非酒精性脂肪性肝病合并2型糖尿病患者同型半胱氨酸水平和中性粒细胞与淋巴细胞比值的临床意义

雷佩茹; 李迎杰; 李静

doi:10.3969/j.issn.1001-5256.2021.10.019

非酒精性脂肪性肝病合并2型糖尿病患者同型半胱氨酸水平和中性粒细胞与淋巴细胞比值的临床意义

DOI: 10.3969/j.issn.1001-5256.2021.10.019

锦州医科大学附属第一医院消化内科，辽宁锦州 121000

基金项目:

辽宁省科技厅自然科学基金资助课题 (20170540391);

辽宁省科技厅科研基金资助课题 (2013020126-215)

详细信息

通信作者:
李静，jz7203@139.com

中图分类号: R575.5
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出版历程
- 收稿日期: 2021-03-25
- 录用日期: 2021-05-08
- 出版日期: 2021-10-20

Clinical significance of homocysteine and neutrophil-to-lymphocyte ratio in patients with nonalcoholic fatty liver disease and type 2 diabetes mellitus

Department of Gastroenterology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China

Research funding:

Natural Science Foundation of Liaoning Province Science and Technology Department (20170540391);

Scientific Research Fund of Liaoning Province Science and Technology Department (2013020126-215)

摘要

摘要: 目的探讨同型半胱氨酸(Hcy)及中性粒细胞与淋巴细胞比值(NLR)在非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者中的水平及临床意义。方法选取2019年1月—12月锦州医科大学附属第一医院内分泌科的NAFLD患者528例，根据其是否合并2型糖尿病分为未合并T2DM组及合并T2DM组，并随机选取未合并NAFLD的单纯性T2DM患者79例，记录3组患者的一般资料及实验室指标。计量资料符合正态分布数据组间比较采用单因素方差分析；计数资料组间比较采用χ²检验。危险因素分析采用二元logistic回归分析，用OR及其95%CI表示相对危险度。采用受试者工作特征曲线(ROC曲线)评价预测效能。结果合并T2DM组患者SBP、DBP及BMI显著高于未合并T2DM组(P值均＜0.05)。Hcy、NLR、ALT、AST、GGT、UA、FBG两两组间比较差异均有统计学意义(P值均＜0.05)。Neut、Lym及HDL-C在合并T2DM组与未合并T2DM组中比较差异有统计学意义(P值均＜0.05)。TC在合并T2DM组与单纯T2DM组、未合并T2DM组与单纯T2DM组比较差异均有统计学意义(P值均＜005)。SBP、HDL-C、NLR、Hcy为NAFLD合并T2DM的独立危险因素[OR(95%CI)：1.040(1.015~1.065)、0.040(0.007~0.228)、6.285(1.504~27.108)、1.291(1.127~1.423)，P值均＜0.05]。Hcy预测NAFLD合并T2DM的曲线下面积为0.741(95%CI：0.698~0783，P＜0.01)，Youden指数为0.394，预测临界值为15.31 μmol/L，敏感度为69.6%，特异度为69.8%。NLR预测NAFLD合并T2DM的曲线下面积为0.782(95%CI：0.744~0.820，P＜0.01)，Youden指数为0.443，预测临界值为2.12，敏感度为72.1%，特异度为72.2%。Hcy联合NLR预测NAFLD合并T2DM的曲线下面积为0.845(95%CI：0.812~0.878，P＜0.01)，Youden指数为0549，敏感度为71.8%，特异度为83.1%。结论 Hcy及NLR是NAFLD合并T2DM发生的危险因素，对于该疾病的发生具有预测价值。Hcy联合NLR检测可提高NAFLD合并T2DM的诊断效能，有助于临床医生早期识别。
- 非酒精性脂肪性肝病 /
- 糖尿病, 2型 /
- 半胱氨酸 /
- 中性粒细胞 /
- 淋巴细胞
Abstract: Objective To investigate the levels and clinical significance of homocysteine (Hcy) and neutrophil-to-lymphocyte ratio (NLR) in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods A total of 528 patients with NAFLD who were treated in Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, from January to December 2019 were enrolled, and according to the presence or absence of T2DM, they were divided into non-T2DM group and T2DM group. A total of 79 T2DM patients without NAFLD were selected randomly. General data and laboratory markers were recorded for the three groups. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a binary logistic regression analysis was used to determine risk factors, and odds ratio (OR) and its 95% confidence interval (CI) were used to represent relative risk; the receiver operating characteristic (ROC) curve was used to evaluate predictive efficiency. Results The T2DM group had significantly higher systolic blood pressure (SBP), diastolic blood pressure, and body mass index than the non-T2DM group (all P < 0.05), and there were significant differences between any two of the three groups in Hcy, NLR, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, uric acid, and fasting blood glucose (all P < 0.05). There were significant differences in neutrophil count, lymphocyte count, and high-density lipoprotein cholesterol (HDL-C) between the T2DM group and the non-T2DM group (all P < 0.05), and there was a significant difference in total cholesterol between the T2DM group and the simple T2DM group and between the non-T2DM group and the simple T2DM group (P < 0.05). SBP (OR=1.040, 95%CI: 1.015-1.065), HDL-C (OR=0.040, 95%CI: 0.007-0.228), NLR (OR=6.285, 95%CI: 1.504-27.108), and Hcy (OR=1.291, 95%CI: 1.127-1.423) were independent risk factors for NAFLD with T2DM. Hcy had an area under the ROC curve (AUC) of 0.741 (95%CI: 0.698-0.783, P < 0.01) in predicting NAFLD with T2DM, with a Youden index of 0.394, a sensitivity of 69.6%, and a specificity of 69.8% at the optimal cut-off value of 15.31 μmol/L. NLR had an AUC of 0.782 (95%CI: 0.744-0.820, P < 0.01) in predicting NAFLD with T2DM, with a Youden index of 0.443, a sensitivity of 72.1%, and a specificity of 72.2% at the optimal cut-off value of 2.12. Hcy combined with NLR had an AUC of 0.845 (95%CI: 0.812-0.878, P < 0.01) in predicting NAFLD with T2DM, with a Youden index of 0.549, a sensitivity of 71.8%, and a specificity of 83.1%. Conclusion Hcy and NLR are risk factors for NAFLD with T2DM and have a certain predictive value. Combined measurement of Hcy and NLR can improve the diagnostic efficiency of NAFLD with T2DM and help clinicians with diagnosis in the early stage.
- Non-Alcoholic Fatty Liver Disease /
- Diabetes Mellitus, Type 2 /
- Cysteine /
- Neutrophil /
- Lymphocytes

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图 1 Hcy、NLR及NLR联合Hcy预测NAFLD合并T2DM发生的ROC曲线

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表 1 合并T2DM组与未合并T2DM组患者一般资料及实验室指标的比较

指标	未合并T2DM组(n=248)	合并T2DM组(n=280)	单纯T2DM组(n=79)	统计值	P值
冠心病史[例(%)]	76(30.6)	94(33.6)	23(29.1)	χ²=0.821	0.663
吸烟[例(%)]	65(26.2)	76(27.1)	17(21.5)	χ²=1.019	0.601
饮酒[例(%)]	71(28.6)	95(33.9)	17(21.5)	χ²=4.965	0.084
高血压病史[例(%)]	48(19.4)	59(21.1)	19(24.1)	χ²=0.834	0.659
高脂血症[例(%)]	86(34.7)	101(36.1)	27(34.2)	χ²=0.158	0.924
高尿酸血症[例(%)]	56(22.6)	66(23.6)	17(21.5)	χ²=0.171	0.918
男性[例(%)]	187(66.8)	187(66.8)	58(73.4)	χ²=5.256	0.072
年龄(岁)	55.29±10.14	56.14±9.15	56.54±8.86	F=0.763	0.467
BMI(kg/m²)	26.46±2.73	27.47±3.05¹⁾²⁾	25.94±2.89	F=12.411	＜0.01
SBP(mmHg)	129.82±16.89	145.71±18.61¹⁾²⁾	128.76±12.32	F=66.484	＜0.01
DBP(mmHg)	81.78±11.39	88.37±11.30¹⁾²⁾	82.28±9.70	F=25.466	＜0.01
TC(mmol/L)	5.31±0.81	5.30±0.92²⁾	4.92±0.72¹⁾	F=7.057	0.001
TG(mmol/L)	1.99±1.29	2.17±1.24	1.91±1.05	F=2.117	0.121
HDL-C(mmol/L)	1.41±0.21	1.26±0.23¹⁾	1.30±0.38¹⁾	F=26.811	＜0.01
LDL-C(mmol/L)	3.34±0.75	3.49±0.89	3.39±0.73	F=2.268	0.104
ALT(U/L)	28.63±9.03	32.11±15.34¹⁾²⁾	24.33±8.13¹⁾	F=13.901	＜0.01
AST(U/L)	20.34±5.97	21.69±8.58¹⁾²⁾	18.47±5.09¹⁾	F=6.759	0.001
GGT(U/L)	34.31±21.14	39.06±23.47¹⁾²⁾	24.18±8.90¹⁾	F=15.601	＜0.01
NLR	1.85±0.59	2.71±0.97¹⁾²⁾	1.81±0.60¹⁾	F=9.450	＜0.01
Hcy(μmol/L)	14.13±3.10	16.70±2.58¹⁾²⁾	10.51±3.06¹⁾	F=15.712	＜0.01
Neut(×10⁹/L)	3.75±0.94	4.89±1.08¹⁾²⁾	3.66±0.68	F=107.415	＜0.01
Lym(×10⁹/L)	2.16±0.61	1.96±0.58¹⁾²⁾	2.18±0.68	F=9.468	＜0.01
UA(μmol/L)	361.36±83.82	384.78±77.71¹⁾²⁾	317.74±57.63¹⁾	F=23.637	＜0.01
FBG(mmol/L)	4.60±0.05	7.54±0.29¹⁾²⁾	10.24±2.15¹⁾	F=178.664	＜0.01
注：与未合并T2DM组比较，1) P＜0.05；与单纯T2DM组比较，2) P＜0.05。

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表 2 NAFLD合并T2DM的独立危险因素的二元logistic回归分析

项目	B值	SE	Wald χ²	OR	95%CI	P值
SBP	0.039	0.012	10.351	1.040	1.015~1.065	0.001
HDL-C	-3.215	0.885	13.192	0.040	0.007~0.228	＜0.001
NLR	1.854	0.738	6.316	6.285	1.504~27.108	0.012
Hcy	0.256	0.049	26.862	1.291	1.127~1.423	＜0.001

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