2型糖尿病合并非酒精性脂肪性肝病患者NLR和PLR变化及其临床意义探讨

Prediction of NAFLD in patients with type 2 diabetes mellitus by NLR and PLR:A preliminary study

目的研究应用中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)评估2型糖尿病(T2DM)患者合并非酒精性脂肪性肝病(NAFLD)的效能。方法2021年1月~2022年10月安徽省第二人民医院内分泌科收治的T2DM患者110例和T2DM合并NAFLD患者121例,使用超声检查诊断脂肪肝,应用二元Logistic回归分析影响T2DM合并NAFLD的危险因素,应用受试者工作特征曲线(ROC)预测NLR和PLR评估T2DM合并NAFLD的效能。结果T2DM合并NAFLD组体质指数(BMI)为(25.4±3.5)kg/m^(2),显著大于T2DM组【(23.2±3.1)kg/m^(2),P<0.05】,而病程为5.0(2.0,8.0)年,显著短于T2DM组【8.0(3.0,13.0)年,P<0.05】;T2DM合并NAFLD组血清ALT、AST、GGT、UA、TG和TC水平均显著大于T2DM组,而血清HDL-C水平则显著低于T2DM组,差异有统计学意义(P<0.05);T2DM合并NAFLD组外周血淋巴细胞计数为(1.7±0.4)×10^(9)/L,显著低于T2DM组【(2.2±0.6)×10^(9)/L,P<0.05】,而NLR和PLR分别为(2.4(1.8,3.2))和(126.1(93.3,157.8)),均显著大于T2DM组【分别为1.5(1.2,2.3)和89.6(66.9,116.5),P<0.05】;采用二元Logistic回归分析,结果显示BMI、NLR和PLR是2型糖尿病合并NAFLD的危险因素(P<0.05);经ROC曲线分析,结果显示NLR和PLR预测T2DM合并NAFLD的灵敏度和特异度分别为64.5%和75.0%,和71.9%和65.4%。结论应用简单的血液学指标NLR和PLR可以帮助初步筛选T2DM患者是否合并NAFLD,值得进一步研究。

Objective The study was conducted to assess the prediction of non-alcoholic fatty liver diseases(NAFLD)in patients with type 2 diabetes mellitus(T2DM)by neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR).Methods 110 patients with T2DM and 121 patients with T2DM and NAFLD were included in the Department of Endocrinology,Second Provincial People's Hospital between January 2021 and October 2022,and the NAFLD was proven by ultrasonography.The blood routine was checked-up.The risk factors of T2DM with NAFLD were assessed by multivariate Logistic analysis,and predictive efficacy was evaluated by ROC curve.Results The body mass index in patients with T2DM and concomitant NAFLD was(25.4±3.5)kg/m^(2),much greater than[(23.2±3.1)kg/m^(2),P<0.05],while the course of disease was 5.0(2.0,8.0)yr,significantly shorter than[8.0(3.0,13.0)yr,P<0.05]in patients with T2DM;serum alanine aminotransferase,aspartate aminotransferase,glutamyl transpeptidase,uric acid,triglyceride and total cholesterol levels in patients with T2DM and NAFLD were all significantly greater than in patients with T2DM,while serum high density lipoprotein cholesterol level was much lower than in patients with T2DM(P<0.05);the blood lymphocyte count in patients with T2DM and NAFLD was(1.7±0.4)×10^(9)/L,much lower than[(2.2±0.6)×10^(9)/L,P<0.05],while the NLR and PLR were(2.4(1.8,3.2))and(126.1(93.3,157.8)),both significantly greater than[1.5(1.2,2.3)and 89.6(66.9,116.5),respectively,P<0.05]in patients with T2DM;the Logistic analysis showed that the BMI,NLR and PLR were the risk factors for coincidence of NAFLD in patients with T2DM(P<0.05);the ROC analysis demonstrated that the sensitivities and the specificities by NLR and PLR in prediction of NAFLD in patients with T2DM were 64.5%and 75.0%,and 71.9%and 65.4%,respectively.Conclusion The surveillance of NLR and PLR,easily accessible,in patients with T2DM might help screen preliminarily NAFLD,and warrants further clinical investigation.