2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化检出率及预测因素分析*

doi:10.3969/j.issn.1672-5069.2024.02.009

摘要/Abstract

摘要： 目的探讨2型糖尿病(T2DM)患者非酒精性脂肪性肝病(NAFLD)及其肝纤维化发生率和影响因素。方法 2020年4月～2022年4月我院收治的482例T2DM患者, 使用超声检查诊断NAFLD, 检测杨氏模量值诊断肝纤维化。应用Lasso回归模型和有序多分类Logistic回归分析法筛查和分析T2DM患者罹患NAFLD严重程度的风险因素, 绘制受试者工作特征(ROC)曲线评估风险因素预测NAFLD患者发生肝纤维化的效能。结果在482例T2DM患者中, 诊断NAFLD者276例(57.3%), 后者包括肝纤维化者58例(12.0%); T2DM/NAFLD/肝纤维化组年龄、周围神经病发生率、体质指数和杨氏模量值分别为(46.0±4.2)岁、82.8%、(28.3±3.2)kg/m²和(10.8±2.2)kPa, 均显著大于T2DM/NAFLD组【分别为(45.6±4.9)岁、45.4%、(27.9±3.1)kg/m²和(5.3±1.0)kPa, P<0.05】或T2DM组【分别为(42.5±5.8)岁、44.2%、(25.0±2.7)kg/m²和(4.8±0.6)kPa, P<0.05】;T2DM/NAFLD/肝纤维化组血清甘油三酯、尿酸、HOMA-IR、甘油三酯/血糖/体质指数、血清TNF-α和IL-6水平分别为(2.6±0.8)mmol/L、(355.2±24.6)μmol/L、(2.6±0.4)、(270.8±18.5)、(8.2±2.3)pg/ml和(13.6±2.4)pg/ml, 显著大于T2DM/NAFLD组【分别为(2.2±0.4)mmol/L、(334.6±31.0)μmol/L、(2.6±0.4)、(219.1±40.4^①)、(5.5±1.4)pg/ml和(9.7±2.1)pg/ml, P<0.05】或T2DM 【分别为(2.1±0.5)mmol/L、(328.7±36.8)μmol/L、(2.3±0.7)、(207.9±39.1)、(5.3±1.1)pg/ml和(6.7±1.1)pg/ml, P<0.05】;LASSO回归和多因素Logistic回归分析结果显示, TyG-BMI(OR=1.012, P=0.000)、IL-6(OR=2.782, P=0.000)、TNF-α(OR=1.008, P=0.026)、UA(OR=1.530, P=0.000)和糖尿病周围神经病(OR=1.855, P=0.010)为T2DM患者罹患NAFLD严重程度的独立危险因素;ROC曲线分析结果显示, TyG-BMI、IL-6、TNF-α和UA预测患者发生肝纤维化的曲线下面积(AUC)分别为0.897、0.928、0.840和0.762。结论 T2DM合并NAFLD患者可能会进展至肝纤维化, 了解一些预测因子并进行有效的干预可能能延缓病情发展。

关键词: 非酒精性脂肪性肝病, 肝纤维化, 2型糖尿病, Lasso回归模型, 诊断

Abstract: Objective The aim of this study was to investigate the risk factors for liver fibrosis (LF) in patients with diabetes mellitus type 2 (T2DM) and non-alcoholic fatty liver diseases(NAFLD). Methods 482 patients with T2DM were recruited in our hospital between April 2020 and April 2022, and the NAFLD was diagnosed based on ultrasonography and the LF was determined by the Young's modulus. The Lasso regression model and ordinal multicategory Logistic regression were applied to reveal the risk factors for LF, and the receiver operating characteristic curves(ROC) was drawn to assess the predictive efficacy of risk factors for LF in patients with NAFLD. Results Out of the 482 patients with T2DM in our series, the concomitant NAFLD was found in 276 cases(57.3%), including LF in 58 cases(12.0%) in the latter; the age, incidence of peripheral neuropathy (PN), body mass index and Young's modulus in patients with T2DM/NAFLD/LF were (46.0±4.2)yr, 82.8%, (28.3±3.2)kg/m² and (10.8±2.2)kPa, all significantly higher than in patients with T2DM/NAFLD or in patients with T2DM; blood TG, UA, HOMA-IR, ratio of triglyceride glucose/body mass index (TyG-BMI), serum TNF-α and IL-6 level in patients with T2DM/NAFLD/LF were(2.6±0.8)mmol/L, (355.2±24.6)μmol/L, (2.6±0.4), (270.8±18.5), (8.2±2.3)pg/ml and (13.6±2.4)pg/ml, all significantly higher than in patients with T2DM/NAFLD or in patients with T2DM; the LASSO and multivariate Logistic regression analysis showed that the ratio of TyG-BMI(OR=1.012, P=0.000), IL-6(OR=2.782, P=0.000), TNF-α(OR=1.008, P=0.026), UA(OR=1.530, P=0.000) and PN (OR=1.855, P=0.010) were the independent risk factors for the severe NAFLD in patients with T2DM; the ROC analysis demonstrated that the AUCs were 0.897, 0.928, 0.840 and 0.762, when the ratio of TyG-BMI, IL-6, TNF-α and UA were applied to predict LF in patients with T2DM/NAFLD. Conclusions The LF could deteriorate the disease in patients with T2DM/NAFLD, and the clinicians should take the risk factors into consideration and the early intervention might improve the prognosis.

Key words: Non-alcoholic fatty liver diseases, Type 2 diabetes mellitus, Liver fibrosis, Lasso regression model, Diagnosis

李敏, 张丽, 曾艾, 刘世裕. 2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化检出率及预测因素分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 193-197.

Li Min, Zhang Li, Zeng Ai, et al.. Liver fibrosis in patients with diabetes mellitus type 2 and non-alcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2024, 27(2): 193-197.

参考文献

[1] Mantovani A, Petracca G, Beatrice G, et al. Non-alcoholic fatty liver disease and risk of incident diabetes mellitus: an updated meta-analysis of 501 022 adult individuals. Gut, 2021,70(5):962-969.
[2] Sinn DH, Kang D, Cho SJ, et al. Lean non-alcoholic fatty liver disease and development of diabetes: a cohort study. Eur J Endocrinol, 2019,181(2):185-192.
[3] Li B, Zhang C, Zhan YT. Nonalcoholic fatty liver disease cirrhosis: a review of its epidemiology, risk factors, clinical presentation, diagnosis, management, and prognosis. Can J Gastroenterol Hepatol, 2018,2018(6):2784537.
[4] Hu Y, Shi R, Mo R, et al. Nomogram for the prediction of diabetic nephropathy risk among patients with type 2 diabetes mellitus based on a questionnaire and biochemical indicators: a retrospective study. Aging (Albany NY), 2020,12(11):10317-10336.
[5] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪肝专家委员会.非酒精性脂肪性肝病防治指南 (2018年版).实用肝脏病杂志,2018,21(2):177-186.
[6] Xia S, Ren X, Ni Z, et al. A noninvasive method——shear-wave elastography compared with transient elastography in evaluation of liver fibrosis in patients with chronic hepatitis B. Ultrasound Q, 2019,35(2):147-152.
[7] 中华医学会内分泌学分会. 非酒精性脂肪性肝病与相关代谢紊乱诊疗共识(第二版). 中华内分泌代谢杂志, 2018,34(7):549-554.
[8] Hameed EK. Tyg index a promising biomarker for glycemic control in type 2 diabetes mellitus. Diabetes Metab Syndr, 2019,13(1):560-563.
[9] Tada T, Toyoda H, Sone Y, et al. Type 2 diabetes mellitus: a risk factor for progression of liver fibrosis in middle-aged patients with non-alcoholic fatty liver disease. J Gastroenterol Hepatol, 2019,34(11):2011-2018.
[10] Cusi K, Sanyal AJ, Zhang S, et al. Non-alcoholic fatty liver disease (nafld) prevalence and its metabolic associations in patients with type 1 diabetes and type 2 diabetes. Diabetes Obes Metab, 2017,19(11):1630-1634.
[11] Kim K, Oh TJ, Cho HC, et al. Liver fibrosis indices are related to diabetic peripheral neuropathy in individuals with type 2 diabetes. Sci Rep, 2021,11(1):24372.
[12] Huang J, Li R, Liu N, et al. Liver fibrosis is independently associated with diabetic peripheral neuropathy in type 2 diabetes mellitus. J Diabetes Investig, 2021,12(11):2019-2027.
[13] Greco C, Nascimbeni F, Carubbi F, et al. Association of nonalcoholic fatty liver disease (nafld) with peripheral diabetic polyneuropathy: a systematic review and meta-analysis. J Clin Med, 2021,10(19):4466.
[14] Mirr M, Skrypnik D, Bogdański P, et al. Newly proposed insulin resistance indexes called tyg-nc and tyg-nhtr show efficacy in diagnosing the metabolic syndrome. J Endocrinol Invest, 2021,44(12):2831-2843.
[15] Paschalis P, Athyros Vasilios G, Achilleas T, et al. Can serum uric acid lowering therapy contribute to the prevention or treatment of nonalcoholic fatty liver disease? Curr Vasc Pharmacol, 2018,16(3):269-275.
[16] Sandra S, Lesmana C, Purnamasari D, et al. Hyperuricemia as an independent risk factor for non-alcoholic fatty liver disease (nafld) progression evaluated using controlled attenuation parameter-transient elastography: lesson learnt from tertiary referral center. Diabetes Metab Syndr, 2019,13(1):424-428.
[17] Stefan N, Cusi K. A global view of the interplay between non-alcoholic fatty liver disease and diabetes. Lancet Diabetes Endocrinol, 2022,10(4):284-296.
[18] Manilla V, Santopaolo F, Gasbarrini A, Ponziani FR.Type 2 Diabetes Mellitus and Liver Disease: Across the Gut-Liver Axis from Fibrosis to Cancer. Nutrients, 2023,15(11):2521.
[19] Jorge A, Andrade J, Paraíso AF, et al. Body mass index and the visceral adipose tissue expression of il-6 and tnf-alpha are associated with the morphological severity of non-alcoholic fatty liver disease in individuals with class iii obesity. Obes Res Clin Pract, 2018,12(2):1-8.
[20] Milaciu MV, Ciumărnean L, Matei DM, et al. Cytokines, paraoxonase-1, periostin and non-invasive liver fibrosis scores in patients with non-alcoholic fatty liver disease and persistently elevated aminotransferases: a pilot study. Exp Ther Med, 2021,21(5):533.

2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化检出率及预测因素分析^*

Liver fibrosis in patients with diabetes mellitus type 2 and non-alcoholic fatty liver diseases

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	徐京杭, 于岩岩, 徐小元. 肝硬化临床研究进展[J]. 实用肝脏病杂志, 2024, 27(2): 161-164.
[2]	高洋, 张静, 卢宣霖. 非酒精性脂肪性肝病患者血清IL-1RA、CTRP13和CK-18水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2024, 27(2): 185-188.
[3]	郭萌, 郭琦, 张峰. 超声瞬时弹性成像检测受控衰减参数评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 189-192.
[4]	郑波, 哈丽达·夏尔甫哈孜, 谈理. 非酒精性脂肪性肝病患者血清HIF-1α、HMGB1和脂联素水平变化及其与颈动脉粥样硬化的关系研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 198-201.
[5]	童静, 张珂瓈, 李昌平. 非酒精性脂肪性肝炎患者血清前神经降压素和微小RNA-122水平变化及其诊断脂肪性肝炎的价值探讨^*[J]. 实用肝脏病杂志, 2024, 27(2): 202-205.
[6]	万贵香, 李忠廉, 赵亚博, 梁微微, 杜辉, 宁振海, 周媛, 万亮. 恩替卡韦联合扶正解毒散结方治疗乙型肝炎肝硬化患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 234-237.
[7]	朱春芬, 任春霖, 郭霞. 血清NT-ProBNP和TnI联合心电图检查早期诊断肝硬化性心肌病价值研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 242-245.
[8]	冯彦菲, 苏明华, 殷倩冰, 黎清梅, 苏土梅, 梁蘅恺, 韦璐, 黄建芳, 江建宁. 一组非肝硬化性门静脉高压症病因分析和诊断路径探讨^*[J]. 实用肝脏病杂志, 2024, 27(2): 246-250.
[9]	哈鹏, 苏晓晨, 付宾鹏. 三期增强CT扫描联合血清AFP和VEGF水平诊断肝细胞癌患者临床研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 251-254.
[10]	谢晶美, 刘浩, 李安, 李华, 陈苗苗, 郭宝琴, 石洋洋, 朱志敏, 郭晨光. 动态增强MRI定量参数术前评估原发性肝癌患者临床分期研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 255-258.
[11]	崔甜甜, 张海波, 陈莉莉. 能谱CT增强扫描参数鉴别诊断肝血管瘤与肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 275-278.
[12]	魏野, 汪施妤, 葛高华, 井桂银. CT增强扫描与磁共振检查诊断肝血管瘤和肝细胞癌价值分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 279-282.
[13]	贾永利, 王鹏川, 郭伟, 孙东莹. 低频与高频超声联合诊断胆囊息肉样病变价值分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 307-310.
[14]	章正威, 夏德鑫, 朱宝林, 章应峰, 王翔, 张彤. 早期原发性胆囊癌增强磁共振和CT扫描征象分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 311-313.
[15]	诸葛宇征. 重视内脏静脉血栓形成的诊断和管理^*[J]. 实用肝脏病杂志, 2024, 27(1): 1-2.