2型糖尿病伴非酒精性脂肪性肝病患者血常规指标与肝脏脂肪含量的相关性

Correlation between blood routine indexes and liver fat content in patients with type 2 diabetes mellitus complicated with non-alcholic fatty liver disease

目的:评价2型糖尿病伴非酒精性脂肪性肝病(non-alcoholic fatty liver disease, NAFLD)患者血常规指标与肝脏脂肪含量(hepatic fat content, HFC)的关系。方法:选择经超声诊断为脂肪肝,并经口服葡萄糖耐量试验筛查为2型糖尿病或有明确糖尿病病史患者,测量身高、体质量、腰围、臀围、血压,血总胆固醇、三酰甘油、低密度脂蛋白胆固醇,空腹及餐后2 h血糖,肝脏功能等指标。以 1H磁共振波谱方法定量测定HFC。结果:共纳入641例患者,平均HFC为(21.56±16.9)%。单因素相关分析结果提示:在所有受试者中,除体质指数(BMI)、腰围、臀围、腰臀比、血脂、肝酶、空腹C肽等一般因素外,HFC也与红细胞计数、血红蛋白、白细胞计数相关( P <0.05);在女性受试者中,除体质量、BMI、腰围、肝酶、血脂、血糖等一般因素外,HFC与红细胞计数、血红蛋白、白细胞计数相关( P <0.05);在男性受试者HFC与红细胞计数、血红蛋白相关( P <0.05),而与白细胞计数无相关性。进一步多元回归分析结果表明:校正年龄、BMI、腰围后,丙氨酸氨基转移酶(ALT)及红细胞增加是影响HFC的独立危险因素( P <0.01);对于男性受试者,血红蛋白及ALT增加是HFC的独立影响因素( P <0.01);对于女性受试者,红细胞计数及ALT增加是影响HFC的独立危险因素( P <0.01)。结论:对伴2型糖尿病的NAFLD患者,红细胞计数、血红蛋白可作为反映HFC的血清学指标。

Objective: To analyze the correlation between blood routine indexes and liver fat content in patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease (NAFLD). Methods: The hospitalized patients with type 2 diabetes and ultrasound-verified NAFLD were selected. Height, weight, waist circumference, hip circumference, blood pressure, blood total cholesterol, triglyceride, low density lipoprotein cholesterol, and fasting and 2 h postprandial blood glucose, liver function, and other parameters were measured. Hepatic fat content was detected by 1H-MRS. Results: A total of 641 patients were selected. The average hepatic fat content of all patients was (21.56±17.0)%. The results of Pearson’s/spearman’s correlation analysis showed that serum red blood cell count, hemoglobin concentration, white blood cell count were significantly correlated with the hepatic fat content, in addition to those traditional risk factors. For female patients, the results were similar. However, in male patients, red blood cell count and hemoglobin concentration were correlated with hepatic fat content, instead of white blood cell count. Logistic regression analysis showed that alanine aminotransferase (ALT) and red blood cell count were independent risk factors affecting hepatic fat content, when age, body mass index (BMI) and waist circumference were adjusted. For male patients, serum hemoglobin and ALT were independent risk factors affecting hepatic fat content. For female patients, red blood cell count and ALT were independent risk factors affecting hepatic fat content. Conclusions: Blood routine parameters, such as red blood cell count or hemoglobin concentration may be considered as serum markers reflecting hepatic fat content in type 2 diabetes patients with NAFLD.