PLR、NLR与T2DM合并代谢相关脂肪性肝病肝纤维化的关系

Relationship between PLR,NLR and hepatic fibrosis in T2DM complicated with metabolic dysfunction-associated fatty liver disease

目的:探讨血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)和中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)与2型糖尿病(type 2 diabetes mellitus,T2DM)合并代谢相关脂肪性肝病(metabolic dysfunction-associated fatty liver disease,MAFLD)肝纤维化的关系。方法:选取2020年7月至2021年7月吉林大学第二医院内分泌科收治的200例T2DM合并MAFLD患者。根据非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)纤维化评分(NAFLD fibrosis score,NFS)将患者分为可排除肝纤维化组(NFS<-1.455,n=71)、不确定肝纤维化组(NFS-1.455~0.676,n=91)和肝纤维化组(NFS>0.676,n=38)3个组。对3组患者的一般资料、血脂、谷氨酸-丙酮酸转氨酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、糖化血红蛋白(hemoglobin Alc,HbA1c)、空腹血清胰岛素(fasting insulin,FINS)、空腹血糖(fasting plasma glucose,FPG)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、NLR、PLR、白蛋白等指标进行分析。结果:相对于其他2组,肝纤维化组患者年龄更大,病程更长,ALT、PLR水平更高(均P<0.05),白蛋白水平更低(P<0.05);肝纤维化程度与年龄、病程、血清总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、ALT、PLR呈正相关(r=0.612、0.325、0.187、0.140、0.291、0.249,均P<0.05),与白蛋白水平呈负相关(r=-0.624,P<0.05);PLR、白蛋白水平是T2DM合并MAFLD患者肝纤维化的独立危险因素(均P<0.05)。结论:PLR与T2DM合并MAFLD患者肝纤维化密切相关,提示炎症与T2DM合并MAFLD患者肝纤维化进程相关。

Objective: To investigate the relationship between neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR) and liver fibrosis in patients with type 2 diabetes mellitus(T2DM) and metabolic dysfunctionassociated fatty liver disease(MAFLD). Methods: Two hundred patients with T2DM and MAFLD admitted to the Department of Endocrinology of the Second Hospital of Jilin University from July 2020 to July 2021 were selected. According to non-alcoholic fatty liver disease(NAFLD) fibrosis score(NFS), the patients were divided into three groups: the non-hepatic fibrosis group(NFS <-1.455, n=71), the uncertain liver fibrosis group(-1.455≤ NFS ≤0.676, n=91) and the liver fibrosis group(NFS >0.676, n=38). Patients’ general data, blood lipid, alanine aminotransferase(ALT), aspartate aminotransferase(AST), hemoglobin A1c(HbA1c), fasting insulin(FINS), fasting plasma glucose(FPG), homeostasis model assessment of insulin resistance(HOMA-IR), NLR, PLR, albumin and other indexes were collected and analyzed in this study. Results: Compared with the other two groups, the age, courses of disease, ALT and PLR of the liver fibrosis group were higher, but its albumin was lower(all P<0.05). The degree of liver fibrosis was positively correlated with age, course of disease, total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), ALT, and PLR(r=0.612, 0.325, 0.187, 0.140, 0.291, 0.249, all P<0.05), while negatively correlated with albumin(r=-0.624, P<0.05). PLR and albumin are independent risk factors for liver fibrosis in patients with T2DM and MAFLD(P<0.05). Conclusion: PLR has a close relationship with hepatic fibrosis in patients with T2DM and MAFLD, suggesting that inflammation is related to the process of hepatic fibrosis in patients with T2DM and MAFLD.