目的:关于2型糖尿病(T2DM)患者血浆脂联素水平与非酒精性脂肪性肝病(NAFLD)之间的关系知之甚少。我们研究了T2DM患者血浆脂联素水平降低与NAFLD的存在/严重程度之间是否存在关联。
方法:我们交叉招募了79名非胰岛素治疗T2DM且无已知肝病的男性,在6个月的时间内连续参加了我们的糖尿病门诊服务,并且同时接受了超声检查和Fibroscan测量的肝硬度(LSM)。研究了与NAFLD相关的9种单核苷酸多态性(PNPLA3rs738409和其他遗传变异)。
结果:在79名参与者中(平均年龄67±10岁,BMI27.7±4kg/m2),28没有NAFLD,32只患有脂肪变性,19例患者患有NAFLD并伴有显著纤维化(Fibroscan®的LSM≥7.0kPa).与没有NAFLD的人相比,单独患有肝性脂肪变性的患者和患有肝性脂肪变性和并存的显着纤维化的患者高分子量脂联素水平较低(5.5[IQR2.3-7.6]vs.2.4[1.8-3.7]vs.1.6[1.0-2.9]µg/mL;p<0.001)。调整后的年龄,身体质量指数,胰岛素抵抗,和PNPLA3rs738409变体,研究发现,较低的血浆脂联素水平与单独脂肪变性(校正比值比[OR]2.44,95%CI1.04~5.56,p=0.042)和同时存在显著纤维化的NAFLD(校正-OR3.84,95%CI1.23~10.0,p=0.020)的几率增加相关.在调整其他8种基因型NAFLD相关多态性后观察到类似的发现。
结论:男性T2DM患者血浆脂联素水平降低与NAFLD的存在和严重程度密切相关,指出脂联素在NAFLD发生和发展中的作用。
OBJECTIVE: Little is known about the association between plasma adiponectin levels and nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). We examined whether there is an association between lower plasma adiponectin levels and the presence/severity of NAFLD in people with T2DM.
METHODS: We cross-sectionally recruited 79 men with non-insulin-treated T2DM and no known liver diseases, who had consecutively attended our diabetes outpatient service over a 6-month period and who underwent both ultrasonography and Fibroscan-measured liver stiffness (LSM). Nine single nucleotide polymorphisms (PNPLA3 rs738409 and other genetic variants) associated with NAFLD were investigated.
RESULTS: Among the 79 participants included (mean age 67 ± 10 years, BMI 27.7 ± 4 kg/m2), 28 did not have NAFLD, 32 had steatosis alone, and 19 had NAFLD with coexisting significant fibrosis (LSM ≥ 7.0 kPa by Fibroscan®). Compared to those without NAFLD, patients with hepatic steatosis alone and those with hepatic steatosis and coexisting significant fibrosis had lower high-molecular-weight adiponectin levels (5.5 [IQR 2.3-7.6] vs. 2.4 [1.8-3.7] vs. 1.6 [1.0-2.9] µg/mL; p < 0.001). After adjustment for age, body mass index, insulin resistance, and the PNPLA3 rs738409 variant, lower plasma adiponectin levels were found to be associated with increased odds of both steatosis alone (adjusted-odds ratio [OR] 2.44, 95% CI 1.04-5.56, p = 0.042) and NAFLD with coexisting significant fibrosis (adjusted-OR 3.84, 95% CI 1.23-10.0, p = 0.020). Similar findings were observed after adjustment for the other eight genotyped NAFLD-related polymorphisms.
CONCLUSIONS: Lower plasma adiponectin levels are closely associated with the presence and severity of NAFLD in men with T2DM, pointing to a role of adiponectin in NAFLD development and progression.