尿微量白蛋白与尿肌酐比值对2型糖尿病合并非酒精性脂肪肝的影响

Effect of urinary microalbumin and urinary creatinine ratio on non-alcoholic fatty liver in patients with type 2 diabetes mellitus

目的检测2型糖尿病(T2DM)病人尿微量白蛋白、尿肌酐、血脂、血清总胆固醇水平,探讨尿微量蛋白与尿肌酐比值对2型糖尿病合并非酒精性脂肪肝的影响。方法选取2018年6月至2019年9月池州市人民医院收治的2型糖尿病病人120例,根据是否合并脂肪肝分为观察组(T2DM合并非酒精性脂肪肝)及对照组(单纯T2DM),其中观察组47例,对照组73例,检测并比较两组血液指标、血生化指标、尿微量白蛋白、尿肌酐(UCr)、三酰甘油(TG)、总胆固醇(TC)及尿微量白蛋白/UCr比值。采用Pearson相关性分析血脂指标与高尿微量蛋白/UCr比值的关系。按照病人是否合并脂肪肝进行赋值(合并脂肪肝=1,不合并脂肪肝=0),绘制尿微量白蛋白与UCr比值对脂肪肝诊断价值的ROC曲线。结果观察组尿微量白蛋白[45.48(32.57,49.38)mg/L比32.84(25.68,36.34)mg/L]、尿微量白蛋白/UCr[(56.42±10.35)mg/g比(37.57±9.28)mg/g]、TG[(3.12±1.05)mmol/L比(2.05±1.84)mmol/L]、TC[(6.28±2.35)mmol/L比(4.96±2.14)mmol/L]、HOMA-IR[3.89(1.86,4.29)比2.74(1.51,3.75)]、HDL-C[(1.98±0.68)mmol/L比(0.96±0.49)mmol/L]、尿酸[(354.36±25.39)mmol/L比(249.63±26.14)mmol/L]显著高于对照组,差异有统计学意义(P<0.05)。经Pearson相关性分析,TG、TC、HDL-C与高尿微量蛋白/UCr比值呈正相关(r值分别为0.770、0.694、0.765,P<0.05)。LDL-C高尿微量蛋白/UCr值无相关性(P>0.05)。ROC曲线结果显示AUC=0.892,95%CI(0.754~0.915),因AUC>0.6,说明尿微量白蛋白/UCr诊断脂肪肝具有一定价值。结论尿酸、尿微量蛋白/UCr、肥胖、脂质代谢紊乱、胰岛素抵抗与T2DM病人非酒精性脂肪肝的发生相关,高尿微量蛋白/UCr对于诊断T2DM病人发生非酒精性脂肪肝具有一定价值。

Objective To measure the levels of urinary microalbumin,urinary creatinine,blood lipid and serum total cholesterol in patients with type 2 diabetes mellitus(T2DM),and to explore the effect of urinary microprotein/urinary creatinine ratio on nonalcoholic fatty liver in T2DM patients.Methods A hundred and twenty T2DM patients treated in The People’s Hospital of Chizhou from June 2018 to September 2019 were enrolled in the study.According to whether combined with fatty liver the patients were assigned into observation group(T2DM combined with non-alcoholic fatty liver)and control group(simple T2DM).There were 47 cases in the observation group and 73 cases in the control group.The blood indexes,blood biochemical indexes,urine micro-albumin,urine myostatin(UCr),triglyceride(TG),total serum cholesterol(TC)and urine micro-albumin/UCr ratio were detected and compared between two groups.The relationship between blood lipid index and hyperuria microprotein/UCr ratio was analyzed by Pearson correlation.According to whether the patients were complicated with fatty liver(fatty liver=1,without fatty liver=0),the ROC curve of the diagnostic value of urinary microalbumin/UCr in fatty liver was drawn.Results The urinary microalbumin[45.48(32.57,49.38)mg/L vs.32.84(25.68,36.34)mg/L]and urinary microalbumin/UCr[(56.42±10.35)mg/g vs·(37.57±9.28)mg/g],TG[(3.12±1.05)mmol/L vs.(2.05±1.84)mmol/L],TC[(6.28±2.35)mmol/L vs.(4.96±2.14)mmol/L],HOMA-IR[3.89(1.86,4.29)vs.2.74(1.51,3.75)],HDL-C[(1.98±0.68)mmol/L vs.(0.96±0.49)mmol/L],uric acid[(354.36±25.39)mmol/L vs.(249.63±26.14)mmol/L]in the observation group were significantly higher than those in the control group(P<0.05).Pearson correlation analysis results showed that TG,TC,HDL-C were positively correlated with high urinary micro-protein/UCr ratio(r=0.770,0.694,0.765,respectively;P<0.05).There was no correlation between LDL-C and high urinary microprotein/UCr(P>0.05).The results of ROC.curve showed that AUC was 0.892 with 95%CI(0.754-0.915).AUC>0.6 indicated that urinary microalbumin/UCr had certain value in the diagnosis of fatty liver.Conclusion Uric acid,urinary microprotein/UCr,obesity,lipid metabolism disorder,insulin resistance are associated with the development of nonalcoholic fatty liver in T2DM patients.Hyperuria microprotein/UCr is of certain value in the diagnosis of nonalcoholic fatty liver in patients with T2DM.