2型糖尿病合并代谢相关性脂肪性肝病患者血尿酸水平变化和其临床意义探讨

Serum uric acid levels and its clinical implications in patients with diabetes mellitus type 2 and concomitant metabolism-related fatty liver diseases

目的研究血尿酸(UA)对新诊断的2型糖尿病(T2DM)患者合并代谢相关性脂肪性肝病(MAFLD)的预测价值。方法2012年1月~2019年12月我院内分泌代谢科病房收治的新诊断的T2DM患者514例,其中非MAFLD组167例,合并MAFLD组347例(67.5%)。收集一般临床资料,行Logistic回归分析引起MAFLD的危险因素,建立受试者工作特征曲线(ROC)评估UA对于T2DM患者合并MAFLD的诊断价值。结果本组T2DM人群高尿酸血症(HUA)发生率为8.2%;MAFLD组HUA发生率为10.7%,显著高于非MAFLD组的4.2%(P<0.05),血脂异常发生率为55.6%,显著高于非MAFLD组的41.3%(P<0.05),肝功能异常发生率为45.2%,显著高于非MAFLD组的31.7%(P<0.05);MAFLD组体质指数(BMI)为(25.9±3.8)kg/m^(2),显著高于非MAFLD组【(23.9±3.1)kg/m^(2),P<0.05】,血清谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶分别为29(19,43)U/L、18(13,25)U/L、39(25,64)U/L,显著高于非MAFLD组【分别为21(15,32)U/L、15(12,20)U/L、31(20,51)U/L,P<0.05】,血清UA、空腹C肽、胰岛素抵抗指数分别为(294.3±91.3)μmol/L、(1.9±1.0)ng/ml、3.6(2.9,4.4),显著高于非MAFLD组【分别为(254.9±79.2)μmol/L、(1.6±0.8)ng/ml、3.2(2.7,4.0),P<0.05】,总胆固醇、甘油三酯、高密度脂蛋白胆固醇分别为(5.0±1.2)mmol/L、2.3(1.7,3.5)mmol/L、(1.0±0.2)mmol/L,与非MAFLD组差异显著【分别为(4.7±1.2)mmol/L、1.8(1.4±2.9)mmol/L、(1.1±0.4)mmol/L,P<0.05】;Logistic回归分析显示UA(OR=1.004,95%CI:1.001~1.006,P=0.005)为罹患MAFLD的独立危险因素;ROC曲线分析显示UA预测T2DM患者发生MAFLD的曲线下面积为0.634。当以UA=267.35μmol/L为截断点,其诊断MAFLD的灵敏度为56.8%,特异度为66.5%。结论在新诊断的T2DM合并MAFLD患者中,容易发生血脂异常、HUA、肝功能损害,UA是新诊断的T2DM患者罹患MAFLD的独立危险因素,提示为防治MAFLD,除了关注肥胖和血脂异常外,同样需要监测和控制血清UA水平。

Objective The aim of this study to investigate serum uric acid( UA) levels and its clinical implications in patients with diabetes mellitus type 2( T2 DM) and concomitant metabolism-related fatty liver diseases( MAFLD). Methods A total of 514 patients with T2 DM were admitted to the Department of Endocrinology and Metabolism in our hospital between 2012 and2019,and out of them,347( 67.5%) had concomitant MAFLD. The Logistic regression analysis was performed to analyze the risk factors for MAFLD,and the ROC curve was established to predict the performance of UA for MAFLD. Results The incidence of hyperuricemia( HUA) in our patients with T2 DM was 8.2%,and the incidence of HUA in MAFLD group was 10.7%,significantly higher than 4.2% in non-MAFLD group( P<0.05);the incidence of dyslipidemia was 55.6%,significantly higher than 41.3% in non-MAFLD group( P<0.05) and the incidence of abnormal liver function tests was 45.2%,significantly higher than 31.7% in non-MAFLD group( P<0.05);the body mass index( BMI) in MAFLD group was( 25.9±3.8) kg/m2,significantly higher than that in non-MAFILD group [( 23. 9 ± 3.1) kg/m2,P< 0.05];serum alanine aminotransferase, aspartate transaminase and glutamyl transpeptidase levels in MAFLD group were 29( 19,43)U/L,18( 13,25) U/L and 39( 25,64) U/L,significantly higher than [21( 15,32) U/L,15( 12,20) U/L and 31( 20,51) U/L,respectively,P < 0. 05] in non-MAFLD group;serum UA,fasting C-peptide and insulin resistance index in MAFLD group were( 294.3±91.3) μmol/L,( 1.9±1.0) ng/m L and 3.6( 2.9,4.4),significantly higher than [( 254.9±79.2) μmol/L,( 1.6±0.8)ng/m L and 3.2( 2. 7,4. 0),P < 0. 05] in non-MAFLD group;srum total cholesterol,triglyceride and high-density lipoprotein cholesterol levels in MAFLD group were( 5.0±1.2) mmol/L,2.3( 1.7,3.5) mmol/L and( 1.0± 0.2) mmol/L,significantly different from [( 4.7±1.2) mmol/L,1.8( 1.4± 2. 9) mmol/L and( 1. 1 ± 0. 4) mmol/L,respectively,P < 0. 05] in non-MAFLD group;the Logistic regression analysis showed that UA( OR = 1.004,95% CI: 1.001-1.006,P = 0. 005) was an independent risk factor for MAFLD,the ROC curve analysis showed that the area under the curve for UA to predict the occurrence of MAFLD in T2 DM patients was 0.634,and when UA equal to 267.35μmol/L as the cut-off value,the diagnostic sensitivity and specificity for MAFLD were 56.8% and 66.5%,respectively. Conclusion In naive patients with T2 DM,the concomitant MAFLD,dyslipidemia,HUA and liver function impairment are common,and UA is an independent risk factor for MAFLD. The findings in our study suggest that we should not only pay attention to obesity and dyslipidemia,it is also necessary to monitor and control UA levels.