2型糖尿病合并非酒精性脂肪性肝病患者血清镍纹样蛋白水平及其预测价值

Serum Metrnl Level and Its Predictive Value in Patients with Type 2 Diabetes Mellitus Complicated with Non-alcoholic Fatty Liver Disease

目的观察2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者血清镍纹样蛋白(Meteorin-like protein,Metrnl)的水平。探讨血清Metrnl对T2DM患者发生NAFLD的预测价值。方法选取2022年1月~2023年6月就诊于徐州医科大学附属徐州市立医院(徐州市第一人民医院)的初诊T2DM患者共218例,根据是否合并NAFLD分为T2DM组(n=105)和T2DM合并NAFLD组(n=113),收集两组患者的一般资料、相关生化及代谢指标,采用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测两组患者的血清Metrnl水平。结果T2DM合并NAFLD组稳态模型胰岛素抵抗指数(homeostasis model assessment insulin resistance index,HOMA-IR)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、甘油三酯(triglyceride,TG)水平均高于T2DM组,高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、Metrn水平均低于T2DM组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,体重指数(body mass index,BMI)、TG为影响T2DM合并NAFLD的危险因素(OR>1,P<0.05),HDL-C、Metrnl为影响T2DM合并NAFLD的保护因素(OR<1,P<0.05)。Spearman相关性分析结果显示,初诊T2DM患者中Metrnl与TG、HbA1c、HOMA-IR、BMI呈负相关(r<0,P<0.05),与HDL-C呈正相关(r>0,P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,BMI、TG、HDL-C、Metrnl预测T2DM合并NAFLD的曲线下面积(area under the curve,AUC)分别为0.719、0.701、0.736、0.771。Metrnl对应的AUC最大。结论初诊T2DM合并NAFLD患者较单纯T2DM患者血清Metrnl水平降低,血清Metrnl水平对初诊T2DM患者是否合并NAFLD有良好的预测效能。

Objective To observe the level of serum Meteorin-like protein(Metrnl)in patients with type 2diabetes mellitus(T2DM)complicated with non-alcoholic fatty liver disease(NAFLD).To explore the predictive value of serum Metrnl for the occurrence of NAFLD in T2DM patients.Methods From January 2022 to June 2023,218 patients with T2DM were initially diagnosed in the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University(Xuzhou First People′s Hospital).According to whether NAFLD was combined,they were divided into T2DM group(n=105)and T2DM combined with NAFLD group(n=113).The general information,related biochemical and metabolic indicators of the two groups of patients were collected,and the serum Metrnl levels of the two groups were detected by enzyme-linked immunosorbent assay(ELISA).Results Homeostasis model assessment insulin resistance index(HOMA-IR),glycosylated hemoglobin(HbA1c)and triglyceride(TG)in T2DM combined with NAFLD group were higher than those in T2DM group,while high-density lipoprotein cholesterol(HDL-C)and Metrnl were lower than those in T2DM group,and the differences were statistically significant(P<0.05).Logistic regression results showed that body mass index(BMI)and TG were risk factors for T2DM with NAFLD(OR>1,P<0.05),HDL-C and Metrnl were protective factors for T2DM with NAFLD(OR<1,P<0.05).Spearman correlation analysis showed that Metrnl was negatively correlated with TG,HbA1c,HOMA-IR and BMI in initially diagnosed T2DM patients(r<0,P<0.05),and positively correlated with HDL-C(r>0,P<0.05).Receiver operating characteristic(ROC)curve analysis show that,the area under the curve(AUC)of BMI,TG,HDL-C and Metrnl predicting T2DM combined with NAFLD was 0.719,0.701,0.736 and 0.771.The AUC of Metrnl was largest.Conclusion The serum Metrnl levels in initially diagnosed T2DM combined with NAFLD patients are lower than those in simple T2DM patients,and serum Metrnl levels has good predictive power for the presence of NAFLD in initially diagnosed T2DM patients.