身体测量指标及代谢指标对2型糖尿病患者合并非酒精性脂肪肝的诊断价值分析

Analysis of the diagnostic values of body measurement indexes and metabolic indexes for non-alcoholic fatty liver disease in type 2 diabetic patients

目的分析体质量指数(BMI)、三酰甘油(TG)、γ-谷氨酰转肽酶(GGT)及胰岛素抵抗(IR)对2型糖尿病患者合并非酒精性脂肪肝(NAFLD)的诊断价值。方法回顾性分析2017年1月至2019年12月榆林市第一医院内分泌科收治的191例2型糖尿病患者临床资料。其中男132例,年龄(49.41±12.29)岁,病程(6.63±5.77)年;女59例,年龄(54.81±11.52)岁,病程(6.74±6.31)年。以超声诊断NAFLD为诊断标准,根据纳入研究人群是否合并NAFLD分为NAFLD组和对照组。绘制受试者工作特征曲线(ROC),分析不同代谢指标TG、GGT、IR及BMI对NAFLD的诊断价值。采用独立样本t检验、χ^(2)检验、logistic回归模型。结果共纳入NAFLD组93例,对照组98例。2型糖尿病患者中NAFLD患病率48.69%(93/191),其中男性患病率48.48%(64/132),女性患病率49.15%(29/59)。NAFLD组TG[(2.49±1.57)mmol/L]、GGT[(41.34±31.93)mmol/L]、IR[(4.01±2.65)mU/L]及BMI[(27.05±4.41)kg/m^(2)]均高于对照组[(1.75±1.10)mmol/L、(27.82±21.41)mmol/L、(2.74±2.82)mU/L、(24.26±3.51)kg/m^(2)],高密度脂蛋白胆固醇(HDL-C)[(0.95±0.22)mmol/L]低于对照组[(1.07±0.30)mmol/L],差异均有统计学意义(均P<0.05)。BMI≥24.45 kg/m^(2)诊断NAFLD的灵敏度和特异度分别为81.72%、59.38%;TG≥1.47 mmol/L诊断NAFLD的灵敏度和特异度分别为82.80%、51.02%;logistic回归模型分析显示BMI、TG是2型糖尿病患者合并NAFLD的独立危险因素(均P<0.05)。结论临床工作中,对于门诊就诊的2型糖尿病患者,若BMI≥24.45 kg/m^(2)和/或TG≥1.47 mmol/L时,应关注患者有无IR及GGT升高,并及时行影像学检查评估NAFLD。

Objective To analyze the diagnostic values of body mass index(BMI),triglyceride(TG),γ-glutamyl transpeptidase(GGT),and insulin resistance(IR)for non-alcoholic fatty liver disease(NAFLD)in type 2 diabetic patients.Methods The clinical data of 191 patients with type 2 diabetes who were admitted to Department of Endocrinology,The First Hospital of Yulin were collected from January 2017 to December 2019.Among them,there were 132 males,with an age of(49.41±12.29)years old and a course of disease of(6.63±5.77)years,and 59 females,with an age of(54.81±11.52)years old and a course of disease of(6.74±6.31)years.The ultrasound diagnosis of NAFLD was used as the diagnostic criteria.The patients were divided into a NAFLD group and a control group according to whether the patients were accompanied by NAFLD or not.The receiver operating characteristic curve(ROC)was drawn to analyze the diagnostic values of different metabolic indexes including TG,GGT,IR,and BMI for NAFLD.Independent sample t test,χ^(2) test,and logistic regression model were used.Results A total of 93 patients in the NAFLD group and 98 patients in the control group were included.The prevalence of NAFLD in patients with type 2 diabetes was 48.69%(93/191),which was 48.48%(64/132)in males and 49.15%(29/59)in females respectively.The levels of TG[(2.49±1.57)mmol/L],GGT[(41.34±31.93)mmol/L],IR[(4.01±2.65)mU/L],and BMI[(27.05±4.41)kg/m^(2)]in the NAFLD group were higher than those in the control group[(1.75±1.10)mmol/L,(27.82±21.41)mmol/L,(2.74±2.82)mU/L,and(24.26±3.51)kg/m^(2)],and the level of high density lipoprotein cholesterol(HDL-C)[(0.95±0.22)mmol/L]was lower than that in the control group[(1.07±0.30)mmol/L],with statistically significant differences(all P<0.05).The sensitivity and specificity of BMI≥24.45 kg/m^(2) in the diagnosis of NAFLD were 81.72%and 59.38%,respectively.The sensitivity and specificity of TG≥1.47 mmol/L in the diagnosis of NAFLD were 82.80%and 51.02%,respectively.Logistic regression model analysis showed that BMI and TG were independent risk factors for NAFLD in type 2 diabetic patients(both P<0.05).Conclusion In clinical practice,when BMI≥24.45 kg/m^(2) and/or TG≥1.47 mmol/L are seen in patients with type 2 diabetes,physicians should pay attention to patients who maybe have IR and elevated GGT,and perform imaging to assess NAFLD timely.