预估葡萄糖处理率与2型糖尿病合并代谢相关脂肪性肝病的相关性研究

Correlation between Estimated Glucose Disposal Rate and Metabolism-associated Fatty Liver Disease in Type 2 Diabetes

背景代谢相关脂肪性肝病(MAFLD)是近年来引起肝脏疾病发病率和死亡率升高的主要原因,2型糖尿病(T2DM)是MAFLD进展的驱动因素。预估葡糖糖处理率(eGDR)是T2DM患者胰岛素抵抗的简易评估指标,但与MAFLD的关系研究较少。目的e GDR与T2DM合并MAFLD的关系及其预测价值。方法选取2019年于河北省人民医院住院治疗的1434例T2DM患者为研究对象。收集患者基本信息,采集患者肘静脉血进行实验室检查,采用腹部超声检查患者肝脏情况。根据腹部超声检查结果,将T2DM患者分为合并MAFLD组(n=734)和未合并MAFLD组(n=700)。根据eGDR三分位数将研究对象分为T1组(eGDR≤5.09,n=477)、T2组(5.097.11,n=479)。采用Spearman秩相关分析探讨eGDR与研究对象基线资料的相关性。采用单因素及多因素Logistic回归分析探究合并MAFLD的影响因素。评价e GDR与性别、年龄、高血压、糖化血红蛋白(HbA1c)、BMI、谷氨酰转移酶(GGT)的相乘交互作用。绘制受试者工作特征曲线(ROC)评估联合预测模型、FBG、HbA1c对T2DM合并MAFLD预测价值,计算ROC曲线下面积(AUC)并采用Delong检验进行比较。结果合并MAFLD组患者年龄、病程、HDL-C、eGDR低于未合并MAFLD组,BMI、饮酒、高血压及吸烟比例、空腹血糖(FBG)、尿酸(UA)、总胆固醇(TC)、TG、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、GGT、ALB水平高于未合并MAFLD组患者(P<0.05)。T3组高血压比例、年龄、BMI、FBG、HbA1c、血清肌酐(Scr)、TG低于T1、T2组,GGT水平低于T1组,HDL-C、ALB高于T1、T2组(P<0.05);T2组高血压比例、BMI、FBG、HbA1c、TG低于T1组(P<0.05)。合并MAFLD组e GDR与年龄、FBG、ALB水平呈负相关(P<0.05);未合并MAFLD组eGDR与年龄、病程、FBG、Scr、TG、ALB呈负相关(P<0.05),与HDL-C、AST、GGT呈正相关(P<0.05)。多因素Logistic回归分析结果显示e GDR[OR=0.814,95%CI(0.772,0.858),P<0.001]、T1组[OR=1.310,95%CI(1.003,1.712),P=0.048]、T2组[OR=2.554,95%CI(1.941,3.359),P<0.001]是T2DM合并MAFLD的影响因素(P<0.05)。BMI(P交互<0.001)、GGT(P交互=0.033)、高血压(P交互<0.001)与eGDR存在交互作用。联合预测模型预测T2DM合并MAFLD的AUC为0.743,大于FBG(Z=3.227,P=0.001)、HbA1c(Z=1.877,P=0.061)。结论合并MAFLD的T2DM患者e GDR低于未合并MAFLD患者。eGDR是T2DM合并MAFLD的危险因素。eGDR联合预测模型可以作为评估T2DM合并MAFLD发生风险的预测指标。

Background Metabolism-associated fatty liver disease(MAFLD)is considered as a major cause of increased morbidity and mortality from liver disease,type 2 diabetes mellitus(T2DM)is a driving factor in the progression of MAFLD.Estimated glucose processing rate(eGDR)is a simple evaluation indicator of insulin resistance in patients with T2DM,while its relationship with MAFLD has been rarely studied.Objective To investigate the correlation between eGDR and MAFLD in type 2 Diabetes and its predictive value.Methods A total of 1434 patients with T2DM who were hospitalized in Hebei Provincial People's Hospital from 2019-01-01 to 2019-12-31 were selected as the study subjects.baseline data of the patients was collected,with their venous blood from the elbow collected for laboratory examination,and liver condition examined by abdominal ultrasound.According to the results of abdominal ultrasonography,T2DM patients were divided into MAFLD group(n=734)and non-MAFLD group(n=700).The subjects were divided into T1 group(eGDR≤5.09,n=477),T2 group(5.09<eGDR≤7.11,n=478)and T3 group(eGDR>7.11,n=479)according to the eGDR tertiles.Spearman rank correlation analysis was used to explore the correlation between eGDR and baseline data.Univariate and multivariate Logistic regression analysis was used to explore the influencing factors of combined MAFLD.The multiplicative interactions of eGDR with gender,age,hypertension,glycated hemoglobin A1c(HbA1c),BMI and glutamyl transferase(GGT)were evaluated.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of combined prediction model,FBG and HbA1c for MAFLD in T2DM and areas under curve(AUC)were calculated and compared by Delong test.Results Age,disease course,HDL-C and eGDR of MAFLD group were lower than non-MAFLD group.BMI,alcohol consumption,proportions of hypertension and smoking,fasting blood glucose(FBG),uric acid(UA),total cholesterol(TC),TG,low density lipoprotein cholesterol(LDL-C),alanine aminotransferase(ALT),aspartate aminotransferase(AST),GGT and ALB were higher than non-MAFLD group(P<0.05).The proportion of hypertension,age,BMI,FBG,HbA1c,Scr and TG in T3 group were lower than those in T1 and T2 groups,GGT was lower than that in T1 group,HDL-C and ALB were higher than those in T1 and T2 groups,the proportion of hypertension,BMI,FBG,HbA1c and TG in T2 group were lower than those in T1 group(P<0.05).eGDR was negatively correlated with age,FBG and ALB in patients with MAFLD(P<0.05).In patients without MAFLD,eGDR was negatively correlated with age,disease course,FBG,Scr,TG and ALB(P<0.05),and positively correlated with HDL-C,AST and GGT(P<0.05).Multivariate Logistic regression analysis showed that eGDR〔OR=0.814,95%CI(0.772,0.858),P<0.001〕,T1 group〔OR=1.310,95%CI(1.003,1.712),P=0.048〕and T2 group〔OR=2.554,95%CI(1.941,3.359),P<0.001〕was an influencing factor of T2DM with MAFLD(P<0.05).BMI(Pinteraction<0.001),GGT(Pinteraction=0.033),hypertension(Pinteraction<0.001)had interaction with eGDR.The AUC of the combined prediction model was 0.743,which was greater than FBG(Z=3.227,P=0.001)and HbA1c(Z=1.877,P=0.061).Conclusion The level of eGDR in T2DM patients with MAFLD is significantly lower than that in patients without MAFLD,and patients with low eGDR level have a higher risk of MAFLD.eGDR is a risk factor for MAFLD with T2MD.The combined prediction model of eGDR can be used as a predictor to evaluate the risk of MAFLD with T2MD.