高敏C反应蛋白对2型糖尿病患者非酒精性脂肪肝的预测价值

Significance of high sensitivity C-reactive protein level for predicting risk of nonalcoholic fatty liver in type 2 diabetes mellitus patients

目的探讨血清高敏C反应蛋白（11ScRP）水平对2型糖尿病患者发生非酒精性脂肪肝（NAFLD）风险的预测价值。方法此研究为前瞻l生队列研究，对象资料来自2006至2007年度河北唐山开滦集团公司员工健康体检数据库，选取符合2型糖尿病诊断标准的研究对象作为观察队列，共9489人，于2008至2009年度进行第2次体检，纳入最终统计分析的有效数据为2802例（男性2344例，女性458例），年龄22～88岁。用hsCRP作为发生NAFLD的一个预测指标，把2006至2007年的hsCRP水平按四分位数分组，比较不同基线hsCRP水平2型糖尿病患者2008至2009年度进行第2次体检时NAFLD的发病率。用logistic回归分析基线hsCRP水平对2型糖尿病患者发生NAFLD风险的预测价值。结果（1）2年间观察队列中有813例发生NAFLD，发生NAFLD的比例为29．0％。（2）2006至2007年hsCRP水平按四分位分组如下：≤0．30mg／L，〉0．30mg／L～≤0．60mg／L，〉0．60mg／L～≤1．92mg／L和〉1．92mg／L，2年后NAFLD的发病率随hsCRP基线水平的增加而增加（分别为22．5％，27．30／0，32．1％和34．3％）。（3）hsCRP最高四分位数组发生NAFLD的风险是最低四分位数组的1．80倍（95％CI：1．42～2．28，P〈0．01）。用多因素logistic回归分析校正基线年龄、性别、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖、人体质量指数后，最高四分位数组发生NAFLD的风险仍是最低四分位数组的1．49倍（95％CI：1．16～1．91，P〈0．01）。结论基线hsCRP水平对2型糖尿病患者发生NAFLD风险具有一定的预测价值，hsCRP水平较高者发生NAFLD的风险增加。

Objective To investigate the significance of high sensitivity C-reactive protein （hsCRP） levels in serum for detecting type 2 diabetes mellitus （T2DM） patients at risk of developing nonalcoholic fatty liver （NAFLD）. Methods Individuals with T2DM （0=9489） were recruited from the Kailuan Company between 2006 and 2007 for the first phase of this community-based prospective cohort study. For the second phase of the study, the original cohort was recruited for follow-up （at two years from each subject＇s original enrollment date （baseline））. The total followed-up subjects （n=2802; 2344 males, 458 females, 22-88 years old） were categorized into quartiles according to baseline measurements of serum hsCRP levels （ ≤ 0.30, 〉 0.30- 0.60, 〉0.60-1.92 and 〉 1.92mg/L） and used to determine the relationship between change in incidence rates of NAFLD and predictive value of baseline serum hsCRP levels by logistic regression analysis. Results Twentynine percent （n = 813） of the followed-up subjects developed NAFLD. The incidence （%） of NAFLD at the two-year follow-up had increased in conjunction with the level of serum hsCRP detected at baseline （quartile 1： 22.5%, 2： 27.3%, 3： 32.1%, and 4： 34.3%; all, P〈0.01）. It was found that the subjects in the highest quartile had an increased risk of NAFLD （odds ratio （OR）= 1.80, 95% confidence interval （CO： 1.42-2.28, P〈0.01）, as compared with those in the lowest quartile. Moreover, when the regression model was adjusted for baseline factors of age, sex, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low- density lipoprotein cholesterol, fasting serum glucose, and body mass index, the risk of NAFLD remained significantly higher for the highest quartile （vs. the lowest quartile; OR = 1.49, 95% CI：1.16-1.91, P〈 0.01）. Conclusion Serum hsCRP levels may be predictive of development of NAFLD in individuals with type 2 diabetes mellitus. The risk of NAFLD increases in parallel with increasing levels of serum hsCRP.