孙艳 陈智伟 张华清 代丹娇 王小庆

【摘要】目的 探討新诊断2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者血清铁调素水平变化及其临床意义。方法 选择216例新诊断T2DM为DM组，根据肝脏彩色多普勒超声（彩超） 筛查结果分为糖尿病非NAFLD组（1组，54例）、糖尿病合并轻度NAFLD组（2组，48例）、糖尿病合并中度NAFLD组（3组，59例）、糖尿病合并重度NAFLD组（4组，55例），另选同期52名健康体检者为对照组（NC组）。记录5组患者的BMI、腰臀比及腰围，检测其血脂、血糖、血尿酸、血清铁调素、铁蛋白、转铁蛋白及超敏CRP（hsCRP）水平，比较各组间的差异，并分析血清铁调素与血脂、血糖、血尿酸、hsCRP的相关性。结果 DM组4个亚组患者的BMI、腰臀比、腰围、血清总胆固醇、甘油三酯、LDL-C、空腹血糖、餐后2 h血糖、GHbA1c、血尿酸、铁蛋白及转铁蛋白水平均高于对照组（P均< 0.05），上述指标在DM组4个亚组中比较差异均无统计学意义（P均> 0.05）。DM组4个亚组患者的血清铁调素、hsCRP亦高于对照组（P均< 0.05），且随脂肪肝分级程度的升高而升高（P均< 0.05）。Pearson相关分析显示，血清铁调素水平与铁蛋白、血尿酸、hsCRP均呈正相关（P均< 0.05）。结论 T2DM患者存在铁代谢异常，合并NAFLD者血清铁调素水平随着肝损伤程度加重而升高。血清铁调素水平在一定程度上可反映T2DM患者NAFLD的病情严重程度。

【关键词】铁调素;铁代谢; 2型糖尿病;非酒精性脂肪肝

【Abstract】Objective To investigate the changes and significance of serum level of hepcidin in patients newly diagnosed with type 2 diabetes mellitus （T2DM） complicated with nonalcoholic fatty liver disease （NAFLD）.  Methods A total of 216 patients newly diagnosed with T2DM were divided into four groups according to results of color Doppler ultrasound screening of the liver including T2DM without NAFLD group （group 1， n = 54）， T2DM complicated with mild NAFLD group （group 2， n = 48）， T2DM complicated with moderate NAFLD group （group 3， n = 59） and T2DM complicated with severe NAFLD group （group 4， n = 55） ， and 52 healthy individuals were assigned into the control group （NC group）. The body mass index （BMI）， waist-to-hip ratio， waist circumference were recorded in 4 groups. The levels of blood lipid， blood glucose， blood uric acid， serum hepcidin， ferritin and hypersensitive C-reactive protein （hsCRP） were detected and statistically compared among four groups. The correlation between hepcidin and blood lipid， blood glucose， blood uric acid and hsCRP was analyzed.  Results The BMI， waist-to-hip ratio， waist circumference， serum total cholesterol， triglyceride， LDL-C， fasting blood glucose， 2h postprandial blood glucose， GHbA1c， uric acid， ferritin and transferrin in the four subgroups of DM group were all significantly higher than those in the control group （all P < 0.05）. These parameters did not significantly differ among four subgroups （all P > 0.05）. The hepcidin level and hsCRP in four subgroups of DM group were considerably higher compared with those in the control group （all P < 0.05）， and remarkably elevated with the severity of fatty liver （both P < 0.05）. Spearman rank correlation analysis demonstrated that serum hepcidin level was positively correlated with ferritin， uric acid and hsCRP （all P < 0.05）.  Conclusions T2DM patients present with abnormal iron metabolism. The serum hepcidin level in T2DM patients complicated with NAFLD is increased with the severity of liver injury. The serum hepcidin level can reflect the severity of NAFLD in T2DM patients to certain extent.

【Key words】Hepcidin;Iron metabolism;Type 2 diabetes mellitus;Nonalcoholic fatty liver disease

非酒精性脂肪性肝病（NAFLD）为2型糖尿病（T2DM）常见的合并症之一，是导致T2DM患者血糖控制困难以及并发症发生、发展的最常见病因[1-2]。研究显示，NAFLD是一种复杂的、非线性的肝脏疾病，涉及不同的方面，例如脂质积累、胰岛素抵抗、氧化应激、线粒体功能不良、炎症、内质网应激和铁代谢等[3]。尽管已经有研究表明，肥胖症患者血清铁调素表达水平较正常人升高[4-5]。人体内铁超载可能对T2DM的发生、发展和慢性并发症的形成有推动作用[6]。高铁蛋白血症和铁储存与NAFLD肝损害的严重程度相关联[7]。然而，国内外关于铁代谢在糖尿病合并NAFLD方面的相关研究较少，脂肪肝的病变程度是否和血清铁代谢相关、是否影响机体铁平衡，对此仍然未有临床研究证实。……