非酒精性脂肪性肝病合并2型糖尿病患者同型半胱氨酸水平和中性粒细胞与淋巴细胞比值的临床意义

Clinical significance of homocysteine and neutrophil-to-lymphocyte ratio in patients with nonalcoholic fatty liver disease and type 2 diabetes mellitus

目的探讨同型半胱氨酸(Hcy)及中性粒细胞与淋巴细胞比值(NLR)在非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者中的水平及临床意义。方法选取2019年1月—12月锦州医科大学附属第一医院内分泌科的NAFLD患者528例,根据其是否合并2型糖尿病分为未合并T2DM组及合并T2DM组,并随机选取未合并NAFLD的单纯性T2DM患者79例,记录3组患者的一般资料及实验室指标。计量资料符合正态分布数据组间比较采用单因素方差分析;计数资料组间比较采用χ^(2)检验。危险因素分析采用二元logistic回归分析,用OR及其95%CI表示相对危险度。采用受试者工作特征曲线(ROC曲线)评价预测效能。结果合并T2DM组患者SBP、DBP及BMI显著高于未合并T2DM组(P值均<0.05)。Hcy、NLR、ALT、AST、GGT、UA、FBG两两组间比较差异均有统计学意义(P值均<0.05)。Neut、Lym及HDL-C在合并T2DM组与未合并T2DM组中比较差异有统计学意义(P值均<0.05)。TC在合并T2DM组与单纯T2DM组、未合并T2DM组与单纯T2DM组比较差异均有统计学意义(P值均<005)。SBP、HDL-C、NLR、Hcy为NAFLD合并T2DM的独立危险因素[OR(95%CI):1.040(1.015~1.065)、0.040(0.007~0.228)、6.285(1.504~27.108)、1.291(1.127~1.423),P值均<0.05]。Hcy预测NAFLD合并T2DM的曲线下面积为0.741(95%CI:0.698~0783,P<0.01),Youden指数为0.394,预测临界值为15.31μmol/L,敏感度为69.6%,特异度为69.8%。NLR预测NAFLD合并T2DM的曲线下面积为0.782(95%CI:0.744~0.820,P<0.01),Youden指数为0.443,预测临界值为2.12,敏感度为72.1%,特异度为72.2%。Hcy联合NLR预测NAFLD合并T2DM的曲线下面积为0.845(95%CI:0.812~0.878,P<0.01),Youden指数为0549,敏感度为71.8%,特异度为83.1%。结论Hcy及NLR是NAFLD合并T2DM发生的危险因素,对于该疾病的发生具有预测价值。Hcy联合NLR检测可提高NAFLD合并T2DM的诊断效能,有助于临床医生早期识别。

Objective To investigate the levels and clinical significance of homocysteine(Hcy)and neutrophil-to-lymphocyte ratio(NLR)in patients with nonalcoholic fatty liver disease(NAFLD)and type 2 diabetes mellitus(T2DM).Methods A total of 528 patients with NAFLD who were treated in Department of Endocrinology,The First Affiliated Hospital of Jinzhou Medical University,from January to December 2019 were enrolled,and according to the presence or absence of T2DM,they were divided into non-T2DM group and T2DM group.A total of 79 T2DM patients without NAFLD were selected randomly.General data and laboratory markers were recorded for the three groups.A one-way analysis of variance was used for comparison of normally distributed continuous data between groups,and the chi-square test was used for comparison of categorical data between groups;a binary logistic regression analysis was used to determine risk factors,and odds ratio(OR)and its 95%confidence interval(CI)were used to represent relative risk;the receiver operating characteristic(ROC)curve was used to evaluate predictive efficiency.Results The T2DM group had significantly higher systolic blood pressure(SBP),diastolic blood pressure,and body mass index than the non-T2DM group(all P<0.05),and there were significant differences between any two of the three groups in Hcy,NLR,alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transpeptidase,uric acid,and fasting blood glucose(all P<0.05).There were significant differences in neutrophil count,lymphocyte count,and high-density lipoprotein cholesterol(HDL-C)between the T2DM group and the non-T2DM group(all P<0.05),and there was a significant difference in total cholesterol between the T2DM group and the simple T2DM group and between the non-T2DM group and the simple T2DM group(P<0.05).SBP(OR=1.040,95%CI:1.015-1.065),HDL-C(OR=0.040,95%CI:0.007-0.228),NLR(OR=6.285,95%CI:1.504-27.108),and Hcy(OR=1.291,95%CI:1.127-1.423)were independent risk factors for NAFLD with T2DM.Hcy had an area under the ROC curve(AUC)of 0.741(95%CI:0.698-0.783,P<0.01)in predicting NAFLD with T2DM,with a Youden index of 0.394,a sensitivity of 69.6%,and a specificity of 69.8%at the optimal cut-off value of 15.31μmol/L.NLR had an AUC of 0.782(95%CI:0.744-0.820,P<0.01)in predicting NAFLD with T2DM,with a Youden index of 0.443,a sensitivity of 72.1%,and a specificity of 72.2%at the optimal cut-off value of 2.12.Hcy combined with NLR had an AUC of 0.845(95%CI:0.812-0.878,P<0.01)in predicting NAFLD with T2DM,with a Youden index of 0.549,a sensitivity of 71.8%,and a specificity of 83.1%.Conclusion Hcy and NLR are risk factors for NAFLD with T2DM and have a certain predictive value.Combined measurement of Hcy and NLR can improve the diagnostic efficiency of NAFLD with T2DM and help clinicians with diagnosis in the early stage.