应用胰岛素抵抗替代指标评估2型糖尿病患者非酒精性脂肪肝及进展性肝纤维化的价值

Predictive value of surrogate indexes of insulin resistance in evaluating non-alcoholic fatty liver disease and advanced liver fibrosis in patients with type 2 diabetes mellitus

目的探讨新诊断2型糖尿病患者胰岛素抵抗替代指标与非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)及进展性肝纤维化患病风险的相关性。方法选取2018年6月至2020年6月上海交通大学医学院附属第九人民医院内分泌科住院的429例新诊断2型糖尿病患者作为研究对象,按腹部超声结果将其分为NAFLD组(n=263)和非NAFLD组(n=166),按NAFLD纤维化评分(NAFLD fibrosis score,NFS)将NAFLD患者分为进展性纤维化组(n=33)和非进展性肝纤维化组(n=230)。分析三酰甘油/高密度脂蛋白胆固醇比值(TG/HDL-C)、三酰甘油葡萄糖指数(triglyceride glucose index,TyG)、内脏脂肪指数(visceral adiposity index,VAI)、三酰甘油葡萄糖-体重指数(triglyceride glucose-body mass index,TyG-BMI)、稳态模型评估的胰岛素抵抗指数(HOMA-IR)与NAFLD及进展性肝纤维化发生的相关性。结果新诊断2型糖尿病患者NAFLD检出率为61.3%,其中进展性肝纤维化检出率为12.5%。多因素logistic回归分析显示,调整混杂因素后,TG/HDL-C、TyG、VAI、TyG-BMI、HOMA-IR与NAFLD独立正相关,仅TyG-BMI与进展性肝纤维化独立正相关(OR=1.021,95%CI 1.009~1.034,P<0.01)。进一步受试者工作特征分析显示,TyG-BMI预测新诊断2型糖尿病患者NAFLD的曲线下面积明显大于TG/HDL-C、TyG、VAI、HOMA-IR(0.83对0.73、0.74、0.73、0.67,P<0.01),但对进展性肝纤维化无预测价值。结论TyG-BMI对新诊断2型糖尿病患者NAFLD的预测价值优于TG/HDL-C、TyG、VAI、HOMA-IR,也是进展性肝纤维化的独立危险因素。

Objective To investigate the association of surrogate indexes of insulin resistance with the risk of nonalcoholic fatty liver disease(NAFLD)and advanced liver fibrosis in newly diagnosed patients with type 2 mellitus.Methods A total of 429 newly diagnosed type 2 diabetic patients hospitalized in the Department of Endocrinology and Metabolism,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine from June 2018 to June 2020 were included.The patients were divided into NAFLD group(n=263)and non-NAFLD group(n=166)according to the results of abdominal ultrasound,NAFLD patients were divided into advanced liver fibrosis group(n=33)and non-advanced liver fibrosis group(n=230)according to the NAFLD fibrosis score(NFS).The correlation of the triglyceride/high density lipoprotein-cholesterol ratio(TG/HDL-C),triglyceride glucose index(TyG),visceral adiposity index(VAI),triglyceride glucose-body mass index(TyG-BMI),homeostasis model assessment of insulin resistance index(HOMA-IR)with NAFLD and the occurrence of advanced liver fibrosis were analyzed.Results The prevalence of NAFLD in newly diagnosed type 2 diabetic patients was 61.3%,and the prevalence of advanced liver fibrosis was 12.5%.After adjusting the potential confounders,multivariate logistic regression analysis showed that TG/HDL-C,TyG,VAI,TyG-BMI,and HOMA-IR were independently and positively correlated with NAFLD,and only TyG-BMI was independently and positively correlated with advanced liver fibrosis(OR=1.021,95%CI 1.009-1.034,P<0.01).The receiver operating characteristic analysis showed that the area under the curue of TyG-BMI was more than those of TG/HDL-C,TyG,VAI and HOMA-IR for predicting the occurrence of NAFLD in newly diagnosed type 2 diabetic patients(0.83 vs 0.73,0.74,0.73,0.67,P<0.01),but had no predictive value for advanced liver fibrosis.Conclusion TyG-BMI is superior to TG/HDL-C,TyG,VAI and HOMA-IR for predicting the occurrence of NAFLD in newly diagnosed type 2 diabetic patients,and it is also an independent risk factor for advanced liver fibrosis.