2型糖尿病合并代谢相关脂肪性肝病患者血清同型半胱氨酸与肝纤维化的相关性  

Association between serum homocysteine and liver fibrosis in T2DM patients with metabolic associated fatty liver disease

作　　者：李卓奇 王嘉欣[1] 唐晚晴 姜雪[1] 张川[1] LI Zhuoqi;WANG Jiaxin;TANG Wanqing;JIANG Xue;ZHANG Chuan(Department of Endocrinology,The Second Hospital of Jilin University,Changchun13004l,China)

机构地区：[1]吉林大学第二医院内分泌科,吉林长春130041

出　　处：《中国实验诊断学》2024年第2期165-169,共5页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)患者血清同型半胱氨酸(HCY)水平与肝纤维化之间的关联。方法选取于吉林大学第二医院收治的T2DM同时伴有MAFLD患者214例,采用肝脏超声影像和瞬时弹性技术测定肝脏硬度(LSM)及受控脂肪衰减参数(CAP),再将入选患者分为非肝纤维化组及肝纤维化组,将肝脂肪变性和显著纤维化分别定义为CAP评分≥260 dB/m和LSM评分≥8 kPa。收集全部病人的基本信息,同时测定了空腹血糖、血脂、肝功、同型半胱氨酸等血液指标,组间比较使用两独立样本t检验、Mann-Whitney检验及χ2检验,用Spearman相关分析方法评价变量与肝纤维化之间的相关程度,将单因素线性回归分析中有统计学意义的变量纳入多因素线性回归中。结果相较于非肝纤维化组,肝纤维化组的体重指数、胰岛素抵抗指数、CAP、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰转肽酶、尿酸、HCY更高(P<0.05),多因素线性回归表明:体重指数、胰岛素抵抗指数、天门冬氨酸氨基转移酶、γ-谷氨酰转肽酶、HCY与LSM独立相关(R2:0.312,调整后R2:0.285,均P<0.05)。结论T2DM合并MAFLD的肝纤维化患者血清中HCY水平较高,HCY是发生肝纤维化的独立危险因素。Objective To investigate the association between serum homocysteine(HCY) levels and liver fibrosis in patients with type 2 diabetes mellitus(T2DM) complicated with Metabolic Associated Fatty Liver Disease(MAFLD).Methods A total of 214 T2DM patients with MAFLD in our hospital were selected.Liver ultrasound imaging and transient elasticity technique were used to detect liver stiffness measurement(LSM) and controlled attenuation parameters(CAP).The selected patients were divided into non-hepatic fibrosis group and fibrosis group.Liver steatosis and significant fibrosis were defined as CAP score ≥260 dB/m and LSM score ≥8 kPa, respectively.Collect the basic information of all patients, and test fasting plasma glucose, blood lipids, liver function, HCY and other blood indicators at the same time.Two independent samples t test or Mann-Whitney test and χ~2 test were used for comparison between groups, Spearman correlation analysis was used to evaluate the correlation between variables and liver fibrosis, and the variables with statistical significance in univariate linear regression analysis were included in multivariate in linear regression.Results The liver fibrosis group had higher levels of body mass index(BMI)、homeostasis model assessment of insulin resistance(HOMA-IR)、CAP、alanine aminotransferase(ALT)、aspartate aminotransferase(AST)、γ-glutamyl transpeptidase(γ-GT)、uric acid(UA) and HCY compared with the non-hepatic fibrosis group(P<0.05).Multivariate linear regression showed that BMI,HOMA-IR,AST,γ-GT,HCY were independently associated with LSM(R~2:0.312,adjusted R~2:0.285,all P<0.05).Conclusion Serum HCY level is higher in T2DM patients with liver fibrosis combined with MAFLD,and HCY is an independent risk factor for liver fibrosis.

关 键 词：2型糖尿病 脂肪性肝病 同型半胱氨酸 肝纤维化 

分 类 号：R446.11[医药卫生—诊断学]