[Study on the correlation between type 2 diabetes mellitus combined with non-alcoholic steatohepatitis and aerobic exercise performance].

Objective: To study the correlation between patients with type 2 diabetes mellitus combined with nonalcoholic steatohepatitis in order to provide theoretical support for the treatment of NAFLD through aerobic exercise performance. Methods: 253 cases with T2DM combined with NAFLD were selected. 93 cases consented to undergo a liver biopsy. Among them, 74 cases with liver biopsy successfully passed the symptom-limited cardiopulmonary exercise test (CPET) and respiratory quotient (RQ)≥1.05. Patients were divided into two groups according to the NAFLD activity score (NAS) of the pathological biopsy: the non-NASH group (NAS < 4) and the NASH group (NAS≥4). The differences in general clinical and biochemical indicators and exercise parameters were compared between the two groups. The relevant factors that affect aerobic exercise performance in NAFLD patients were explored by correlation and regression analysis. Results: The peak oxygen uptake [VO2 @ peak, (17.82 ± 5.61) ml·kg(-1)·min(-1) and (23.14 ± 5.86) ml·kg(-1)·min(-1)] and anaerobic threshold [VO2 @ AT, (11.47 ± 3.12) ml·kg(-1)·min(-1) and (13.81 ± 3.53) ml·kg(-1)·min(-1)] were lower in the NASH group than those in the non-NASH group in T2DM patients, with P < 0.01, indicating a significant decrease in aerobic exercise performance in NASH patients compared to non-NASH patients. Correlation analysis showed that patients with T2DM combined with NAFLD VO2@peak was positively correlated with RQ, carbohydrate oxidation rate (%CHO), daily carbohydrate energy supply (CHO Kcal/d), high-density lipoprotein cholesterol (HDL-C), and maximal voluntary ventilation (MVV) (r 0.360, 0.334, 0.341, 0.255, 0.294, P < 0.05 or P < 0.01, respectively) and negatively correlated with NAS score, fat attenuation, liver stiffness, fat oxidation rate (%FAT), daily fat energy supply (FAT Kcal/d), aspartate aminotransferase (AST), alanine aminotransferase (ALT), body mass, and body mass index (BMI) (r -0.558, -0.411, -0.437, -0.340, -0.270, -0.288, -0.331, -0.295, -0.469, P < 0.05 or P < 0.01, respectively). VO2@AT were positively correlated with RQ, %CHO, total cholesterol (TC), and HDL-C (r 0.351, 0.247, 0.303, 0.380, P < 0.05 or P < 0.01, respectively), while it was negatively correlated with NAS score, fat attenuation, liver stiffness, %FAT, FAT (Kcal/d), ferritin (Fer), ALT, AST, body weight, and BMI (r -0.330, -0.384, -0.428, -0.270, -0.318, 0.320, -0.404, -0.416, -0.389, -0.520, P < 0.05 or P < 0.01, respectively). Stepwise multiple regression analyses revealed that BMI, RQ, and NAS scores were independent correlated factors of aerobic exercise performance. Conclusion: Hepatic inflammation and fibrosis affect the aerobic exercise performance of patients with T2DM combined with NAFLD.目的： 研究2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者有氧运动能力与非酒精性脂肪型肝炎（NASH）的关系，以期为运动治疗NAFLD提供理论支持。 方法： 选取T2DM合并NAFLD患者253例，93例同意行肝穿病理活检，其中74例肝穿刺病理活检患者顺利完成症状限制性心肺运动功能测试（CPET）检测且呼吸商（RQ）≥1.05，根据患者病理活检NAFLD活动度积分为（NAS）分为2组：非NASH组（NAS < 4）及NASH组（NAS≥4），比较两组一般临床及生化指标及运动参数的差别，并通过相关及回归分析探讨影响NAFLD患者有氧运动能力的相关因素。 结果： T2DM患者中NASH组与非NASH组相比峰值摄氧量[VO2 @peak,（17.82±5.61）ml·kg(-1)·min(-1)与（23.14±5.86）ml·kg(-1)·min(-1)]和无氧阈值[VO2@AT,（11.47±3.12）ml·kg(-1)·min(-1)与（13.81±3.53）ml·kg(-1)·min(-1)]减低，P值均< 0.01，提示NASH患者较非NASH患者有氧运动能力明显下降。相关性分析显示，T2DM合并NAFLD患者VO2@peak与RQ、碳水化合物氧化率（%CHO）、每日碳水化合物供能（CHO Kcal/d）、高密度脂蛋白胆固醇（HDL-C）、分钟最大通气量（MVV）呈正相关（r分别为0.360、0.334、0.341、0.255、0.294, P < 0.05或P < 0.01）；与NAS评分、脂肪衰减、肝脏硬度、脂肪氧化率（%FAT）、每日脂肪供能（FAT Kcal/d）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、体质量、体质量指数（BMI）呈负相关（r分别为-0.558、-0.411，-0.437、-0.340、-0.270、-0.288、-0.331、-0.295、-0.469 P < 0.05或P < 0.01）。VO2@AT与RQ、%CHO、总胆固醇(TC)、HDL-C呈正相关（r分别为0.351、0.247、0.303、0.380, P < 0.05或P < 0.01）；与NAS评分、脂肪衰减、肝脏硬度、%FAT、FAT（Kcal/d）、铁蛋白（Fer）、ALT、AST、体质量、BMI呈负相关（r分别为-0.330、-0.384、-0.428、-0.270、-0.318、0.320、-0.404、-0.416、-0.389、-0.520, P < 0.05或P < 0.01）。多元逐步回归分析显示BMI、RQ、NAS评分是有氧运动能力的独立相关因素。 结论： 肝脏炎症及纤维化可影响T2DM合并NAFLD患者有氧运动能力。.