甘油三酯对2型糖尿病患者新发非酒精性脂肪肝的预测价值

Prediction of the incidence of nonalcoholic fatty liver in type 2 diabetes mellitus by triglyrcerid levels

目的探讨甘油三酯（TG）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。方法此研究为前瞻性队列研究,对象来自2006-2007年度河北唐山开滦集团公司员工健康查体数据库,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9 489人,于2008-2009年度进行第二次体检,纳入最终统计分析的有效数据为2 937例（男性2 460例,女性477例）。用甘油三酯（TG）作为发生NAFLD的一个预测指标,比较不同基线TG水平2型糖尿病患者2008-2009年度进行第二次体检时NAFLD的发病率。用Logistic回归分析基线TG水平对2型糖尿病患者发生NAFLD风险的预测价值。结果 12年间观察队列中有850例发生NAFLD,发生NAFLD的比例为28.9%。2按2006-2007年TG水平四分位分组如下：〈0.96mmol/L,0.96mmol/L≤TG〈1.34mmol/L,1.34mmol/L≤TG〈2.01mmol/L和TG≥2.01mmol/L,2年后NAFLD的发病率随TG基线水平的增加而增加（分别为17.7%、27.0%、31.9%和39.5%,P〈0.01）。3TG最高四分位组（TG≥2.01mmol/L）发生NAFLD的风险是最低四分位组（TG〈0.96mmol/L）的3.03倍（95%CI：2.39~3.85,P〈0.01）。用多因素Logistic回归分析校正年龄、性别、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸、空腹血糖、BMI后,最高四分位数组发生NAFLD的风险仍是最低四分位数组的3.07倍（95%CI：2.41~3.90,P〈0.01）。结论基线甘油三酯水平对2型糖尿病患者发生NAFLD的风险有一定的预测价值,甘油三酯水平较高者发生NAFLD的风险增加。

Objective To investigate the value of triglyrcerid （TG） level in predicting the incidence of nonalcoholic fatty liver disease （NAFLD） in patients with type 2 diabetes mellitus（T2DM）. Methods Based on the health examination data of the workers in Kailuan Company in 2006 - 2007, 9,489 individuals with T2DM were recruited in the community - based prospective cohort study. After 2 - year follow - up , data were collected and available data of 2,937 subjects （2,460 males and 477 females） were analyzed. Having TG as the predictor of NAFLD, the incidence of NAFLD in 2008 - 2009 was compared among T2DM patients with various baseline TG levels. Logistic regression analysis was used to explore the prognostic significance of baseline TG for the incidence of NAFLD in T2DM patients. Results Totally, 850 subjects （28.9 % ） developed into NAFLD after the 2 - year follow - up. In 2006 - 2007, TG levels were categorized into the following quartiles： 〈 0.96 mmol/L, 0.96 mmol/L≤ TG〈 1.34 mmol/L, 1.34 mmol/L≤TG〈2.01 mmol/L and TG≥2.01 mmol/L. In 2008 - 2009, the incidence of NAFLD in the groups of four quartiles increased with the baseline TG levd （ 17.7 %, 27.0 %, 31.9 % and 39.5 %, P〈 0.01 ）. In addition , the individuals with the highest quartile TG levds（TG≥2.01 mmol/L） had an increased risk of NAFLD as compared with those with the lowest quartile （TG〈0.96 mmol/L） （OR = 3.03, 95% CI 2.39 - 3.85, P〈0.01）. Logistic regression analysis showed that after the baseline age, gender, TC, HDL- C, LDL- C, SUA, FBG and BMI were adjusted, the risk of NAFLD in the group with the highest quartile of TG at baseline was still higher than that in the group with the lowest quartile （ OR = 3.07, 95 % CI 2.41 - 3.90, P 〈 0.01 ）. Conclusions Risk of NAFLD in patients with type 2 diabetes mellitus might be prognosed by the baseline triglyrcerid level. With the rising of triglyreerid, the risk of NAFLD is increased.