新诊断糖尿病合并NAFLD患者血清高分子量脂联素、HOMA-IR及其比值与肝纤维化的相关性

摘要/Abstract

摘要： 目的探讨新诊断2型糖尿病合并非酒精性脂肪性肝病(NAFLD)患者血清高分子量脂联素(HMWA)、稳态模型胰岛素抵抗指数(HOMA-IR)及两者比值(A/H)与肝纤维化的相关性。方法回顾性分析2020年5月至2021年5月广州市花都区人民医院收治的279例新诊断2型糖尿病合并NAFLD患者的临床资料,分析其肝纤维化发生情况,并采用单因素分析、多因素logistic 回归分析法探讨患者肝纤维化的独立影响因素,判断HMWA、HOMA-IR和A/H比值对肝纤维化的预测价值。结果新诊断2型糖尿病合并NAFLD患者肝纤维化患病率为15.77％(44/279)。肝纤维化患者血清HMWA、HOMA-IR和A/H比值水平分别为1.20(0.91,1.78) mg/L、3.41(2.57,5.70)和0.33(0.18,0.62),非肝纤维化患者血清HMWA、HOMA-IR和A/H比值水平分别为2.74(1.57,3.84)mg/L、2.18(1.61,3.12)和1.21(0.55,2.16)。两组患者血清HMWA、HOMA-IR和A/H比值水平比较,差异均有统计学意义(P<0.05)。除年龄、腰围外,HMWA、HOMA-IR和A/H亦是2型糖尿病合并NAFLD患者发生肝纤维化的独立影响因素(P<0.05),且其对肝纤维化有一定预测价值,A/H的曲线下面积明显大于HMWA和HOMA-IR(Z=2.768,P=0.006;Z=2.491,P=0.013),当A/H比值最佳截断值为0.52时,灵敏度为75.00%,特异度为78.72%。结论 HMWA、HOMA-I和A/H与2型糖尿病合并NAFLD患者肝纤维化发生风险独立相关,并具有一定预测价值,A/H的预测效能最佳。

关键词: 2型糖尿病, 非酒精性脂肪性肝病, 肝纤维化, 高分子量脂联素, 稳态模型胰岛素抵抗指数, 比值, 预测价值

Abstract: Objective To investigate the association between serum high-molecular weight adiponectin(HMWA),homeostatic model assessment insulin resistance index (HOMA-IR)and their ratio(A/H)and liver fibrosis in patients with newly diagnosed type 2 diabetes mellitus(T2DM)and nonalcoholic fatty liver disease(NAFLD). Methods The clinical data of 279 newly diagnosed T2DM patients with NAFLD enrolled in our hospital from May 2020 to May 2021 were retrospectively analyzed for their status of liver fibrosis.Univariate analysis and multivariate logistic regression analysis was applied to explore the independent influence factors of liver fibrosis,and to determine the predictive value of HMWA, HOMA-IR and A/H ratio for liver fibrosis. Results The prevalence of liver fibrosis in newly diagnosed T2DM patients with NAFLD was 15.77%(44/279).The serum levels of HMWA,HOMA-IR and A/H ratio of patients with liver fibrosis were 1.20 (0.91,1.78) mg/L,3.41 (2.57,5.70) and 0.33 (0.18,0.62),respectively.The serum levels of HMWA,HOMA-IR and A/H ratio of patients with non-liver fibrosis were 2.74 (1.57,3.84) mg/L,2.18 (1.61,3.12) and 1.21 (0.55,2.16) respectively. There were significant differences in the serum levels of HMWA,HOMA-IR and A/H ratio between the two groups(P<0.05).In addition to age and waist circumference,HMWA,HOMA-IR and A/H ratio were also independent predictive factor associated with liver fibrosis(P<0.05),and had a certain predictive value for liver fibrosis. The area under the curve of A/H was significantly larger than those of HMWA and HOMA-IR(Z=2.768,P=0.006;Z=2.491,P=0.013). The optimal cutoff value of the A/H ratio was 0.52,which displayed a sensitivity of 75.00% and a specificity of 78.72% for the prediction of liver fibrosis in newly diagnosed T2DM patients with NAFLD. Conclusion HMWA,HOMA-I and A/H are independently associated with the risk of liver fibrosis in newly diagnosed T2DM patients with NAFLD,and have certain predictive value. A/H has the best predictive efficacy.

Key words: Type 2 diabetes mellitus, Nonalcoholic fatty liver disease, High-molecular weight adiponectin, Liver fibrosis, Homeostatic model assessment insulin resistance index, Ratio, Predictive value

戈荧, 颜文盛, 张艳飞. 新诊断糖尿病合并NAFLD患者血清高分子量脂联素、HOMA-IR及其比值与肝纤维化的相关性[J]. 肝脏, 2021, 26(12): 1364-1368.

GE Ying, YAN Wen-sheng, ZHANG Yan-fei. Association between serum high-molecular weight adiponectin,homeostatic model assessment insulin resistance index and their ratio and liver fibrosis in newly diagnosed diabetic patients with nonalcoholic fatty liver disease[J]. Chinese Hepatolgy, 2021, 26(12): 1364-1368.

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