2型糖尿病患者社会经济地位与非酒精性脂肪肝相关性的回顾性队列研究

Relationship of socioeconomic status and non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

目的通过采用回顾性队列研究的方法，探讨2型糖尿病（T2DM）患者社会经济地位（SES）与非酒精性脂肪性肝病（NAFLD）的相关性。方法回顾性查阅2007年和2012年重复住院的T2DM患者的病历资料，选取第一次住院时无NAFLD的病例，电话随访受试对象的SES（包括受教育程度、家庭成员平均月收入、职业类型），按SES高低将其分为2组，比较两组第二次住院时NAFLD的发病率，计算相对危险度（RR）、归因危险度（AR）、归因危险度百分比，并分析SES与各变量的相关眭。采用SPSSStatistics17．0软件分析数据，用t检验，z。检验比较两组间差异，Spearman相关分析分析SES与其他自变量之间的关系。结果两组间年龄、性别等基线资料比较，差异无统计学意义，具有可比性。低SES的相对危险度（RR）：2．19，归因危险度（AR）=20．74％，归因危险度百分比（ARP）=54．39％。相关分析显示SES总分与体质量指数、糖化血红蛋白、空腹胰岛素、胰岛素抵抗指数、低密度脂蛋白和C反应蛋白呈负相关（，分别为-0．582、-0．421、-0．570、-0．487、-0．396、-0．353，P值均〈0．01），与高密度脂蛋白呈正相关（r=0．539，P〈0．01）。结论SES可能是T2DM合并NAFLD发病的重要社会学病因，T2DM合并NAFLD患者的SES与肥胖、胰岛素抵抗、血脂紊乱、低度炎症等病理状态相关。

Objective To explore the relationship between socioeconomic status （SES） and non-alcoholic fatty liver disease （NAFLD） in patients with type 2 diabetes mellitus （T2DM）. Methods The medical records of Tianjin Third Central Hospital were retrospectively reviewed to identify patients who had been hospitalized for treatment of T2DM but without diagnosis of NAFLD between 2007 and 2012 and who had required a second hospitalization during this same period. Each patient was contacted by telephone for self-reporting of SES. Analysis was carried out with patients grouped according to SES （high vs. low） to determine association of SES with incidence of NAFLD at the second hospitalization; the relative risk （RR）, attributable risk （AR） and attributable risk percent （ARP） were calculated. Furthermore, the correlation of SES with other clinical and socio-psychological variables was assessed. Results The patients in the high and low SES groups showed no significant differences at baseline. For development of NAFLD by the time of the second hospitalization, the low SES group had an RR of 2.19, an AR of 20.74%, and an ARP of 54.39%. Correlation analysis showed that S ES was positively correlated with body mass index （r= -0.582） and levels of glycated hemoglobin （1＂ = -0.421）, fasting serum insulin （r= -0.570）, insulin resistance （as assessed by the HOMA method） （r= -0.487）, low-density lipoprotein （r= -0.396） and C-reactive protein （r= -0.353） （all P 〈 0.05）, and negatively correlated with high-density lipoprotein （r = 0.539） and with the scores for physical functioning （r = 0.241）, general health （r = 0.234）, social functioning （r = 0.286）, emotional health （r = 0.251）, and mental health （r = 0.215） （all P 〈 0.05）. Conclusion SES is an influencing factor of NAFLD in patients with T2DM and is closely related to obesity, insulin resistance, lipid metabolic disorder, chronic inflammation and life quality in patients with NAFLD and T2DM.