空腹C肽评估NAFLD合并T2DM患者肝纤维化进展价值分析*

doi:10.3969/j.issn.1672-5069.2020.01.012

摘要/Abstract

摘要： 目的探讨空腹C肽对非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者肝纤维化进展的评估价值。方法在456例NAFLD合并T2DM患者中,经肝脏硬度检测(LSM),发现非进展性肝纤维化组415例和进展性肝纤维化组41例。采用Logistic回归分析影响肝纤维化进展的因素,并采用受试者工作特征曲线(ROC)评价空腹 C 肽对进展性肝纤维化的诊断价值。结果进展性肝纤维化患者血清HDL-C、PLT计数、AST、空腹C肽和糖化血红蛋白(HbA1c)分别为(1.5±0.2)mmol/L、(259.3±50.3)×10⁹/L、(39.3±5.1)U/L、(2.7±0.8)ng/ml和(10.7±1.0)%,与非进展性肝纤维化组比,差异显著【分别为(1.4±0.3)mmol/L、(267.1±48.2)×10⁹/L、(26.1±4.1)U/L、(2.1±0.7)ng/ml和(8.1±1.1)%,P<0.05】;经Logistic回归分析发现,年龄【OR=0.915,95 %CI:0.841～0.995,P=0.038】、性别(OR=1.250,95% CI:1.005～1.554,P=0.045)、BMI(OR=1.117,95% CI:1.011～1.235,P=0.030)、HbA1c水平(OR=1.117,95% CI:1.011～1.235,P=0.030)和空腹C肽水平(OR=1.206,95% CI:1.068～1.361,P=0.003)是进展性肝纤维化发生的独立影响因素;经ROC曲线分析发现,空腹 C 肽诊断进展性肝纤维化的ROC下面积(AUC)为0.7(95% CI:0.7～0.81,P<0.05),即当空腹C肽水平为2.36 ng/mL时,其诊断的灵敏度为73.2%,特异度为67.0%。结论利用空腹 C 肽水平诊断NAFLD合并T2DM患者进展性肝纤维化具有一定的诊断价值,值得临床进一步研究。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 肝纤维化, 空腹C肽, Logistic分析, 诊断

Abstract: Objective The purpose of this study was to explore the clinical value of fasting C-peptide in assessing the progression of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods 456 patients with NAFLD and T2DM were recruited in this study, and all of them underwent liver stiffness measurement (LSM), which showed that 41 patients had progressive hepatic fibrosis (PHF, LSM >7.9 kPa) and 415 hadn’t (Nphf, LSM ＜7.9 kPa). The Logistic regression analysis was applied to explore the risk factors of liver fibrosis progression, and the receiver operating characteristic curve(ROC) was used to evaluate the diagnostic value of fasting C-peptide for progressive liver fibrosis in this setting. Results The blood HDL-C, PLT counts, serum AST, fasting C-peptide and HbA1c levels in patients with PHF were (1.5±0.2)mmol/L, (259.3±50.3)×10⁹/L, (39.3±5.1)U/L, (2.7±0.8)ng/ml and (10.7±1.0)%, significantly different as compared to 【(1.4±0.3)mmol/L, (267.1±48.2)×10⁹/L, (26.1±4.1)U/L,(2.1±0.7)ng/ml and (8.1±1.1)%, respectively, P<0.05】 in patients with nPHF; non-conditional univariate analysis and multivariate analysis showed that the age , gender (OR=1.250, 95% CI:1.005-1.554, P=0.045), BMI (OR=1.117, 95% CI:1.011-1.235, P=0.030), HbA1c level (OR=1.117, 95% CI:1.011-1.235, P=0.030) and fasting C-peptide (OR=1.206, 95% CI:1.068-1.361, P=0.003) were the risk factors, and the ROC analysis demonstrated that the area under ROC (AUC) for fasting C peptide was 0.7 (95% CI:0.7-0.81, P<0.05), e.g. when serum fasting C-peptide level equal to 2.36 ng/mL as the cut-off-value, the sensitivity was 73.2% and the specificity was 67.0%. Conclusion The application of fasting C-peptide in the diagnosis of PHF in patients with NAFLD and T2DM is valuable, which warrants further investigation.

Key words: Nonalcoholic fatty liver disease, Type 2 diabetes mellitus, Liver fibrosis, Fasting C-peptide, Logistic analysis, Diagnosis

陈丽丽, 符茂雄, 蒙绪标, 方其超. 空腹C肽评估NAFLD合并T2DM患者肝纤维化进展价值分析^*[J]. 实用肝脏病杂志, 2020, 23(1): 38-41.

Chen Lili, Fu Maoxiong, Meng Xubiao, et al. Clinical value of fasting C-peptide in assessing the progression of liver fibrosis in patients with NAFLD and T2DM[J]. Journal of Practical Hepatology, 2020, 23(1): 38-41.

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空腹C肽评估NAFLD合并T2DM患者肝纤维化进展价值分析^*

Clinical value of fasting C-peptide in assessing the progression of liver fibrosis in patients with NAFLD and T2DM

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