血浆致动脉粥样硬化指数预测2型糖尿病发生代谢相关脂肪性肝病的价值分析

高梦雅; 秦迁; 王守俊

doi:10.3969/j.issn.1001-5256.2023.06.012

血浆致动脉粥样硬化指数预测2型糖尿病发生代谢相关脂肪性肝病的价值分析

DOI: 10.3969/j.issn.1001-5256.2023.06.012

高梦雅^a,
秦迁^b,
王守俊^a, , ,

a.
郑州大学第一附属医院内分泌科，郑州 450000
b.
郑州大学第一附属医院体检科，郑州 450000

基金项目:

河南省科技攻关项目 (212102310204)

伦理学声明：本研究经郑州大学医学部伦理委员会批准，批号为2023-KY-0397-001。所有受试者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：高梦雅提出研究的思路或设计，并参与数据收集、分析及论文撰写；秦迁参与研究数据的获取分析解释过程；王守俊、秦迁对文章内容及格式进行了重要修改。

详细信息

通信作者:
王守俊，wangshoujun02@126.com (ORCID: 0000-0002-0209-8545)

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出版历程
- 收稿日期: 2022-12-01
- 录用日期: 2022-12-29
- 出版日期: 2023-06-20

Value of atherogenic index of plasma in predicting metabolic associated fatty liver disease in patients with type 2 diabetes mellitus

Mengya GAO^a,
Qian QIN^b,
Shoujun WANG^{a
, ,
,}

a.
Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
b.
Department of Physical Examination, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China

Research funding:

Science and Technology Research Project of Henan Province (212102310204)

More Information

Corresponding author: WANG Shoujun, wangshoujun02@126.com (ORCID: 0000-0002-0209-8545)

摘要

摘要: 目的探讨血浆致动脉粥样硬化指数(AIP)与2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)的关系。方法 2021年9月—2022年9月于郑州大学第一附属医院内分泌科住院治疗的T2DM患者375例，根据是否合并MAFLD分为T2DM合并MAFLD组(T2DM+MAFLD组，n=245)和T2DM组(T2DM组，n=130)。记录患者的临床资料，并计算AIP。根据AIP四分位数将受试者分为四组：Q1组，AIP≤0.20；Q2组: 0.20＜AIP≤0.24；Q3组：0.24＜AIP≤0.48；Q4组: AIP＞0.48。正态分布的计量资料组间比较采用成组t检验；非正态分布计量资料组间比较采用Wilcoxon秩和检验；计数资料趋势性分析采用趋势χ²检验。采用多因素Logistic回归探讨AIP对MAFLD的影响；采用受试者工作特征曲线(ROC曲线)评估AIP、BMI、ALT等指标对T2DM合并MAFLD的预测价值。结果与T2DM组相比，T2DM+MAFLD组BMI、收缩压、尿酸、空腹血糖、糖化血红蛋白、ALT、AST、GGT、ALP、甘油三酯、低密度脂蛋白、AIP水平均明显升高，而高密度脂蛋白水平降低(P值均＜0.05)。趋势χ²检验显示T2DM患者MAFLD的患病率随AIP水平的升高而呈增加趋势(χ_趋势²=20.338，P＜0.05)。多因素Logistic回归分析显示与Q1组相比，Q4组(OR=2.396，95%CI：1.018~5.640)发生MAFLD的风险增加(P=0.045)。ROC曲线分析结果显示，AIP联合ALT、BMI作为诊断模型有最佳的诊断效能(AUC=0.816)，最佳临界值为0.670，灵敏度为70.2%，特异度78.5%。结论 AIP是T2DM合并MAFLD的独立危险因素，其中AIP联合BMI、ALT对T2DM合并MAFLD有较好的预测价值。
- 血浆致动脉粥样硬化指数 /
- 糖尿病, 2型 /
- 非酒精性脂肪性肝病
Abstract: Objective To investigate the association between atherogenic index of plasma (AIP) and metabolic associated fatty liver (MAFLD) in type 2 diabetes mellitus (T2DM). Methods A total of 375 patients with T2DM who were hospitalized and treated in Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, from September 2021 to September 2022 were enrolled, and according to the presence or absence of MAFLD, they were divided into T2DM+MAFLD group with 245 patients and T2DM group with 130 patients. Related clinical data were recorded, and AIP was calculated. According to the quartiles of AIP, the patients were divided into Q1 group (AIP≤0.20), Q2 group (0.20 < AIP≤0.24), Q3 group (0.24 < AIP≤0.48), and Q4 group (AIP > 0.48). The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the trend chi-square test was used for the trend analysis of categorical data. The multivariate logistic regression analysis was used to investigate the effect of AIP on MAFLD, and the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to assess the value of the indicators such as AIP, body mass index (BMI), and alanine aminotransferase (ALT) in predicting T2DM with MAFLD. Results Compared with the T2DM group, the T2DM+MAFLD group had significant increases in BMI, systolic pressure, uric acid, fasting blood glucose, glycosylated hemoglobin, ALT, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, triglyceride, low-density lipoprotein, and AIP and a significant reduction in high-density lipoprotein (all P < 0.05). The trend chi-square test showed that the prevalence rate of MAFLD in T2DM patients tended to increase with the increase in AIP level (χ_trend²=20.338, P < 0.05). The multivariate logistic regression analysis showed that compared with the Q1 group, the Q4 group had a significant increase in the risk of MAFLD (odds ratio =2.396, 95% confidence interval: 1.018-5.640, P=0.045). The ROC curve analysis showed that the diagnostic model of AIP combined with BMI and ALT had the best diagnostic performance (AUC=0.816), with a sensitivity of 70.2% and a specificity of 78.5% at the optimal cut-off value of 0.670. Conclusion AIP is an independent risk factor for MAFLD in T2DM patients, and AIP combined with BMI and ALT has a good predictive value for T2DM with MAFLD.
- Atherogenic Index of Plasma /
- Diabetes Mellitus, Type 2 /
- Non-alcoholic Fatty Liver Disease

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图 1 AIP 4组间T2DM合并MAFLD患病率的比较

Figure 1. Relationship between AIP quartile and the prevalence of fatty liver disease

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图 2 AIP、BMI、ALT及三者联合预测MAFLD的ROC曲线

Figure 2. ROC curves of AIP, BMI, ALT and their combination to predict MAFLD

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图 3 BMI＜28 kg/m²组AIP、BMI、ALT及三者联合预测T2DM合并MAFLD的ROC曲线

Figure 3. ROC curves of AIP, BMI, ALT and their combination for predicting T2DM with MAFLD in BMI < 28 kg/m² group

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图 4 28 kg/m²≤BMI＜40 kg/m²组AIP、BMI、ALT及三者联合预测T2DM合并MAFLD的ROC曲线

Figure 4. ROC curves of AIP, BMI, ALT and their combination for predicting T2DM with MAFLD in 28 kg/m²≤ BMI < 40 kg/m²

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表 1 MAFLD与非MAFLD组的临床资料比较

Table 1. Comparison of clinical data between MAFLD and non-MAFLD groups

指标	T2DM组(n=130)	T2DM+MAFLD组(n=245)	统计值	P值
T2DM病程(年)	1(0~3)	1(0~4)	Z=-1.415	0.157
年龄(岁)	49(41~55)	47(38~55)	Z=-0.837	0.403
性别(男/女，例)	74/56	150/95	χ²=0.653	0.419
BMI(kg/m²)	23.03(21.38~24.97)	26.57(24.07~28.99)	Z=-8.966	＜0.001
SBP(mmHg)	125(117~131)	126(122~134)	Z=-3.272	0.001
DBP(mmHg)	78(75~80)	79(75~86)	Z=-2.034	0.042
FBG(mmol/L)	6.6(5.7~7.5)	7.0(6.2~8.1)	Z=-3.799	＜0.001
HbA1C(%)	8.0(6.8~10.3)	8.9(7.3~10.5)	Z=-2.346	0.019
2hPG(mmol/L)	14.44±4.25	14.79±3.70	t=0.837	0.403
UA(μmol/L)	264.97±76.69	305.60±84.56	t=4.490	＜0.001
ALT(U/L)	15(11~21)	22(14~36)	Z=-6.089	＜0.001
AST(U/L)	15(12~18)	18(14~25)	Z=-5.302	＜0.001
GGT(U/L)	16(12~15)	27(18~41)	Z=-7.203	＜0.001
ALP(U/L)	71(59~85)	77(66~92)	Z=-2.766	0.006
TC(mmol/L)	4.53±1.11	4.64±1.06	t=0.897	0.370
TG(mmol/L)	1.34(0.92~2.18)	1.85(1.28~3.06)	Z=-4.674	＜0.001
HDL-C(mmol/L)	1.01(0.88~1.24)	0.95(0.81~1.08)	Z=1.422	0.035
LDL-C(mmol/L)	2.66±0.80	2.93±0.77	t=3.148	0.002
AIP	0.12(-0.09~0.36)	0.28(0.10~0.53)	Z=4.742	＜0.001

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表 2 AIP与T2DM合并MAFLD发生关系的多因素Logistic回归分析

Table 2. Multivariate Logistic regression analysis of the relationship between AIP and MAFLD

组别	模型1		模型2		模型3
组别	OR (95%CI)	P值	OR (95%CI)	P值	OR (95%CI)	P值
Q1组	1.000		1.000		1.000
Q2组	1.974(1.094~3.562)	0.024	1.658(0.845~3.252)	0.142	1.295(0.630~2.662)	0.481
Q3组	2.543(1.388~4.662)	0.003	1.566(0.776~3.162)	0.211	1.213(0.574~2.566)	0.613
Q4组	5.634(2.852~11.132)	＜0.001	3.954(1.774~8.815)	0.001	2.396(1.018~5.640)	0.045
注：模型1，未校正任何危险因素；模型2，校正T2DM病程、SBP、DBP、BMI; 模型3, 在模型2的基础上进一步调整FBG、HbA1C、LDL-C、ALT。

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表 3 AIP、BMI、ALT预测T2DM合并MAFLD发生的ROC曲线分析

Table 3. ROC curve analysis of AIP, BMI and ALT predictingT2DM and MAFLD occurrence

变量	AUC	95%CI	最佳临界值	灵敏度(%)	特异度(%)	P值
总人群
联合诊断模型	0.816	0.773~0.860	0.670	70.2	78.5	0.023
AIP	0.661	0.604~0.718	0.103	75.1	49.2	0.030
ALT	0.691	0.638~0.744	25.500	43.7	86.9	0.027
BMI	0.781	0.733~0.809	25.635	58.8	83.8	0.025
BMI＜28 kg/m²
联合诊断模型	0.760	0.704~0.815	0.550	69.4	68.3	0.028
AIP	0.630	0.564~0.695	0.104	71.3	51.2	0.033
ALT	0.632	0.569~0.696	25.500	33.8	87.8	0.033
BMI	0.717	0.656~0.777	23.205	76.3	56.9	0.031
28 kg/m²≤BMI＜40 kg/m²
联合诊断模型	0.741	0.507~0.976	0.885	82.4	71.4	0.035
AIP	0.597	0.388~0.805	0.469	41.2	85.7	0.397
ALT	0.742	0.494~0.990	11.500	94.1	57.1	0.034
BMI	0.541	0.308~0.775	28.930	72.9	57.1	0.119

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