2型糖尿病患者合并非酒精性脂肪性肝病的影响因素分析

Influencing factors for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者的相关影响因素。方法选取2021年5月—2022年3月上海市宝山区中西医结合医院中纳入国家标准化代谢性疾病管理中心的252例T2DM患者,根据患者的脂肪肝情况,分为单纯T2DM组(n=105)和T2DM合并NAFLD组(n=147)。分析患者一般资料,包括性别、年龄、血压、身高、体质量、颈围、甘油三酯(TG)、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇、空腹血糖、糖化血红蛋白、超敏C反应蛋白、晨尿白蛋白/肌酐、促甲状腺激素、尿酸、肝内脂肪沉积情况、颈动脉内膜中层厚度以及踝臂脉搏波等。正态分布的计量资料两组间比较采用成组t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验。多因素Logistic回归分析T2DM合并NAFLD的相关危险因素,应用受试者工作特征曲线(ROC曲线)评估相关影响因素的预测价值。结果按年龄分层统计分析发现,<50岁T2DM合并NAFLD患者的BMI、内脏脂肪、TG、肱踝脉搏波传导速度、晨尿白蛋白/肌酐、尿酸水平均显著高于单纯T2DM患者(P值均<0.05),血清HDL-C水平显著低于单纯T2DM患者(P<0.05);≥50岁T2DM合并NAFLD患者的血压、BMI、内脏脂肪、TG、肱踝脉搏波传导速度、晨尿白蛋白/肌酐、尿酸水平显著高于单纯T2DM患者(P值均<0.05),血清HDL-C水平显著低于单纯T2DM患者(P<0.05)。多因素Logistic回归分析结果显示,BMI(OR=1.408,95%CI:1.136~1.746,P=0.002)、HDL-C(OR=0.031,95%CI:0.001~0.647,P=0.025)、左肱踝脉搏波传导速度(OR=1.003,95%CI:1.001~1.006,P=0.003)、尿酸(OR=1.011,95%CI:1.005~1.016,P<0.001)是T2DM合并NAFLD的独立影响因素。ROC曲线结果显示,HDL-C、BMI、左肱踝脉搏波传导速度、尿酸评估T2DM合并NAFLD的曲线下面积分别为0.695(95%CI:0.574~0.812)、0.708(95%CI:0.628~0.788)、0.611(95%CI:0.523~0.698)、0.698(95%CI:0.617~0.779)。结论低水平HDL-C、BMI、左肱踝脉搏波传导速度及尿酸对T2DM患者NAFLD发生具有预测价值。

Objective To investigate related influencing factors in patients with type 2 diabetes mellitus(T2DM)and nonalcoholic fatty liver disease(NAFLD).Methods A total of 252 patients with T2DM who were treated in Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine from May 2021 to March 2022 were enrolled as subjects,and these patients were also included in Metabolic Management Center of China.According to the presence or absence of fatty liver disease,the patients were divided into simple T2DM group(n=105)and T2DM+NAFLD group(n=147).Related general data were analyzed,including sex,age,blood pressure,body height,body weight,neck circumference,triglyceride(TG),total cholesterol,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol,fasting blood glucose,glycosylated hemoglobin,high-sensitivity C-reactive protein,albumin/creatinine ratio in morning urine,thyroid stimulating hormone,uric acid,intrahepatic fat deposition,carotid intima-media thickness,and brachial-ankle pulse wave velocity.The group t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between groups.A multivariate logistic regression analysis was used to investigate the risk factors for T2DM with NAFLD,and the receiveroperating characteristic(ROC)curve was used to assess the predictive value of related influencing factors.Results The age-stratified analysis showed that in the<50 years age group,compared with the patients with T2DM alone,the patients with T2DM and NAFLD had significantly higher levels of body mass index(BMI),visceral fat,TG,brachial-ankle pulse wave velocity,albumin/creatinine ratio in morning urine,and uric acid(P<0.05);in the≥50 years age group,compared with the patients with T2DM alone,the patients with T2DM and NAFLD had significantly higher levels of blood pressure,BMI,visceral fat,TG,brachial-ankle pulse wave velocity,albumin/creatinine ratio in morning urine,and uric acid(P<0.05)and a significantly lower level of serum HDL-C(P<0.05).The multivariate logistic regression analysis showed that BMI(odds ratio[OR]=1.408,95%confidence interval[CI]:1.136-1.746,P=0.002),HDL-C(OR=0.031,95%CI:0.001-0.647,P=0.025),left brachial-ankle pulse wave velocity(OR=1.003,95%CI:1.001-1.006,P=0.003),and uric acid(OR=1.011,95%CI:1.005-1.016,P<0.001)were independent influencing factors for T2DM with NAFLD.The ROC curve analysis showed that HDL-C,BMI,left brachial-ankle pulse wave velocity,and uric acid had an area under the ROC curve of 0.695(95%CI:0.574-0.812),0.708(95%CI:0.628-0.788),0.611(95%CI:0.523-0.698),and 0.698(95%CI:0.617-0.779),respectively,in evaluating T2DM with NAFLD.Conclusion Low levels of HDL-C,BMI,left brachial-ankle pulse wave velocity,and uric acid have a certain value in predicting NAFLD in patients with T2DM.