2型糖尿病合并代谢相关脂肪性肝病的危险因素分析及与促甲状腺素、骨钙素的相关性研究

摘要/Abstract

摘要： 目的分析2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)的危险因素,探讨其与促甲状腺素(TSH)和骨钙素(OC)的相关性。方法收集海安市人民医院内分泌科2022年1月至2024年3月收治的T2DM患者372例,根据腹部彩超检查结果分为MAFLD组(n=228)和无MAFLD组(n=144);收集和比较两组的基线资料和临床指标,采用logistic多因素回归分析T2DM患者发生MAFLD的危险因素,绘制ROC曲线分析单个高危因素和预测模型的评估价值。结果 T2DM合并MAFLD组的BMI、FBG、HbA_1c、ALT、AST、ALP、TG、TyG、TSH水平分别为(26.38±1.45)kg/m²、(8.35±1.76)mmol/L、8.79%±1.83%、(35.68±5.92)U/L、(41.56±6.41)U/L、(79.68±9.53)U/L、(2.14±0.53)mmol/L、8.85±1.79、(1.96±0.48)μU/mL,高于无MAFLD组的(24.52±1.34)kg/m²、(7.26±1.54)mmol/L、7.32%±1.51%、(32.57±5.63)U/L、(37.18±6.15)U/L、(61.37±8.64)U/L、(1.85±0.49)mmol/L、7.24±1.46、(1.63±0.42)μU/mL;合并MAFLD组的OC水平为(4.02±0.85)ng/L,无MAFLD组为(6.38±1.02) ng/L,差异有统计学意义(t/χ²分别为6.028、5.794、6.372、5.872、5.659、6.836、5.328、6.578、7.204、8.529,均P<0.05)。Logistic回归分析显示,HbA_1c、ALP、TyG、TSH水平升高,以及OC水平下降是T2DM患者发生MAFLD的独立影响因素(95%CI分别为0.964～1.478、0.624～1.056、1.027～1.619、0.839～1.372、0.706～1.235,OR分别为1.217、0.839、1.348、1.105、0.972,均P<0.05);其中TyG的灵敏度最高,HbA_1c的特异度最高。结论 HbA_1c、ALP、TyG、TSH水平升高和OC水平下降,是T2DM患者发生MAFLD独立危险因素,可为早期预警、早期诊断和及时干预提供参考依据。

Abstract: Objective To analyze the risk factors of type 2 diabetes mellitus (T2DM) combined with metabolically associated fatty liver disease (MAFLD), and explore the correlation with thyrotropin (TSH) and osteocalcin (OC). Methods A total of 372 T2DM patients admitted to the Department of Endocrinology of Haian People's Hospital from January 2022 to March 2024 were collected and divided into MAFLD group (n=228) and non-MAFLD group (n=144) according to the results of abdominal color ultrasonography. Baseline data and clinical indicators of the two groups were collected and compared. Multivariate logistic regression was used to analyze the risk factors for MAFLD in T2DM patients, and the evaluation value of individual risk factors and prediction model was plotted by ROC analysis. Results The levels of BMI, FBG, HbA1c, ALT, AST, ALP, TG, TyG and TSH in T2DM group with MAFLD were (26.38±1.45) kg/m², (8.35±1.76) mmol/L, 8.79%±1.83%, (35.68±5.92) U/L and (41.56±6.41) U /L, (79.68±9.53) U/L, (2.14±0.53) mmol/L, 8.85±1.79, (1.96±0.48) μU/mL, higher than that in the non-MAFLD group [(24.52±1.34) kg/m², (7.26±1.54) mmol/L, 7.32%±1.51%, (32.57±5.63) U/L, (37.18±6.15) U/L, (61.37±8.64) U/L, (1.85±0.49) mmol/L, 7.24±1.46, (1.63±0.42) μU/mL)]; The OC level in the MAFLD group was (4.02±0.85) ng/L, and the difference was statistically significant between two groups (6.38±1.02 ng/L) (t/χ²=6.028, 5.794,6.372,5.872, 5.659, 6.836, 5.328, 6.578, 7.204, 8.529, all P<0.05). Logistic regression analysis showed that increased levels of HbA1c, ALP, TyG and TSH and decreased levels of OC were independent influencing factors for the occurrence of MAFLD in T2DM patients (95%CI 0.964~1.478, 0.624~1.056, 1.027~1.619, 0.839~1.372, 0.706~1.235. OR=1.217, 0.839, 1.348, 1.105, 0.972, all P<0.05); TyG had the highest sensitivity and HbA1c had the highest specificity. Conclusion The elevated levels of HbA1c, ALP, TyG and TSH and the decreased levels of OC are independent risk factors for NAFLD in T2DM patients, which can provide a reference for early diagnosis and timely intervention.

Key words: Type 2 diabetes mellitus, Metabolically associated fatty liver disease, Risk factors, Thyrotropin, Osteocalcin

叶晶晶, 李建平, 顾艳红, 席巍. 2型糖尿病合并代谢相关脂肪性肝病的危险因素分析及与促甲状腺素、骨钙素的相关性研究[J]. 肝脏, 2025, 30(12): 1700-1705.

YE Jing-jing, LI Jian-ping, GU Yan-hong, XI Wei. Risk factors analysis of type 2 diabetes mellitus with metabolically associated fatty liver disease and correlation with thyrotropin and osteocalcin[J]. Chinese Hepatolgy, 2025, 30(12): 1700-1705.

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