2型糖尿病患者CRP/ALB比值与合并非酒精性脂肪肝的相关性

Correlation between CRP/ALB ratio and non-alcoholic fatty liver in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者C反应蛋白(CRP)、白蛋白(ALB)比值与非酒精性脂肪肝(NAFLD)的相关性。方法选取2019年3月-2020年4月在新乡医学院第一附属医院就诊的248例2型糖尿病(T2DM)患者为研究对象。根据T2DM患者是否合并非酒精性脂肪肝(NAFLD),将其分为T2DM合并NAFLD组(n=105)和T2DM组(n=143)。检查患者CRP、ALB表达水平并计算CRP/ALB比值,观察并记录各患者的一般临床指标。单因素分析T2DM患者合并NAFLD的影响因素。Pearson相关性分析CRP/ALB比值与其他各临床指标的关系。多因素logistic回归分析T2DM患者合并NAFLD的危险因素。受试者工作特征(ROC)曲线分析CRP/ALB比值对T2DM并发NAFLD的诊断价值。结果与T2DM组比较,T2DM合并NAFLD组患者CRP/ALB比值[(0.05±0.01)vs.(0.11±0.03)]升高,差异有统计学意义(t=22.302,P<0.001)。单因素分析结果显示,T2DM合并NAFLD组患者体质量指数(BMI)、甘油三酯(TG)、尿酸(UA)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)均显著高于T2DM组,而高密度脂蛋白胆固醇(HDL-C)、餐后2 h血糖(2 h PG)显著低于T2DM组,差异均有统计学意义(P均<0.05)。Pearson相关性分析结果显示,CRP/ALB比值与TG、UA、HOMA-IR、AST成正相关(r=0.327、0.376、0.338、0.289,P均<0.05),与HDL-C、2 h PG成负相关(r=-0.237、-0.318,P均<0.05)。多因素logistic回归分析显示,BMI、ALT、UA和CRP/ALB比值过高是T2DM患者发生NAFLD的独立危险因素。ROC曲线分析显示,CRP/ALB比值预测T2DM患者发生NAFLD的曲线下面积为0.854,明显高于CRP或ALB单一指标诊断价值。结论CRP/ALB比值在T2DM合并NAFLD患者中上调,并对T2DM患者发生NAFLD有一定的预测作用。

Objective To investigate the correlation between the C-reactive protein/albumin(CRP/ALB)ratio and nonalcoholic fatty liver(NAFLD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 248 patients with type 2 diabetes mellitus(T2DM)who came to our hospital from March 2019 to April 2020 were selected as the research subjects.According to whether T2DM patients had non-alcoholic fatty liver(NAFLD),the patients were divided into T2DM combined with NAFLD group and T2DM group.The expression levels of CRP and ALB in patients were detected and the CRP/ALB ratio was calculated;the general clinical indicators of each patients were observed and recorded.Univariate analysis was used to analyze the influencing factors of T2DM patients with NAFLD.Pearson correlation was used to analyze the relationship between CRP/ALB ratio and other clinical indicators.Multivariate logistic regression was used to analyze the risk factors of T2DM patients with NAFLD.Receiver operating characteristic(ROC)curve was used to analyze the value of CRP/ALB ratio in the diagnosis of T2DM complicated by NAFLD.Results Compared with the T2DM group,the CRP/ALB ratio of the T2DM combined with NAFLD group was increased(t=22.302,P<0.001).The results of univariate analysis showed that the body mass index(BMI),triglycerides(TG),uric acid(UA),fasting insulin(FINS),insulin resistance index(HOMA-IR),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)of patients in the T2DM combined with NAFLD group were significantly higher than those in the T2DM group,while high-density lipoprotein cholesterol(HDL-C)and 2 h postprandial blood glucose(2 h PG)were significantly lower than those in the T2DM group(P<0.05).Pearson correlation analysis results showed that the CRP/ALB ratio was positively correlated with TG,UA,HOMA-IR and AST,and negatively correlated with HDL-C and 2 h PG(P<0.05).Multivariate logistic regression analysis showed that excessive BMI,ALT,UA and CRP/ALB ratio were independent risk factors for NAFLD in T2DM patients.ROC curve analysis showed that the area under the curve(AUC)of the CRP/ALB ratio predicting NAFLD in T2DM patients was0.854,and the diagnostic value of the CRP/ALB ratio was significantly higher than the value of a single index of CRP or ALB.Conclusion The CRP/ALB ratio in the T2DM combined with NAFLD group was up-regulated,and might be used to predict the occurrence of NAFLD in T2DM patients.