血清尿酸水平与初诊2型糖尿病患者肝脏脂肪含量的相关性研究

Relationship between serum uric acid level and liver fat content in newly diagnosed type 2 diabetic mellitus patients

目的探讨血清尿酸水平与初诊2型糖尿病(type 2 diabetic mellitus,T2DM)患者肝脏脂肪含量的相关性。方法选取2019年1月至2021年6月于武汉科技大学附属孝感医院住院的初诊T2DM患者195例,均通过FibroScan测量肝脏受控衰减参数(controlled attenuation parameter,CAP),并行口服糖耐量试验(oral glucose tolerance test,OGTT)及胰岛素释放试验(insulin release test,IRT)。收集患者的基本信息、血常规、生化、肝纤四项及糖化血红蛋白(HbA1c);计算早相胰岛素分泌指数(ΔI30/ΔG30)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)。根据多项式拟合法获得OGTT糖负荷后血糖峰值(Gmax)及胰岛素分泌峰值(Imax)。根据肝脏脂肪含量(以CAP值表示)三分位数将研究对象分为低CAP组[CAP≤197.7 db/m,共67例,年龄(54±11)岁,其中男53例]、中CAP组[197.7 db/m<CAP≤216.6 db/m,共64例,年龄(53±9)岁,其中男42例]和高CAP组[CAP>216.6 db/m,共64例,年龄(54±11)岁,其中男40例]。比较各组的临床参数,探讨肝脏CAP值与其他指标的相关性,筛选肝脏CAP值的影响因素。采用单因素方差分析、Kruskal-Wallis H检验、χ^(2)检验等。结果3组患者高尿酸血症、体质量指数(BMI)、空腹胰岛素(I0)、I30(75 g葡萄糖负荷后30 min胰岛素)、I60、I120、I180、Imax、HOMA-β、HOMA-IR、Ⅳ型胶原、谷丙转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶及血尿素氮水平比较,差异均有统计学意义(均P<0.05);其中高CAP组高尿酸血症、BMI水平高于低CAP组和中CAP组(均P<0.05);高CAP组I0、I30、I60、I120、Imax、HOMA-β、HOMA-IR、γ-谷氨酰转肽酶水平高于低CAP组,血尿素氮水平低于低CAP组(均P<0.05);低CAP组I180、Ⅳ型胶原、碱性磷酸酶水平低于中CAP组和高CAP组(均P<0.05)。肝脏CAP值与BMI、I0、I30、I60、I120、I180、Imax、HOMA-β、HOMA-IR、Ⅳ型胶原、谷丙转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶呈正相关(均P<0.05)。多元logistic回归分析显示,高尿酸血症[OR=2.380,95%CI(1.023,5.538)]和肥胖(BMI≥28.0 kg/m^(2))[OR=3.901,95%CI(1.491,10.207)]是CAP值的保护因素(均P<0.05)。结论血清尿酸水平升高和肥胖(BMI≥28.0 kg/m^(2))是初诊T2DM患者肝脏脂肪含量增加的危险因素。

Objective To investigate the relationship between serum uric acid level and liver fat content in newly diagnosed type 2 diabetic mellitus(T2DM)patients.Methods A total of 195 patients with newly diagnosed T2DM who were hospitalized in Department of Endocrinology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2019 to June 2021 were selected.The hepatic controlled attenuation parameter(CAP)was measured by the FibroScan®system.The standard oral glucose tolerance test(OGTT)and insulin release test(IRT)were carried out.The patients'essential information,blood routine,blood biochemistry,four indicators of hepatic fibrosis,and glycosylated hemoglobin(HbA1c)were collected.The early phase insulin secretion index(ΔI30/ΔG30),isletβ-cell function index(HOMA-β),and insulin resistance index(HOMA-IR)were calculated.The blood glucose peak(Gmax)and insulin secretion peak(Imax)after glucose load were obtained by the polynomial function curve fitting method.We divided all the subjects into a low CAP group(CAP≤197.7 db/m;67 cases),a middle CAP group(197.7 db/m<CAP≤216.6 db/m;64 cases),and a high CAP group(CAP>216.6 db/m;64 cases)based on the hepatic CAP tertiles.The clinical parameters were firstly compared between the groups.The correlations of liver CAP with other indicators were analyzed.The influencing factors of liver CAP were estimated.One-way ANOVA,Kruskal-Wallis H test,andχ^(2) test were applied.Results There were statistical differences in hyperuricemia,body mass index(BMI),fasting insulin level(I0),I30(insulin level 30 minutes after 75 g OGTT),I60,I120,I180,Imax,HOMA-β,HOMA-IR,type IV collagen(IV-Col),a anine amino-transferase(ALT),alkaline phosphatase(ALP),gamma-glutamyl transpeptidase(GGT),and blood urea nitrogen BUN between the three groups(all P<0.05).The high CAP group had higher hyperuricemia and BMI than the other groups(all P<0.05).The high CAP group had higher I0,I30,I60,I120,Imax,HOMA-β,HOMA-IR,and GGT but lower BUN than the low CAP group(all P<0.05).The low CAP group had lower I180,IV-Col,and ALP than the other groups(all P<0.05).The CAP was positively correlated with BMI,I0,I30,I60,I120,I180,Imax,HOMA-β,HOMA-IR,IV-Col,ALT,ALP,and GGT(all P<0.05).Multivariate logistic regression analysis revealed that hyperuricemia[OR=2.380,95%CI(1.023,5.538)]and obese(BMI≥28.0 kg/m^(2))[OR=3.901,95%CI(1.491,10.207)]were protective factors for CAP(both P<0.05).Conclusion The elevated serum uric acid level and obesity(BMI≥28.0 kg/m^(2))are risk factors for increase of liver fat content in newly diagnosed type 2 diabetic mellitus patients.