2024 年第 11 期 第 19 卷

血清25-羟维生素D及白细胞介素6在2型糖尿病合并不同程度非酒精性脂肪性肝病患者中的临床应用价值

The clinical application value of serum 25-hydroxy vitamin D and interleukin-6 in patients with type 2 diabetes mellitus complicated with different degrees of non-alcoholic fatty liver disease

作者：邵宁马晶梁桂敏陈萍吴东红柳杰

英文作者：Shao Ning Ma Jing Liang Guimin Chen Ping Wu Donghong Liu Jie

单位：黑龙江省哈尔滨市第一医院内分泌一科，哈尔滨150010

英文单位：The First Department of Endocrinology the First Hospital of Harbin Heilongjiang Province Harbin 150010 China

关键词：2型糖尿病；非酒精性脂肪性肝病；25-羟维生素D；白细胞介素6

英文关键词：Type2diabetesmellitus;Non-alcoholicfattyliverdisease;25-hydroxylvitaminD;Interleukin-6

• 摘要：

• 目的 分析血清25-羟维生素D［25-(OH)D］、白细胞介素6（IL-6）在2型糖尿病（T2DM）合并不同程度非酒精性脂肪性肝病（NAFLD）患者中的临床应用价值。方法 选取2023年1—12月在黑龙江省哈尔滨市第一医院住院及门诊就诊的T2DM及T2DM合并NAFLD患者（病例组，90例）和同期体检健康者30例作为研究对象。本研究将30例同期体检健康者设为A组，病例组根据肝脏彩色多普勒超声及肝功能检测结果分为B组、C组、D组，各30例；B组为 T2DM不合并NAFLD患者，C组为T2DM合并NAFLD但无肝功能异常患者，D组为T2DM合并NAFLD同时伴肝功能异常患者。比较各组25-(OH)D、IL-6水平变化并分析其与相关代谢指标之间的相关性。结果 D组血清25-(OH)D水平明显低于A、B、C组，IL-6水平明显高于A、B、C组［25-(OH)D：（12.3±5.9）μg/L比（23.7±2.5）、（20.0±5.2）、（16.0±3.1）μg/L；IL-6：（12.9±4.8）ng/L比（3.8±2.0）、（5.5±3.0）、（8.0±5.3）ng/L］，差异均有统计学意义（均P＜0.05）。C组血清25-(OH)D水平低于A、B组，IL-6水平高于A、B组，差异均有统计学意义（均P＜0.05）。B组血清25-(OH)D水平低于A组，差异有统计学意义（P＜0.05）。血清25-(OH)D水平与IL-6、体重、体重指数、腰围、臀围、收缩压、糖化血红蛋白（HbA1c）、空腹血糖、餐后2 h血糖（2 hPG）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰转肽酶（γ-GGT）、总胆固醇、甘油三酯、空腹胰岛素（FINS）、稳态模型胰岛素抵抗指数（HOMA-IR）均呈负相关（均P<0.05）；IL-6水平与体重、体重指数、腰围、臀围、HbA1c、空腹血糖、2 hPG、ALT、AST、γ-GGT、总胆固醇、甘油三酯、β2微球蛋白、血肌酐、FINS、HOMA-IR均呈正相关（均P<0.05）。结论 T2DM合并NAFLD患者血清25-(OH)D水平明显降低、IL-6水平明显升高。血清25-(OH)D与IL-6水平与多项代谢指标相关，联合检测两项指标有助于早期监测病情，有利于及时采取措施阻止或延缓T2DM合并NAFLD的发生发展。

• Objective To analyze the clinical application value of serum 25-hydroxy vitamin D ［25-(OH)D］ and interleukin-6 (IL-6) in patients with type 2 diabetes mellitus (T2DM) complicated with different degrees of non-alcoholic fatty liver disease (NAFLD). Methods From January to December 2023, 90 inpatients and outpatients with T2DM or T2DM combined with NAFLD (case group) in the First Hospital of Harbin, Heilongjiang Province and 30 healthy people in the same period were selected as the research objects. In this study, 30 healthy people who underwent physical examination during the same period were set as group A. The case group was divided into group B, group C and group D according to the results of liver color Doppler ultrasound and liver function test, with 30 cases in each group. Group B was T2DM without NAFLD, group C was T2DM with NAFLD but without abnormal liver function, and group D was T2DM with NAFLD and abnormal liver function. The changes of 25-(OH) D and IL-6 levels in each group were compared, and the correlation between them and related metabolic indexes was analyzed. Results The levels of serum 25-(OH) D in group D were significantly lower than those in group A, group B and group C, while the levels of serum IL-6 in group D were significantly higher than those in groups A, B and C ［(12.3±5.9)μg/L vs (23.7±2.5), (20.0±5.2), (16.0±3.1)μg/L; (12.9±4.8)ng/L vs (3.8±2.0), (5.5±3.0), (8.0±5.3)ng/L］(all P<0.05). The levels of serum 25-(OH) D in group C were lower than those in group A and group B, while the levels of serum IL-6 were higher than those in group A and group B (all P<0.05). The level of serum 25-(OH) D in group B was lower than that in group A (P<0.05). Serum 25-(OH)D level was negatively correlated with IL-6, body weight, body mass index, waist circumference, hip circumference, systolic blood pressure, glycosylated hemoglobin (HbA1c), fasting blood glucose, 2 h postprandial blood glucose (2 hPG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (γ-GGT), total cholesterol, triglyceride, fasting insulin （FINS）, and homeostasis model assessment insulin resistance index (HOMA-IR) (all P<0.05). IL-6 level was positively correlated with body weight, body mass index, waist circumference, hip circumference, HbA1c, fasting blood glucose, 2 hPG, ALT, AST, γ-GGT, total cholesterol, triglyceride, β2-microglobulin, serum creatinine, FINS and HOMA-IR (all P<0.05). Conclusions The level of serum 25-(OH)D is significantly decreased and the level of IL-6 is significantly increased in T2DM patients with NAFLD. Serum 25-(OH)D and IL-6 levels are related to a number of metabolic indicators. Combined detection of the two indicators is helpful for early monitoring of the disease and timely taking measures to prevent or delay the occurrence and development of T2DM combined with NAFLD.