[摘要] 目的 探讨T2DM合并非酒精性脂肪性肝病(NAFLD)患者血清脂联素(APN)和内脂素的临床意义。 方法 选取2011年9月至2013年3月于我院就诊的T2DM患者230例，根据中华医学会NAFLD诊断标准将研究对象分为单纯T2DM组148例和T2DM合并NAFLD组92例，另选正常体检者106名(NC组)。根据影像学诊断再将T2DM合并NAFLD组分为轻度亚组38例，中度组28例和重度组26例，比较各组血清APN和内脂素水平。 结果 T2DM组和T2DM合并NAFLD 组脂肪百分含量(BF%)、内脂素、BMI、WC、WHR、ALT、ALT、FPG、FIns、TG、TC及HOMA-IR较NC组升高(P<0.05或P<0.01)。T2DM合并NAFLD组血清APN水平较NC组和T2DM组降低(P<0.01)，T2DM组较NC组降低(P<0.01)。T2DM合并NAFLD组轻、中、重度组HOMA-IR逐渐升高;血清APN水平逐渐降低，且轻、中、重度组间比较差异均有统计学意义(P<0.05);血清内脂素水平逐渐升高，但轻度和中度组间比较差异无统计学意义(P>0.05)。相关分析结果显示，血清APN与性别呈正相关;与BMI、FPG、FIns、TG、HOMA-IR、ALT呈负相关。结论 T2DM合并NAFLD患者血清APN较正常人明显降低，且与NAFLD严重程度相关。低脂联素血症可能与NAFLD发生发展有关;内脂素水平随NAFLD严重程度明显升高，可能参与了向脂肪性肝炎及肝脏纤维化的发展。

　　[关键词] 非酒精性脂肪肝;糖尿病，2型，脂联素;内脂素;胰岛素抵抗

　　[ Abstract ] Objective To investigate the serum levels of adiponectin (APN) and visfatinin patients with type 2 diabetes and nonalcoholic fatty liver disease(NAFLD)and its clinical significance. Methods 230 cases of T2DM patients admitted to our hospital from September 2011 to March 2013 were divided into T2DM group (148 cases) and T2DM plus NAFLD group (92 cases) according to the Chinese Medical Association diagnostic criteria for NAFLD subjects. 106 healthy peoplewas selected as control.Patients with T2DM plus NAFLD were further divided into mild ( 38 cases) , moderate (28 cases) and severe (26 cases) groups based on NAFLD severity.Serum APN and visfatin levels were compared among groups. Results Compared with NC group, T2DM and T2DM plus NAFLD groupsshowed the increased levels of fat percentage (BF%), visfatin , BMI, WC, WHR, ALT, ALT, FPG, FIns, TG, TC and HOMA-IR (P< 0.05 or P<0.01). Serum APN levels were lower in T2DM plus NAFLD than in NC group and T2DM group (P<0.01) and serum APN levels were lower in T2DM groupthan in NC group (P<0.01). HOMA-IR was positively correlated to disease severity in patients with T2DM plus NAFLD ; serum APN levels were negatively correlated to disease severity, (both P<0.05); visfatin level was positively correlated to disease severity in patients with T2DM plus NAFLD, but the difference between mild and moderate groups was not statistically significant (P>0.05). Correlation analysis showed that serum APN was positively correlated with gender and negatively correlated with BMI, FPG, FIns, TG, HOMA-IR and ALT. Conclusion APN is significantly lower in patients with T2DM plus NAFLD than in normal individuals, and is correlated with NAFLD severity. Hypoadiponectinemia may be related to the development of NAFLD; visfatin significantly is increasedin severe NAFLD and NAFLD may be involved in the development of liver fibrosis.

　　[ Key word ] Non-alcoholic fatty liver; Diabetes, type 2;Adiponectin; Visfatin; Insulin resistance