首页|2型糖尿病患者胰腺脂肪沉积的影响因素及其与胰岛功能的相关性分析

2型糖尿病患者胰腺脂肪沉积的影响因素及其与胰岛功能的相关性分析

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目的 分析2型糖尿病(T2DM)患者胰腺脂肪沉积的影响因素及其与胰岛功能的相关性。方法 2015年10月-2016年12月对浦东新区泥城镇某社区548名居民进行糖尿病患病情况调查,其中T2DM患者301例,正常糖代谢(NGT)者247名。记录受试者一般资料,测定血液生化、胰岛素指标,应用双能X线吸收法测定人体成分,计算胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)等。采用超声检测脂肪肝和胰腺脂肪沉积情况,以有无胰腺脂肪沉积将T2DM组及NGT组分别再分为两个亚组,比较各组一般资料、生化指标和体脂指标之间的差异。采用多因素logistic回归分析胰腺脂肪沉积的影响因素。结果 NGT组中,有胰腺脂肪沉积亚组的年龄、腰围、腰臀比(WHR)、体重指数(BMI),空腹胰岛素(FINS)、餐后2 h胰岛素(2h INS)、三酰甘油(TG)、血尿酸(UA)、谷丙转氨酶(ALT)水平,以及脂肪肝患病率、腹部脂肪百分比、腹臀比均高于无胰腺脂肪沉积亚组,高密度脂蛋白胆固醇(HDL-C)水平和四肢脂肪百分比均低于无胰腺脂肪沉积亚组(P<0。05或P<0。01);T2DM组中,有胰腺脂肪沉积亚组的腰围、BMI,FINS、2h INS、TG、UA、ALT、谷草转氨酶(AST)水平,以及脂肪肝患病率、腹部脂肪百分比均高于无胰腺脂肪沉积亚组(P<0。05)。NGT组与T2DM组有胰腺脂肪沉积亚组的HOMA-IR、HOMA-β和IR发生率均明显高于无胰腺脂肪沉积亚组(P<0。05)。多因素logistic回归分析显示,HDL-C、HOMA-β、腹部脂肪百分比、年龄和脂肪肝是NGT人群胰腺脂肪沉积的影响因素(P<0。05);脂肪肝和HOMA-IR是T2DM人群胰腺脂肪沉积的影响因素(P<0。001)。结论 高龄、腹型肥胖合并脂肪肝人群易发生胰腺脂肪沉积,后者可影响胰岛功能,加重胰岛素抵抗程度。
Analysis of influencing factors of pancreatic fat deposition and the association with islet function in type 2 diabetes mellitus
Objective To analyze the influencing factors of pancreatic fat deposition in patients with type 2 diabetes mellitus(T2DM),and to explore the relationship between pancreatic fat deposition and islet function.Methods A survey on diabetes prevalence was conducted among 548 residents in the Nicheng community of Pudong New Area from October 2015 to December 2016,including 301 patients with T2DM and 247 subjects with normal glucose tolerance(NGT).General information of the subjects were recorded,blood biochemical and insulin indexes were measured,body composition was measured by dual-energy X-ray absorptiometry,and insulin resistance index(HOMA-IR)and islet cell sensitivity index(HOMA-β)were calculated.Fatty liver and pancreatic fat deposition were detected by ultrasound.Both the T2DM group and NGT group were further divided into two subgroups according to the pancreatic fat deposition.Differences in general demographic information,biochemical and body fat indices among the groups were compared.Multivariate logistic regression was used to analyze the influencing factors of pancreatic fat deposition.Results In the NGT group,the subgroup with pancreatic fat deposition showed higher levels of age,waist circumference,waist-to-hip ratio(WHR),body mass index(BMI),fasting insulin levels(FINS),2-hour postprandial insulin levels(2 h INS),triglycerides(TG),uric acid(UA),alanine aminotransferase(ALT),fatty liver prevalence,abdominal fat percentage,and abdomen-to-hip ratio(AHR),compared with the subgroup without pancreatic fat deposition.High-density lipoprotein cholesterol(HDL-C)and limb fat percentage were lower in the subgroup with pancreatic fat deposition.In the T2DM group,the subgroup with pancreatic fat deposition showed higher levels of waist circumference,BMI,FINS,2 h INS,TG,UA,ALT,aspartate aminotransferase(AST),fatty liver prevalence,and abdominal fat percentage,compared with the subgroup without pancreatic fat deposition,with statistically significant differences(P<0.05).The HOMA-IR and HOMA-β in both NGT and T2DM groups with pancreatic fat deposition were significantly higher than those in the groups without pancreatic fat deposition.The prevalence of insulin resistance also significantly increased,with statistically significant differences(P<0.05).The results of multivariate logistic regression analysis showed that HDL-C,HOMA-β,abdominal fat percentage,age and fatty liver were the influencing factors for pancreatic fat deposition in NGT.Conclusion Elderly individuals with abdominal obesity and fatty liver are more prone to developing pancreatic fat deposition,which can affect islet function and aggravate the insulin resistance.

pancreatic fat depositiondiabetes mellitus,type 2insulin resistance

花慧、祝超瑜、肖元元、蒋伏松、高清歌、乔寄、魏丽

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上海海洋大学水产与生命学院生物系,上海 201306

上海交通大学附属第六人民医院内分泌代谢科,上海 200233

胰腺脂肪沉积 糖尿病,2型 胰岛素抵抗

上海市浦东新区卫生计生科技项目

PW2018D-14

2024

解放军医学杂志
人民军医出版社

解放军医学杂志

CSTPCD北大核心
影响因子:1.644
ISSN:0577-7402
年,卷(期):2024.49(5)