2型糖尿病非酒精性脂肪肝的相关因素分析

Risk factors of non - alcoholic fatty liver in type 2 diabetes mellitus

目的探讨汉族2型糖尿病（T2DM）病人发生非酒精性脂肪肝（NAFLD）的危险因素及其预测价值。方法收集我院2009年1月至12月门诊汉族T2DM病人，进行腹部B超检查以判断有无NAFLD，同时检测体质量、腰围、血糖、血脂、胰岛素，计算体质量指数（BMI）和胰岛素抵抗指数，并进行糖尿病并发症的全面检查。结果共收集360例T2DM病人，其中52．2％（188／360）患有NAFLD。单因素对比发现，NAFLD组的BMI、腰围、胰岛素、胰岛素抵抗、甘油三酯、低密度脂蛋白水平较非NAFLD组显著升高（P〈0．05），但多因素Logistic回归提示仅腰围和甘油三酯为独立的NAFLD危险因素（P〈0．05）。NAFLD与血糖控制指标及各种糖尿病并发症无关（P〉0．05）。受试者工作特征曲线显示腰围和甘油三酯对NAFLD的发生均有预测价值，但腰围的预测价值更大。以84cm作为腰围的预测截断值，预测敏感性和特异性分别为80％和72％。结论T2DM病人NAFLD患病率高，腰围和甘油三酯为其独立的危险因素。腰围为NAFLD发生较好的预测指标，以84cm作为预测临界值时，具有较好的预测敏感及特异性。

Objective To explore the risk factors of non - alcoholic fatty liver（NAFLD） in Han type 2 diabetes mellitus （T2DM） population and to evaluate the prediction value of the risk factors for NAFLD. Methods Han outpatient T2DM patients of our hospital were recruited from Jan. 2009 to Dee. 2009. Abdominal uhrasonography was performed for each patient to diagnose NAFLD. Body weight, waist circumference, plasma insulin, plasma glucose and plasma lipid were measured. Body mass index （BMI） and insulin resistance index were calculated. Thorough physical and instrumental examinations were performed to evaluate the diabetic complications. Results Three hundred and sixty T2DM patients were recruited, one hundred and eighty -eight patients among them were diagnosed as NAFLD （52.2%）. One- factor analysis revealed that BMI, waist circumference, plasma insulin level, insulin resistance index, plasma triglyceride level and plasma low density lipoprotein level were significantly higher in NAFLD than that in the non -NAFLD T2DM patients（ P 〈0.05 ）. Multifactorial Logistic regression showed that only waist circumference and plasma triglyceride level were independent risk factors for NAFLD （ P 〈 0.05 ）. No association was found between NAFLD and blood glucose as well as diabetic complications （ P 〉 O. 05 ）. The receiver operating characteristic curves demonstrated that waist circumference was better than plasma triglyceride level in predicting the presence of NAFLD. The prediction sensitivity and specificity were 80% and 72% , respectively with 84 cm being the best cutoff value of waist circumference. Conclusions There is a high prevalence of NAFLD in T2DM patients with waist circumference and plasma triglyceridc level being independent risk factors. Waist circumference does better in predicting the presence of NAFLD with the best cutoff value of 84 cm.