代谢相关脂肪性肝病伴2型糖尿病患者内脏脂肪与肝纤维化的关系

Between visceral fat and liver fibrosis in patients with metabolic associated fatty liver disease and type 2 diabetes mellitus

目的探讨代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)伴2型糖尿病(type 2 diabetes mellitus,T2DM)患者内脏脂肪(visceral fat,VFA)与肝纤维化的关系。方法纳入T2DM患者418例,依据腹部超声分为T2DM组(n=136),T2DM+MAFLD组(n=282),依据肝纤维化评分(non-alcoholic fatty liver disease fibrosis score,NFS)将T2DM+MAFLD组分为肝纤维化低危组(n=94)、中危组(n=154)、高危组(n=34),测定上述患者VFA及相关血清学指标。结果与T2DM组相比,T2DM+MAFLD组患者体重指数(body mass index,BMI)、腰围(waist circumference,WC)、腹围(hip circumference,HC)、VFA、皮下脂肪(subcutaneous fat area,SFA)、三酰甘油(triglyceride,TG)、丙氨酸转氨酶(alanine transaminase,ALT)、白蛋白(albumin,Alb)显著升高,而病程、高密度脂蛋白胆固醇(high density lipoprotein cholesferol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)显著降低;T2DM+MAFLD各亚组血小板(platelet,PLT)比较:高危组>中危组>低危组,肝纤维化高危组BMI、VFA显著升高,TC、LDL-C、ALT显著降低,差异有统计学意义(P<0.05);T2DM+MAFLD患者VFA及SFA与体重(weight,W)、BMI、白细胞(white blood cell,WBC)、ALT、AST呈正相关,与病程、HDL-C呈负相关;Logistic回归显示,BMI、VFA、PLT、ALT、Alb是T2DM+MAFLD患者发生肝纤维化的影响因素。结论T2DM合并MAFLD患者肝纤维化风险与BMI、VFA、PLT、ALT、Alb具有相关性。

Objective To explore the relationship between visceral fat area(VFA)and liver fibrosis in patients with metabolic associated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM).Methods In total,418 patients with T2DM were included,and divided into T2DM group(n=136)and T2DM+MAFLD group(n=282)based on abdominal ultrasound.According to non-alcoholic fatty liver disease fibrosis score(NFS),T2DM-MAFLD group was subdivided into low-risk subgroup(n=94),moderate-risk subgroup(n=154),and high-risk subgroup(n=34).VFA and related serological indexes of those patients were determined.Results Compared with the T2DM group,patients in the T2DM+MAFLD group had significantly increased body mass index(BMI),waist circumference(WC),hip circumference(HC),VFA,subcutaneous fat area(SFA),triglyceride(TG),alanine transaminase(ALT),and albumin(Alb)but significantly shorter course of disease and significantly reduced high density lipoprotein cholesferol(HDL-C),and low-density lipoprotein cholesterol(LDL-C).Comparison of platelet(PLT)in T2DM+MAFLD subgroups showed the highest PLT in high-risk subgroup,followed by moderate-risk subgroup and low-risk subgroup;high-risk subgroup had significantly increased BMI and VFA,and significantly decreased TC,LDL-C and ALT,suggesting a significant difference(P<0.05).VFA and SFA in T2DM+MAFLD groups were positively correlated with weight(W),BMI,white blood cell(WBC),ALT and AST,and negatively correlated with the course of disease and HDL-C.Logistic analysis showed that BMI,VFA,PLT,ALT,and Alb were the influencing factors for developing liver fibrosis in patients with T2DM+MAFLD.Conclusion The findings of this study show that the risk of liver fibrosis in patients with T2DM and MAFLD is associated with BMI,VFA,PLT,ALT,and Alb.