2型糖尿病合并非酒精性脂肪肝患者血清non-HDL、RBP、RBP-4及脂联素水平观察

Observation on serum levels of non-HDL,RBP,RBP-4 and adiponectin in patients with type 2 diabetes mellitus and nonalcoholic fatty liver

目的观察2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者的血清非高密度脂蛋白(non-HDL)、视黄醇结合蛋白(RBP)、视黄醇结合蛋白4(RBP-4)以及脂联素水平。方法回顾性分析2020年3月至2022年3月在青岛市城阳区人民医院接受治疗的104例T2DM患者的临床资料。依据腹部B超结果分为T2DM合并NAFLD组,与T2DM组。比较两组基线资料以及实验室指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、non-HDL、RBP、RBP-4、脂联素]。通过ROC分析ALT、non-HDL、RBP、RBP-4及脂联素水平预测T2DM合并NAFLD的价值。采用多因素Logistic回归分析T2DM合并NAFLD的危险因素。结果104例T2DM患者中,检出脂肪肝患者50例,检出率48.08%,依据检出情况进行分组T2DM合并NAFLD组50例,T2DM组54例。两组性别、年龄、病程、收缩压、SDP、AST、GGT水平比较,差异均无统计学意义(P>0.05);T2DM合并NAFLD组体重指数>28 kg/m^(2)、内脏型肥胖、高血脂、高血压、冠心病人数占比显著高于T2DM组,ALT、non-HDL、RBP、RBP-4水平均高于T2DM组,脂联素低于T2DM组,差异均有统计学意义(P<0.05)。经ROC分析证实ALT、non-HDL、RBP、RBP-4及脂联素水平均可用于预测T2DM合并NAFLD,曲线下面积分别为0.701、0.899、0.636、0.679、0.775,预测价值较好(P<0.05);经多因素Logistic回归分析证实,体重指数>28 kg/m^(2)、内脏型肥胖、高血脂、高血压、冠心病、ALT≥26.930 U/L、non-HDL≥3.865 mmol/L、RBP≥35.600 mg/L、RBP-4≥30.090 mg/L、脂联素≤9.955 mg/L均为T2DM合并NAFLD的危险因素,预测价值较好(P<0.05)。结论T2DM合并NAFLD的危险因素较多,若non-HDL≥3.865 mmol/L、RBP≥35.600 mg/L、RBP-4≥30.090 mg/L、脂联素≤9.955 mg/L时可用于T2DM合并NAFLD的预测中,临床医师应对此类患者进行重点监测。

Objective To observe the serum levels of non high density lipoprotein(non-HDL),retinol binding protein(RBP),retinol binding protein 4(RBP-4)and adiponectin in patients with type 2 diabetes mellitus(T2DM)and nonalcoholic fatty liver disease(NAFLD).Methods The clinical data of 104 patients with T2DM who were treated in Qingdao Chengyang District People's Hospital from March 2020 to March 2022 were analyzed retrospectively.The patients were divided into T2DM combined with NAFLD group and T2DM group according to the results of abdominal B-ultrasound.The baseline data,obesity type,systolic blood pressure,diastolic blood pressure and laboratory indicators [alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyltransferase(GGT),non-HDL,RBP,RBP-4,adiponectin]were compared.The ROC analysis of ALT,non-HDL,RBP,RBP-4 and adiponectin levels predicted the value of T2DM combined with NAFLD.Multivariate Logistic regression was used to analyze the risk factors of T2DM combined with NAFLD.Results Among 104 T2DM patients,50 patients with fatty liver were detected,with a detection rate of 48.08%.According to the detection,50 patients in T2DM combined with NAFLD group and 54 patients in T2DM group were divided into two groups;There was no significant difference in sex,age,course of disease,systolic blood pressure,diastolic blood pressure,AST and GGT between the two groups(P>0.05);the proportion of body mass index>28 kg/m^(2),visceral obesity,hyperlipidemia,hypertension and coronary heart disease in T2DM combined with NAFLD group was significantly higher than that in T2DM group,the levels of ALT,non-HDL,RBP and RBP-4 in T2DM group with NAFLD were higher than those in T2DM group,while adiponectin was lower than those in T2DM group(P<0.05);ROC analysis confirmed that ALT,non-HDL,RBP,RBP-4 and adiponectin levels can be used to predict T2DM combined with NAFLD,and the area under the curve is 0.701,0.899,0.636,0.679 and 0.775,respectively,good predictive value(P<0.05);Multivariate Logistic regression analysis confirmed that body mass index>28 kg/m^(2),visceral obesity,hyperlipidemia,hypertension,coronary heart disease,ALT≥26.930 U/L,non-HDL≥3.865 mmol/L,RBP≥35.600 mg/L,RBP-4≥30.090 mg/L,adiponectin≤9.955 mg/L were all risk factors for T2DM with NAFLD,all of which were P<0.05.Conclusion There are many risk factors for T2DM combined with NAFLD,such as obesity,combined with underlying diseases,serum levels of non-HDL,RBP,RBP-4 and adiponectin.If non-HDL≥3.865 mmol/L,RBP≥35.600 mg/L,RBP-4≥30.090 mg/L,and adiponectin≤9.955 mg/L,it can be used in the prediction of T2DM combined with NAFLD,and clinicians should focus on monitoring such patients.