL),high-density lipoprotein(HDL),glycosylated hemoglobin A1 c(Hb A1 c),fasting plasma glucose(FBG),2 h postprandial glycemia(2 h PG),body mass index(BMI),and waist circumference were measured,the results of above parameters among groups were compared.Multiple linear regression analysis was used to analyze the correlation between EAT thickness and clinical and laboratory indexes.ResultsEAT thickness of the mild,moderate,and severe NAFLD groups[(3.98±0.37)mm,(4.59±0.58)mm,(5.52±0.30)mm]were higher than that of control group[(3.21±0.35)mm],the differences between them were statistically significant(all P<0.05).The moderate and severe NAFLD groups had higher EAT thickness compared with the mild group,and the EAT thickness of severe group was higher than that of moderate group,the difference were statistically significant(all P<0.05).The TG,Hb A1 c and BMI were higher in the mild,moderate and severe NAFLD groups than those of control group(all P<0.05).The severe NAFLD group was higher than the moderate and mild NAFLD group in terms of TG and Hb A1 c(all P<0.05).The differences in TG and Hb A1 c between moderate and mild groups were not statistically significant.The waist circumference of patients with NAFLD was higher than that of the control group(P<0.05). The severe NAFLD group had higher waist circumference than that of mild and moderate NAFLD groups(both P<0.05).There was no statistical difference between other parameters among groups.EAT thickness were positively correlated with Hb A1 c,TG,BMI and waist circumference(r=0.679,0.649,0.601,0.564,all P<0.05). Multiple linear regression analysis showed that Hb Alc,TG and BMI were independent predictors of the EAT thickness.ConclusionWhen T2 DM patients with NAFLD,EAT thickness is significantly thickened,and EAT thickness increases with the severity of NAFLD. Ultrasound can objectively evaluate the abnormal changes of EAT in patients with T2 DM and NAFLD,which has important clinical significance.更多还原