外周血CysC及OPG在2型糖尿病合并非酒精性脂肪性肝病患者中的表达及其临床意义

Expression and clinical significance of peripheral blood CysC and OPG in patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease

目的:探讨分析外周血血胱抑素C(CysC)及骨保护素(OPG)在2型糖尿病合并非酒精性脂肪性肝病患者中的表达及其临床意义。方法:选取128例2型糖尿病患者作为研究对象,根据肝脏超声检查结果,将合并非酒精性脂肪性肝病的57例患者作为观察组,将无合并非酒精性脂肪性肝病的71例单纯2性糖尿病患者作为对照组。检测其外周血CysC、OPG水平,比较不同患者外周血中CysC及OPG表达情况,分析其水平表达与2型糖尿病合并非酒精性脂肪性肝病的关系。结果:两组性别、年龄、吸烟等项目无差异(P>0.05),而2型糖尿病合并非酒精性脂肪性肝病组患者BMI、病程、饮酒、HOMA-IR显著高于单纯性2型糖尿病患者(P<0.05);2组患者HbA1c、FBG、FBG2h水平无差异(P>0.05);观察组患者TC、TG、HDL-C、LDL-C、HOMA-IR、CysC高于对照组,外周血OPG水平低于对照组(P<0.05);以外周血CysC和OPG水平表达为自变量,是否合并NAFLD为因变量,绘制ROC曲线,结果显示外周血CysC截断值为0.90 mg/L时,评估2型糖尿病合并非酒精性脂肪性肝病的ROC曲线下面积0.72(95%CI:1.435~3.269),此时的敏感度和特异度分别为75.34%和71.52%;外周血OPG截断值为320 ng/L时评估2型糖尿病合并非酒精性脂肪性肝病的ROC曲线下面积0.70(95%CI:1.248~2.537),此时的敏感度和特异度分别为72.48%和70.63%。对2型糖尿病合并非酒精性脂肪性肝病的相关因素进行多因素Logisyic回归分析,结果显示BMI(OR=5.202,95%CI:1.726~15.681)、病程(OR=25.739,95%CI:1.253~528.647)、TG(OR=6.328,95%CI:1.251~32.006)、HOMA-IR(OR=8.662,95%CI:1.142~65.736)、外周血CysC(OR=5.094,95%CI:1.216~21.344)、外周血OPG(OR=4.651,95%CI:1.278~16.922)是2型糖尿病合并非酒精性脂肪性肝病的独立危险因素(OR>1,P<0.05)。结论:2型糖尿病合并非酒精性脂肪性肝病患者外周血CysC、OPG呈较低表达,外周血CysC、OPG是2型糖尿病合并非酒精性脂肪性肝病的独立危险因素,外周血CysC高表达、OPG低表达2型糖尿病患者合并非酒精性脂肪性肝病患病风险增加。

Objective:To investigate the expression and clinical significance of peripheral blood cystatin C and osteoprotegerin in patients with type two diabetes mellitus complicated with nonalcoholic fatty liver disease.Methods:A total of 128 patients with type two diabetes who were treated in our hospital from July 2019 to July 2020 was selected as the research subjects. According to the results of liver ultrasonography, 57 patients with nonalcoholic fatty liver disease were selected as the observation group. Seventy-one patients with simple type two diabetes mellitus with nonalcoholic fatty liver disease served as the control group. The levels of CysC and OPG in peripheral blood were detected,and the expressions of CysC and OPG in peripheral blood of different patients were compared, and the relationship between their expression and type two diabetes mellitus complicated with nonalcoholic fatty liver disease was analyzed.Results:There were no differences in gender,age, smoking and other items between the two groups(P> 0. 05), while the BMI, course of disease, alcohol consumption, and HOMA-IR in patients with type two diabetes Mellitus combined with nonalcoholic fatty liver disease were significantly higher than those in patients with simple type two diabetes mellitus(P< 0. 05). There was no difference in the levels of HbA1c, FBG, and FBG2h between the two groups(P>0. 05). While the TC, TG, HDL-C, LDL-C, HOMA-IR, and CysC in the observation group were higher than those in the control group,while the observation group. The level of OPG in peripheral blood was lower than that in the control group(P< 0. 05). With the expression of CysC and OPG levels in peripheral blood as independent variables, and whether NAFLD was combined as the dependent variable, the ROC curve was drawn. The results showed that the cut-off value of CysC in peripheral blood was 0. 90 mg/L. The area under the ROC curve for evaluating type two diabetes mellitus complicated with nonalcoholic fatty liver disease was 0. 72(95%CI: 1. 435 ~ 3. 269), and the sensitivity and specificity at this time were 75. 34% and 71. 52%, respectively. The cut-off value of peripheral blood OPG At 320 ng/L, the area under the ROC curve for evaluating type two diabetes mellitus complicated with nonalcoholic fatty liver disease was 0. 70(95%CI: 1. 248 ~2. 537), and the sensitivity and specificity were 72. 48% and 70. 63%, respectively. Multivariate Logisyic regression analysis was performed on the related factors of type two diabetes mellitus complicated with nonalcoholic fatty liver disease. Results show that the BMI(OR= 25. 739,95%CI:1. 253 ~ 528. 647), TG(OR= 6. 328,95%CI: 1. 251 ~ 32. 006), HOMA-IR(OR= 8. 662,95%CI: 1. 142 ~ 65. 736),peripheral blood CysC(OR= 5. 094, 95%CI: 1. 216 ~ 21. 344) and peripheral blood OPG(OR= 4. 651,95%CI: 1. 278 ~ 16. 922) were independent risk factors for type two diabetes mellitus complicated with non-alcoholic fatty liver disease(OR> 1,P< 0. 05).Conclusion:The expression of CysC and OPG in peripheral blood of patients with type two diabetes and non-alcoholic fatty liver disease is low. CysC and OPG in peripheral blood are independent risk factors for type two diabetes and non-alcoholic fatty liver disease. Expression of type two diabetes mellitus patients with the nonalcoholic fatty liver disease increased risk.