摘要
目的 探讨T2DM合并代谢相关脂肪性肝病(MAFLD)肝纤维化的相关炎症指标.方法 选取2020年1月至2023年12月于徐州医科大学第二附属医院内分泌科住院治疗的T2DM患者769例,根据是否合并MAFLD分为单纯T2DM组(n=389)和MAFLD组(n=380).依据FIB-4评分将MAFLD组分为非肝纤维化亚组(FIB-4<1.3,n=267)、可疑肝纤维化亚组(1.3≤FIB-4≤2.67,n=99)和肝纤维化进展期亚组(FIB-4>2.67,n=14).比较各组一般资料和生化指标,Logistic回归分析T2DM合并MAFLD患者肝纤维化的影响因素.受试者工作特征(ROC)曲线分析中性粒细胞/淋巴细胞比值(NLR)、全身炎症反应指数(SIRI)、血小板/淋巴细胞比值(PLR)、血小板/HDL-C比值(PHR)预测T2DM合并MAFLD肝纤维化的诊断价值.结果 MAFLD组BMI、淋巴细胞(LY)、红细胞(RBC)、血红蛋白(Hb)、FPG、TG、TC、LDL-C、谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、谷氨酰转移酶(GGT)、血尿酸(SUA)高于T2DM组(P<0.05),年龄、DM病程、平均血小板体积、HDL-C低于T2DM组(P<0.05).与非肝纤维化亚组比较,可疑肝纤维化亚组年龄、DM病程、平均红细胞体积、AST、NLR升高(P<0.05),LY、PLR、PHR降低(P<0.05),肝纤维化进展期亚组年龄、AST、NLR升高(P<0.05),LY、RBC、LDL-C、PLR、PHR降低(P<0.05).与可疑肝纤维化亚组比较,肝纤维化进展期亚组FPG、HbA1c、SIRI升高(P<0.05),Hb、PLT、ALB降低(P<0.05).Logistic回归分析显示,NLR、SIRI、PLR、PHR是T2DM合并MAFLD肝纤维化的影响因素.NLR、SIRI、PLR、PHR预测T2DM合并MAFLD肝纤维化曲线下面积分别为 0.712、0.757、0.703、0.806,敏感度分别为0.929、0.500、0.857、0.929,特异度分别为0.388、0.902、0.497、0.593,最佳截断值分别为 1.573、1.465、110.819、185.379.结论 NLR、SIRI、PLR、PHR是T2DM合并MAFLD患者肝纤维化的影响因素,对其诊断具有辅助作用.
Objective To explore the correlation between inflammatory markers and fibrosis of metabolic dysfunction‑associated fatty liver disease(MAFLD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 769 hospitalized patients with T2DM were enrolled in this study from the Department of Endocrinology,The Second Affiliated Hospital of Xuzhou Medical University from January 2020 to December 2023.They were divided into T2DM group(n=389)and MAFLD group(n=380)according to whether they were combined with MAFLD.According to the FIB‑4 score,the MAFLD group was further divided into non‑hepatic fibrosis subgroup(FIB‑4<1.3,n=267),suspected hepatic fibrosis subgroup(1.3≤FIB‑4≤2.67,n=99)and advanced hepatic fibrosis subgroup(FIB‑4>2.67,n=14).The general data and biochemical indicators of each group were compared,Logistic regression analysis of influencing factors for liver fibrosis in T2DM patients with MAFLD.The diagnostic value of NLR,SIRI,PLR and PHR in predicting T2DM complicated with MAFLD liver fibrosis was evaluated by ROC curve analysis.Results BMI,lymphocytes(LY),red blood cells(RBC),hemoglobin(Hb),FPG,TG,TC,LDL‑C,alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),γ‑glutamyl transpeptidase(GGT),and serum uric acid(SUA)were higher,while age,duration of DM,mean platelet volume and high‑density lipoprotein cholestero(l HDL‑C)were lower in MAFLD group than in T2DM group(P<0.05).Compared with the non‑hepatic fibrosis subgroup,the age,duration of DM,mean platelet volume AST and NLR were increased,while LY,PLR and PHR were decreased in the suspected hepatic fibrosis subgroup(P<0.05).The age,AST and NLR were higher,while LY,RBC,LDL‑C,PLR and PHR were lowerin the advanced hepatic fibrosis subgroup than in non‑hepatic fibrosis subgroup(P<0.05).Compared with the suspected hepatic fibrosis subgroup,FPG,HbA1c and SIRI were increased(P<0.05),however,Hb,PLT and ALB were decreased in the advanced hepatic fibrosis subgroup(P<0.05).Logistic regression analysis showed that N
作者
张莹
黄蕤
张雪
樊宽鲁
ZHANG Ying;HUANG Rui;ZHANG Xue(Department of Endocrinology,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2024年第10期731-736,共6页
Chinese Journal of Diabetes
基金
徐州医科大学附属医院发展基金(XYFC2020005)。
关键词
炎症指标
糖尿病
2型
代谢相关脂肪性肝病
肝纤维化
Inflammatory markers
Diabetes mellitus,type 2
Metabolic dysfunction‑associated fatty liver disease
Liver fibrosis