2型糖尿病合并非酒精性脂肪性肝病肝纤维化与骨密度的相关性
| 作者: |
1徐雅倩,
2樊宽鲁,
2蔡可英
1 徐州医科大学研究生院，江苏 徐州 221000 2 徐州医科大学第二附属医院内分泌科，江苏 徐州 221000 |
| 通讯: |
蔡可英
Email: 3078199499@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.03.022 |
| 基金: | 江苏省徐州市科技局计划项目(KC14SH065)。 |
摘要
目的：探讨2型糖尿病(type 2 diabetes mellitus，T2DM)合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease，NAFLD)肝纤维化与骨密度的关系。方法：筛选T2DM患者539例，依据腹部超声分为T2DM组(n=234)、T2DM+NAFLD组(n=305)，再依据非酒精性脂肪肝肝纤维化评分(non-alcoholic fatty liver disease fibrosis score，NAFLDFS)分为<−1.455排除纤维化亚组、−1.455~0.676可疑纤维化亚组、>0.676诊断纤维化亚组，行骨密度检查并测定空腹血糖(fasting blood glucose，FBG)、空腹C肽(fasting C-peptide，F-CP)、空腹胰岛素(fasting insulin，Fins)、糖化血红蛋白(HbA1c)、肝功能及血脂等血清学指标。结果：与T2DM组相比，T2DM+NAFLD组股骨颈、Ward’s三角、大粗隆、股骨干及全部股骨的骨密度及T值下降(P<0.05)。与−1.455~0.676亚组及<−1.455亚组相比，>0.676亚组股骨颈、Ward’s三角的骨密度及T值下降(P<0.05)。T2DM组和T2DM+NAFLD组骨量异常(骨量减少和骨质疏松)发生率存在差异(48.29% vs 65.90%，P<0.01)；<−1.455亚组，−1.455~0.676亚组，>0.676亚组骨量异常发生率存在差异(48.39% vs 67.98% vs 82.5%，两两比较均P<0.01)。相关性分析示：NAFLDFS与股骨颈、Ward’s三角的骨密度及T值呈负相关(P<0.05)。Logistic回归分析示：在控制年龄、性别、BMI、病程、FBG、ALT、HDLC、HbA1C及载脂蛋白B(APOB)后，NAFLDFS评分是骨量减少的独立危险因素。−1.455~0.676亚组相对于<−1.455亚组骨量减少的风险增加(OR=2.235，95%CI 1.040~4.803，P<0.05)；>0.676亚组相对于<−1.455亚组骨量减少的风险增加(OR=4.463，95%CI 1.221~16.308，P<0.05)。结论：T2DM合并NAFLD肝纤维化患者骨密度减低，两者具有相关性，进展性肝纤维化是骨量减少的危险因素。
关键词：
2型糖尿病；非酒精性脂肪性肝病；肝纤维化；骨密度
Relationship between liver fibrosis and bone mineral density in type 2 diabetes with nonalcoholic fatty liver disease
CorrespondingAuthor: CAI Keying Email: 3078199499@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.03.022
Foundation: This work was supported by Science and Technology Bureau Plan Project of Xuzhou City, China (KC14SH065).
Abstract
Objective: To investigate the relationship between liver fibrosis and bone mineral density (BMD) in patients with type 2 diabetes (T2DM) and nonalcoholic fatty liver disease (NAFLD). Methods: A total of 539 T2DM patients were divided into a T2DM group (n=234) and a T2DM+NAFLD group (n=305) according to abdominal ultrasonography, the T2DM+NAFLD group were further divided into a <−1.455 excluding fibrosis subgroup, a −1.455 to 0.676 suspicious fibrosis subgroup, and a >0.676 diagnosing fibrosis subgroup according to non-alcoholic fatty liver fibrosis score (NAFLDFS). BMD was examined and serological indexes such as fasting blood glucose (FBG), fasting C peptide (F-CP), fasting insulin (Fins), glycosylated hemoglobin (HbA1c), liver function,blood fat were determined. Results: BMD and T value of femoral neck, Ward’s triangle, trochanter, femoral shaft and all femurs in the T2DM+NAFLD group were lower than those in the T2DM group (P<0.05). BMD and T value of femoral neck and Ward’s triangle in the >0.676 subgroup were lower than those in the −1.455 to 0.676 subgroup and the <−1.455 subgroup (P<0.05). The incidence of osteopenia and osteoporosis was different between the T2DM and the T2DM+NAFLD group (48.29% vs 65.90%, P<0.01), and also different in the subgroups <−1.455, −1.455 to 0.676 and >0.676 (48.39% vs 67.98% vs 82.5%, P<0.01, for both comparisons). Relevance analysis showed NAFLDFS was positively correlated with BMD and T value of femoral neck and Ward’s triangle (P<0.05). Logistic regression analysis showed that NAFLDFS was an independent risk factor for BMD after controlling for age, sex, BMI, course of disease, FBG, ALT, HDLC, HbA1C, APOB. The risk of bone loss increased in the –1.455 to 0.676 subgroup when compared with the <–1.455 subgroup (OR=2.235, 95%CI: 1.040–4.803, P<0.05), and increased in the >0.676 subgroup when compared with the <–1.455 subgroup (OR=4.463, 95%CI: 1.221–16.308, P<0.05). Conclusion: BMD is decreased in patients with hepatic fibrosis of T2DM combined with NAFLD. There is a correlation between them. Progressive hepatic fibrosis is a risk factor for bone loss.
Keywords：
type 2 diabetes; nonalcoholic fatty liver disease; liver fibrosis; bone mineral density