肥胖患者不同糖代谢状态对非酒精性脂肪性肝病严重程度的影响  

The impact of different glucose metabolism status onnonalcoholic fatty liver disease in obese patients

作　　者：陈有为 康星[2] 严雨 俞杭 陈思含 孙喜太[1,2] CHEN Youwei;KANG Xing;YAN Yu;YU Hang;CHEN Sihan;SUN Xitai(Nanjing University Medical School,Nanjing Jiangsu 210008;Bariatric Surgery and Metabolism Disease Center,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing Jiangsu 210008,China)

机构地区：[1]南京大学医学院,江苏南京210008 [2]南京大学医学院附属鼓楼医院减重代谢外科,江苏南京210008

出　　处：《江苏大学学报（医学版）》2023年第3期231-238,共8页Journal of Jiangsu University：Medicine Edition

摘　　要：目的:探讨肥胖患者不同糖代谢状态对非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)严重程度的影响。方法:选取2018年7月至2021年7月行减重手术的111例肥胖合并NAFLD患者为研究对象,根据不同糖代谢状态分为2型糖尿病(T2DM)组与非T2DM组,比较两组基线资料及NAFLD不同病理变化的发生率;采用Spearman相关分析糖代谢参数与NAFLD各病理严重程度间的相关性;采用Lasso回归对数据进行共线性分析;应用单因素与多因素Logistic回归分析非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)的影响因素;采用受试者工作特征(ROC)曲线评估影响因素对NASH的预测价值。结果:T2DM组肝脂肪变性评分及NAFLD活动度评分明显高于非T2DM组(P均<0.05)。相比于非T2DM组,T2DM组患者肝脏脂肪变性较为严重且NASH及肝纤维化例数占比更高,差异具有统计学意义(P<0.05)。空腹胰岛素、空腹C肽、糖化血红蛋白(HbA1c)、稳态模型评估胰岛素抵抗指数(HOMA-IR)与肝脏脂肪变性程度呈正相关(P<0.05),与肝小叶炎症程度、气球样变及肝纤维化程度无明显相关性(P>0.05);单因素Logistic回归分析显示BMI、空腹血糖、空腹C肽、HbA1c、HOMA-IR为NASH的影响因素;Lasso回归变量选择为BMI、HbA1c、空腹C肽、空腹血糖;进一步采用多因素Logistic回归向前LR法及向前条件法排除相关混杂因素后,结果显示空腹C肽为NASH的独立预测因素;ROC曲线显示空腹C肽预测NASH的曲线下面积为0.754(95%CI:0.609~0.899,P=0.001)。结论:当肥胖患者存在糖代谢紊乱时,会增加NAFLD肝脏脂肪变性的严重程度,并促进非酒精性脂肪肝向NASH及肝纤维化的转变;随着空腹C肽值的升高,发生NASH的可能性也会随之增加。Objective:To explore the effect of different glucose metabolism status on nonalcoholic fatty liver disease(NAFLD)in patients with obesity.Methods:A total of 111 obese patients with NAFLD who underwent bariatric surgery from July 2018 to July 2021 were enrolled.All patients were divided into type 2 diabetes group and non-type 2 diabetes group according to different glucose metabolism status.The basic information and incidence of pathological changes of NAFLD of two groups were compared.Spearman correlation analysis was applied to investigate the correlation between glucose metabolism parameters and different pathological changes of NAFLD.The collinearity of data was analyzed by lasso regression.Univariate and multivariate logistic regression were used to analyze the impact factors associated with non-alcoholic steatohepatitis(NASH).Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of impact factors in NASH.Results:The scores of liver steatosis and NAFLD activity in type 2 diabetes group were significantly higher than that of non-type 2 diabetes group(P<0.05).Comparing with non type 2 diabetes group,the hepatic steatosis in type 2 diabetes group were more severe and the incidence of NASH and hepatic fibrosis even higher,the difference was statistically significant(P<0.05).The fasting insulin,fasting C-peptide,HbA1c,and homeostasis model assessment of insulin resistance(HOMA-IR)were positively correlated with degree of liver steatosis,while there was no correlation with the degree of liver lobule inflammation,ballooning degeneration and hepatic fibrosis.Univariate logistic regression analysis showed that BMI,fasting blood glucose,fasting C-peptide,HbA1c and HOMA-IR were all impact factors of NASH.Lasso regression variables were selected as following:BMI,HbA1c,fasting C-peptide,fasting blood glucose.Then the forward LR and forward conditional method of multivariate were used to control confounding factors and showed that fasting C-peptide was an independent risk factor for NASH.ROC

关 键 词：肥胖 非酒精性脂肪性肝病 2型糖尿病 空腹C肽 

分 类 号：R589.2[医药卫生—内分泌]