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2型糖尿病患者合并非酒精性脂肪性肝病的影响因素分析

张顺宵 张晟 张妍 李园园 陈月 孙明瑜

引用本文:
Citation:

2型糖尿病患者合并非酒精性脂肪性肝病的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2023.05.013
基金项目: 

山东省重点研发计划 (2021CXGC010509)

国家中医药管理局中医肝胆病重点学科、慢性肝病虚损重点研究室和上海市中医临床重点实验室 (20DZ2272200)

上海市临床重点专科建设项目 (shslczdzk01201)

上海市宝山区科学技术委员会 (21-E-62)

伦理学声明:本研究方案于2017年5月30日经由瑞金医院伦理委员会审批,批号:(2017)临伦审第(42)号。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:张顺宵负责查阅文献,整理资料,撰写论文;张晟、张妍、李园园负责录入及整理数据,收集患者资料;陈月负责提出选题,指导撰写文章;孙明瑜负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    陈月,13701994461@163.com (ORCID: 0000-0003-3398-9516)

    孙明瑜,mysun248@hotmail.com (ORCID: 0000-0001-8103-7283)

Influencing factors for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

Research funding: 

Key Research & Development of Shandong Province (2021CXGC010509);

Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Key Disciplines of Liver and Gall Bladder Diseases, and Key Laboratory of Chronic Deficiency Liver Disease of the State Administration of Traditional Chinese Medicine of the People's Republic of China (20DZ2272200);

Shanghai Key Clinical Specialty Construction Project (shslczdzk01201);

Shanghai Baoshan District Science and Technology Commission (21-E-62)

More Information
  • 摘要:   目的  探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者的相关影响因素。  方法  选取2021年5月—2022年3月上海市宝山区中西医结合医院中纳入国家标准化代谢性疾病管理中心的252例T2DM患者,根据患者的脂肪肝情况,分为单纯T2DM组(n=105)和T2DM合并NAFLD组(n=147)。分析患者一般资料,包括性别、年龄、血压、身高、体质量、颈围、甘油三酯(TG)、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇、空腹血糖、糖化血红蛋白、超敏C反应蛋白、晨尿白蛋白/肌酐、促甲状腺激素、尿酸、肝内脂肪沉积情况、颈动脉内膜中层厚度以及踝臂脉搏波等。正态分布的计量资料两组间比较采用成组t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验。多因素Logistic回归分析T2DM合并NAFLD的相关危险因素,应用受试者工作特征曲线(ROC曲线)评估相关影响因素的预测价值。  结果  按年龄分层统计分析发现,<50岁T2DM合并NAFLD患者的BMI、内脏脂肪、TG、肱踝脉搏波传导速度、晨尿白蛋白/肌酐、尿酸水平均显著高于单纯T2DM患者(P值均<0.05),血清HDL-C水平显著低于单纯T2DM患者(P<0.05);≥50岁T2DM合并NAFLD患者的血压、BMI、内脏脂肪、TG、肱踝脉搏波传导速度、晨尿白蛋白/肌酐、尿酸水平显著高于单纯T2DM患者(P值均<0.05),血清HDL-C水平显著低于单纯T2DM患者(P<0.05)。多因素Logistic回归分析结果显示,BMI(OR=1.408,95%CI:1.136~1.746,P=0.002)、HDL-C(OR=0.031,95%CI:0.001~0.647,P=0.025)、左肱踝脉搏波传导速度(OR=1.003,95%CI:1.001~1.006,P=0.003)、尿酸(OR=1.011,95%CI:1.005~1.016,P<0.001)是T2DM合并NAFLD的独立影响因素。ROC曲线结果显示,HDL-C、BMI、左肱踝脉搏波传导速度、尿酸评估T2DM合并NAFLD的曲线下面积分别为0.695(95%CI:0.574~0.812)、0.708(95%CI:0.628~0.788)、0.611(95%CI:0.523~0.698)、0.698(95%CI:0.617~0.779)。  结论  低水平HDL-C、BMI、左肱踝脉搏波传导速度及尿酸对T2DM患者NAFLD发生具有预测价值。

     

  • 图  1  HDL-C的ROC曲线

    Figure  1.  ROC curves of HDL-C

    图  2  BMI、baPWV、尿酸的ROC曲线

    Figure  2.  ROC curves of BMI, baPWV and uric acid

    表  1  50岁以下患者一般资料比较

    Table  1.   Baseline data and univariate analysis of patients under 50 years old

    指标 总体(n=94) 单纯T2DM组(n=33) T2DM合并NAFLD组(n=61) 统计值 P
    男/女(例) 65/29 21/12 44/17 χ2= 0.724 0.395
    年龄(岁) 42.00(36.50~45.00) 42.00(34.50~45.00) 42.00(37.00~45.75) Z=-0.540 0.589
    舒张压(mmHg) 84.68±10.12 83.18±12.16 85.62±8.90 t=-1.112 0.269
    收缩压(mmHg) 132.15±17.60 129.45±21.69 133.67±14.76 t=-0.999 0.323
    BMI(kg/m2) 27.20(23.60~30.90) 24.00(22.65~27.20) 28.70(26.18~31.93) Z=-3.672 <0.001
    内脏脂肪(cm2) 99.89±43.50 75.82±38.67 112.93±40.16 t=-4.332 <0.001
    FBG(mmol/L) 7.80(6.45~10.00) 7.30(6.20~9.00) 8.35(6.32~10.35) Z=-1.383 0.167
    HbA1c(%) 9.46±2.11 8.99±2.21 9.76±2.02 t=-1.701 0.092
    TG(mmol/L) 1.61(1.12~2.32) 1.25(0.79~1.72) 1.73(1.34~2.96) Z=-3.680 <0.001
    TC(mmol/L) 4.80±1.01 4.72±0.87 4.84±1.16 t=-0.528 0.599
    HDL-C(mmol/L) 0.97(0.80~1.12) 1.10(0.98~1.17) 0.93(0.79~1.06) Z=-3.082 0.002
    LDL-C(mmol/L) 3.28±0.83 3.24±0.82 3.31±0.83 t=-0.322 0.748
    hsCRP(mg/L) 1.38(0.61~4.79) 1.18(0.57~3.01) 1.95(0.62~5.67) Z=-1.153 0.249
    右颈IMT(μm) 70.0(60.5~80.0) 70.0(60.0~80.0) 70.5(64.0~80.0) Z=-1.442 0.149
    左颈IMT(μm) 70.0(60.0~80.0) 70.0(60.0~80.0) 74.0(67.5~80.0) Z=-1.880 0.060
    左踝臂指数 1.04±0.10 1.06±0.08 1.03±0.11 t=1.764 0.081
    右踝臂指数 1.07±0.11 1.09±0.10 1.06±0.10 t=1.681 0.096
    LbaPWV(cm/s) 1 384.19±205.61 1 297.97±234.77 1 429.79±171.15 t=-3.118 0.006
    RbaPWV(cm/s) 1 382.29±195.47 1 315.03±237.12 1 418.14±157.54 t=-2.244 0.029
    晨尿白蛋白/肌酐(mg/g) 30.00(22.00~45.00) 26.00(20.00~36.00) 34.50(24.25~48.75) Z=-2.358 0.018
    TSH(μIU/mL) 1.45(1.01~2.42) 1.44(0.99~2.44) 1.47(1.02~2.34) Z=-0.091 0.927
    颈围(cm) 40.00(37.50~44.00) 39.00(35.75~42.50) 40.00(39.00~44.75) Z=-1.899 0.058
    尿酸(μmol/L) 355.68±96.92 327.61±99.98 370.41±91.82 t=-2.091 0.039
    注:LbaPWV,左肱踝脉搏波传导速度;RbaPWV,右肱踝脉搏波传导速度。
    下载: 导出CSV

    表  2  50岁以上患者一般资料比较

    Table  2.   Baseline data and univariate analysis of patients over 50 years old

    指标 总体(n=158) 单纯T2DM组(n=72) T2DM合并NAFLD组(n=86) 统计值 P
    男/女(例) 100/58 49/23 51/35 χ2=1.292 0.256
    年龄(岁) 59.00(56.00~64.00) 60.00(56.00~66.00) 58.00(54.00~63.25) Z=-1.205 0.228
    舒张压(mmHg) 79.93±10.41 77.11±9.07 82.22±10.89 t=-3.170 0.002
    收缩压(mmHg) 133.88±20.32 129.10±17.40 137.86±21.66 t=-2.770 0.006
    BMI(kg/m2) 25.3(23.3~27.9) 23.8(22.6~26.7) 26.5(24.3~28.8) Z=-4.494 <0.001
    内脏脂肪(cm2) 87.0(67.5~113.5) 75.0(57.0~105.0) 97.0(76.0~125.0) Z=-3.857 <0.001
    FBG(mmol/L) 6.9(5.8~8.9) 6.6(5.8~8.4) 7.3(5.8~9.3) Z=-1.589 0.112
    HbA1c(%) 8.60(7.25~9.80) 7.90(7.10~9.80) 8.75(7.58~9.73) Z=-1.235 0.217
    TG(mmol/L) 1.40(1.01~2.05) 1.27(0.94~1.81) 1.55(1.14~2.31) Z=-2.849 0.004
    TC(mmol/L) 4.56(4.02~5.54) 4.61(3.93~5.32) 4.48(4.09~5.61) Z=-0.592 0.554
    HDL-C(mmol/L) 1.08(0.88~1.27) 1.13(0.92~1.34) 1.06(0.85~1.20) Z=-2.250 0.024
    LDL-C(mmol/L) 3.10±0.88 3.04±0.90 3.15±0.90 t=0.744 0.458
    hsCRP(mg/L) 2.10(0.65~3.59) 1.53(0.50~3.24) 2.34(0.89~3.83) Z=-1.309 0.191
    右颈IMT(μm) 80(70~80) 80(63~80) 80(70~80) Z=-0.719 0.472
    左颈IMT(μm) 80(70~81) 80(66~80) 80(70~81) Z=-1.094 0.274
    左踝臂指数 1.10(1.02~1.16) 1.12(1.02~1.18) 1.08(1.01~1.15) Z=-1.425 0.154
    右踝臂指数 1.12(1.04~1.20) 1.15(1.04~1.21) 1.11(1.03~1.19) Z=-1.471 0.141
    LbaPWV(cm/s) 1 600.0(1 416.0~1 798.5) 1 547.0(1 343.0~1 731.0) 1 652.5(1 422.0~1 872.0) Z=-2.390 0.017
    RbaPWV(cm/s) 1 554.0(1 398.5~1 777.0) 1 508.0(1 360.0~1 716.0) 1 639.5(1 402.8~1 851.8) Z=-2.350 0.019
    晨尿白蛋白/肌酐(mg/g) 30.00(20.00~47.00) 24.00(17.00~34.00) 35.50(23.00~55.75) Z=-3.124 0.002
    TSH(μIU/mL) 1.69(1.16~2.38) 1.71(1.21~2.26) 1.64(1.11~2.49) Z=-0.187 0.852
    颈围(cm) 38.00(35.75~41.00) 38.00(35.00~40.00) 39.00(36.00~42.00) Z=-1.697 0.090
    尿酸(μmol/L) 307.0(262.0~374.5) 288.0(246.0~329.0) 342.0(289.0~403.5) Z=-4.286 <0.001
    下载: 导出CSV

    表  3  50岁以下患者组多因素Logistic回归分析

    Table  3.   Multivariate Logistic regression analysis of patients under 50 years old

    指标 OR 95%CI P
    BMI(kg/m2) 1.131 0.912~1.403 0.263
    内脏脂肪(cm2) 1.020 0.994~1.047 0.126
    TG(mmol/L) 1.231 0.612~2.474 0.560
    HDL-C(mmol/L) 0.031 0.001~0.647 0.025
    LbaPWV(cm/s) 1.004 0.999~1.009 0.082
    RbaPWV(cm/s) 1.002 0.997~1.007 0.488
    晨尿白蛋白/肌酐(mg/g) 0.999 0.994~1.004 0.775
    尿酸(μmol/L) 0.999 0.992~1.006 0.766
    下载: 导出CSV

    表  4  50岁以上患者组多因素Logistic回归分析

    Table  4.   Multivariate Logistic regression analysis of patients over 50 years old

    指标 OR 95%CI P
    舒张压(mmHg) 1.049 0.996~1.106 0.072
    收缩压(mmHg) 0.971 0.941~1.002 0.064
    BMI(kg/m2) 1.408 1.136~1.746 0.002
    内脏脂肪(cm2) 0.993 0.975~1.011 0.454
    TG(mmol/L) 0.976 0.760~1.255 0.852
    HDL-C(mmol/L) 0.582 0.117~2.889 0.508
    LbaPWV(cm/s) 1.003 1.001~1.006 0.003
    RbaPWV(cm/s) 1.000 0.999~1.000 0.187
    晨尿白蛋白/肌酐(mg/g) 0.999 0.996~1.001 0.257
    尿酸(μmol/L) 1.011 1.005~1.016 <0.001
    下载: 导出CSV
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