血清A1AT水平与2型糖尿病合并非酒精性脂肪肝及肝脏纤维化的关联性分析  

Analysis on the correlation between serum A1AT level and type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease and liver fibrosis

作　　者：泽娜 米玛次仁 扎西卓玛[1] ZE Na;Mimaciren;Zhaxizhuoma(Department of Clinical Laboratory,the Second People′s Hospital of Tibet Autonomous Region,Lhasa 850030,China)

机构地区：[1]西藏自治区第二人民医院检验科,拉萨850030 [2]西藏自治区第二人民医院内科,拉萨850030

出　　处：《中国临床新医学》2023年第8期816-820,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：西藏自治区科技计划项目(编号:XZ202001Y0005C)。

摘　　要：目的分析血清α1抗胰蛋白酶(A1AT)水平与2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)及肝脏纤维化的关联性。方法招募2019年3月至2020年3月西藏自治区第二人民医院收治的117例T2DM合并NAFLD患者为T2DM+NAFLD组,于同期纳入性别、年龄与NAFLD+T2DM组匹配的单纯T2DM患者(单纯T2DM组)和健康体检者(对照组)各80例。采用免疫比浊法检测血清A1AT水平,采用非酒精性脂肪肝纤维化评分(NAFLDFS)评估患者肝脏纤维化情况。采用多因素logistic回归分析T2DM合并NAFLD的影响因素,采用受试者工作特征(ROC)曲线分析血清A1AT水平对T2DM合并NAFLD的诊断价值,采用Spearman秩相关分析血清A1AT水平与NAFLDFS的相关性。结果多因素logistic回归分析结果显示,较高水平的空腹血糖(FPG)、空腹胰岛素(FINS)、HOMA稳态模型计算胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、肝脏脂肪含量(LFC)和A1AT是T2DM患者发生NAFLD的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清A1AT水平具有诊断T2DM患者发生NAFLD的应用价值[AUC(95%CI)=0.793(0.758~0.829),P<0.001],其最佳截断值为2.91 g/L,对应的灵敏度和特异度分别为0.81、0.69。Spearman秩相关分析结果显示,T2DM合并NAFLD患者血清A1AT水平与NAFLDFS呈正相关性(r s=0.635,P<0.001)。结论血清A1AT在T2DM合并NAFLD患者中表达上升,可作为辅助诊断T2DM患者合并NAFLD以及评估肝纤维化程度的生化标志物。Objective To analyze the correlation between serum alpha 1-antitrypsin(A1AT)level and type 2 diabetes mellitus(T2DM)complicated with non-alcoholic fatty liver disease(NAFLD)and liver fibrosis.Methods One hundred and seventeen T2DM patients complicated with NAFLD who were admitted to the Second People′s Hospital of Tibet Autonomous Region from March 2019 to March 2020 were enrolled as the T2DM+NAFLD group,and 80 T2DM patients(the T2DM group)and 80 healthy subjects(the control group)matched with the NAFLD+T2DM group in gender and age were enrolled during the same period.The serum levels of A1AT were detected by immunoturbidimetry,and liver fibrosis was evaluated by non-alcoholic fatty liver disease fibrosis score(NAFLDFS).Multivariate logistic regression was used to analyze the influencing factors of T2DM complicated with NAFLD.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of serum A1AT level in T2DM complicated with NAFLD.Spearman rank correlation was used to analyze the correlation between serum A1AT level and NAFLDFS.Results The results of multivariate logistic regression analysis showed that higher levels of fasting blood glucose(FPG),fasting insulin(FINS),homeostasis model assessment(HOMA)insulin resistant index(HOMA-IR),triglyceride(TG),liver fat content(LFC)and A1AT were independent risk factors for NAFLD in the T2DM patients(P<0.05).The results of ROC curve analysis showed that serum A1AT level had the application value in diagnosing NAFLD in the T2DM patients[AUC(95%CI)=0.793(0.758-0.829),P<0.001],and its optimal cut-off value was 2.91 g/L,and the corresponding sensitivity and specificity were 0.81 and 0.69,respectively.The results of Spearman rank correlation analysis showed that serum A1AT level in the T2DM complicated with NAFLD patients was positively correlated with NAFLDFS(r s=0.635,P<0.001).Conclusion Serum A1AT is up-expressed in the T2DM complicated with NAFLD patients,which can be used as a biochemical marker to assist the diagnosis of NAFLD and to evalua

关 键 词：Α1抗胰蛋白酶 2型糖尿病 非酒精性脂肪肝 肝纤维化 

分 类 号：R589.2[医药卫生—内分泌]