老年2型糖尿病合并非酒精性脂肪肝患者血清vWF、sST2水平与胰岛素抵抗及肝功能的相关性分析

Correlation of Serum vWF and sST2 Level with Insulin Resistance and Liver Function in Elderly Patients with Type 2 Diabetes Mellitus Complicated with Nonalcoholic Fatty Liver Disease

目的探究老年2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者血清血管性血友病因子(vWF)、可溶性生长刺激因子2(sST2)水平与胰岛素抵抗及肝功能的相关性。方法选取2020年4月至2022年4月我院收治的116例确诊为老年T2DM合并NAFLD患者为患病组,根据肝功能等级,将其分为A级组(41例)、B级组(39例)和C级组(36例);根据是否存在胰岛素抵抗,将其分为抵抗组(42例)和非抵抗组(74例)。选取我院同期收治的单纯T2DM患者116例作为对照组。比较各组血清vWF、sST2水平;多因素Logistic回归分析老年T2DM合并NAFLD的影响因素;受试者工作特征(ROC)曲线分析血清vWF、sST2水平对T2DM合并NAFLD的诊断价值。结果患病组肥胖人数占比、HOMA-IR评分、BMI、饮酒史人数占比、低密度脂蛋白胆固醇、总胆固醇、三酰甘油、vWF、sST2水平均高于对照组,而总胆红素低于对照组(P<0.05);随着肝功能等级增加,血清vWF、sST2水平逐渐升高(P<0.05);抵抗组血清vWF、sST2水平高于非抵抗组(P<0.05)。饮酒史、低密度脂蛋白胆固醇、总胆固醇、三酰甘油、HOMA-IR、vWF、sST2为老年T2DM合并NAFLD的独立危险因素,总胆红素为独立保护因素(P<0.05)。血清vWF、sST2水平诊断T2DM合并NAFLD的曲线下面积(AUC)分别为0.870、0.866,截断值分别为24.05 ng/ml、20.28 ng/ml,二者联合诊断的AUC为0.940,二者联合诊断优于各指标单独诊断(Z_(二者联合-vWF)=2.056、Z_(二者联合-sST2)=2.417,P=0.040、0.016)。结论老年T2DM合并NAFLD患者血清vWF、sST2水平均上调,且vWF、sST2与胰岛素抵抗及肝功能密切相关,二者联合对老年T2DM合并NAFLD具有较高的诊断价值。

Objective To explore the relationship between serum von willebrand factor(vWF),soluble growth stimulating factor 2(sST2)levels and insulin resistance and liver function in elderly patients with type 2 diabetes mellitus(T2DM)and nonalcoholic fatty liver disease(NAFLD).Methods From April 2020 to April 2022,total 116 confirmed elderly T2DM patients with NAFLD who were treated at our hospital were regarded as the diseased group.According to liver function,they were separated into level A group(41 cases),level B group(39 cases),and level C group(36 cases).According to the presence of insulin resistance,they were separated into resistance group(42 cases)and non resistance group(74 cases).116 cases of simple T2DM who were treated at our hospital in the same time were selected as the control group.The serum vWF and sST2 levels of each group were compared.Multivariate Logistic regression was applied to analyze the influencing factors of elderly T2DM with NAFLD.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of serum vWF and sST2 levels for T2DM combined with NAFLD.Results The proportion of obesity,HOMA-IR score,BMI,drinking history,low-density lipoprotein cholesterol,total cholesterol,triglycerides,vWF,and sST2 levels in the diseased group were higher than those in the control group,while total bilirubin level was lower than that in the control group(P<0.05).As the liver function level increased,serum vWF and sST2 gradually increased(P<0.05).The serum vWF and sST2 in the resistance group were higher than those in the non resistance group(P<0.05).A history of alcohol consumption,low-density lipoprotein cholesterol,total cholesterol,triglycerides,HOMA-IR,vWF,and sST2 were independent risk factors for elderly T2DM with NAFLD,while total bilirubin was an independent protective factor(P<0.05).The area under the curve(AUC)of serum vWF and sST2 for diagnosing T2DM with NAFLD was 0.870 and 0.866,respectively,with cutoff value of 24.05 ng/ml and 20.28 ng/ml,and the AUC for combined diagnosis of the two was 0.940,the combined diagnosis of the two was superior to the individual diagnosis of each indicator(Z_(combined diagnosis-vWF)=2.056,Z_(combined diagnosis-sST2)=2.417,P=0.040,0.016).Conclusion The serum vWF and sST2 are upregulated in elderly patients with T2DM combined with NAFLD,and vWF and sST2 are closely related to insulin resistance and liver function.The combination has high diagnostic value for elderly patients with T2DM combined with NAFLD.