2型糖尿病男性患者性激素结合球蛋白与非酒精性脂肪肝的相关性

摘要

Objective To investigate the correlation between sex hormone-binding globulin(SHBG) and non-alcoholic fatty liver disease in male patients with type 2 diabetes.Methods A total of 157 male patients with T2DM hospitalized from January 2014 to June 2016 were enrolled and divided into 2 groups:NAFLD group(n =74) and non-NAFLD group(n =83).The patients were also divided into low SHBG group(n =52),middle SHBG group (n =52) and high SHBG group (n =53) according to the SHBG level.The waist circumference(WC),body mass index(BMI),glycolipid metabolisn items,liver function items,and SHBG level were measured and compared between NAFLD group and non-NAFLD group,between low,middle and high SHBG groups respectively.Results Compared with non-NAFLD group,BMI,waist circumference,glucose,HbAlc,FINS,HOMA-IR,TC and TG levels were significantly increased in NAFLD group,while HDL-C and SHBG levels were decreased(P ＜0.05).Compared with high SHBG group,BMI,WC,FINS,TC and TG levels were significantly increased,but HDL-C was decreased in low SHBG group and middle SHBG group(P ＜0.05).Compared with middle SHBG group,FINS and HOMA-IR levels were increased in low SHBG group(P ＜0.05).The incidence of NAFLD was 65.4％ and 24.5％ in low SHBG group and high SHBG group,respectively.The incidence of NAFLD in low SHBG group was 2.69 times higher than that in high SHBG group.Pearson correlation analysis showed that SHBG was negatively correlated withBMI,FINS,HOMA-IR,TGandTC(r=-0.435,P＜0.05;r=-0.228,P＜0.05;r=-0.314,P＜0.05;r=-0.373,P＜0.05;r =-0.247,P ＜ 0.05).Logistic regression analysis showed that SHBG,TG,BMI and HOMA-IR were the risk factors of non-alcoholic fatty liver disease in T2DM patients.Conclusion Type 2 diabetes male patients with low SHBG level are more prone to develop NAFLD,insulin resistance,hyperlipidemia and overweight or obese.%目的 观察2型糖尿病男性患者性激素结合球蛋白(SHBG)水平与非酒精性脂肪性肝病(NAFLD)的相关性. 方法 选择2014-01 ～ 2016-06住院2型糖尿病(T2DM)男性患者157例,分为T2DM合并NAFLD组(NAFLD组)74例和T2DM不合并NAFLD组(非NAFLD组)83例;按SHBG三分位法,分为低SHBG组52例,中SHBG组52例和高SHBG组53例.所有患者测定腰围、体质量指数(BMI)、糖脂代谢指标、肝功能指标和SHBG水平.分别比较NAFLD组与非NAFLD组,低、中、高SHBG组各指标差异;偏相关分析SHBG与各代谢变量间的相关性;Logistic二元回归分析NAFLD的影响因素. 结果 与非NAFLD组相比,NAFLD组BMI及腰围增加,血糖和糖化血红蛋白明显增高,FINS和HOMA-IR水平显著升高,TC和TG水平明显增高,HDL-C水平降低,血清SHBG水平降低,差异有统计学意义(P＜0.05);与高SHBG组相比,低SHBG组和中SHBG组BMI和腰围增加,FINS和HOMA-IR水平显著升高,TC和TG水平明显增高,HDL-C水平降低,差异有统计学意义(P＜0.05);与中SHBG组相比,低SHBG组FINS和HOMA-IR水平升高,差异有统计学意义(P＜0.05),低SHBG组和高SHBG组NAFLD的发生率分别为65.4％和24.5％,低SHBG组NAFLD的发生率是高SHBG组的2.69倍;Pearson相关分析发现,SHBG与BMI、FINS、HOMA-IR、TG和TC呈显著负相关(r分别为-0.435、-0.228、-0.314、-0.373和-0.247,均P＜0.05);Logistic回归分析表明,SHBG、TG、BMI和HOMA-IR是非酒精性脂肪肝的危险因素. 结论 低SHBG的2型糖尿病男性患者更容易合并非酒精性脂肪肝,并且存在胰岛素抵抗,脂代谢紊乱明显,超重与肥胖患者比例增加.