基于胰岛素抵抗替代指标评估非肥胖2型糖尿病患者NAFLD的价值  

Evaluation of NAFLD in non⁃obese type 2 diabetes mellitus patients based on insulin resistance proxies

作　　者：李梦婷 陆璧 张彦 蒋琳 Li Mengting;Lu Bi;Zhang Yan;Jiang Lin(Department of Rheumatology,Immunology and Endocrinology,AoYang Hospital of Zhangjiagang,Suzhou 215600,China)

机构地区：[1]张家港澳洋医院风湿免疫内分泌科,江苏苏州215600

出　　处：《海军医学杂志》2024年第7期739-744,共6页Journal of Navy Medicine

摘　　要：目的探讨胰岛素抵抗替代指标评估非肥胖2型糖尿病(T2DM)患者发生非酒精性脂肪性肝病(NAFLD)的价值。方法选取2020年5月至2022年5月张家港澳洋医院收治的201例T2DM患者为研究对象,其中119例合并NAFLD。119例患者中103例患者为非进展性肝纤维化者。收集患者基本资料,分析T2DM患者发生NAFLD的影响因素和胰岛素抵抗替代指标预测T2DM患者发生NAFLD的价值,统计不同病情NAFLD患者血清胰岛素抵抗替代指标情况。结果多因素Logistic回归分析显示稳态模型评估胰岛素抵抗指数(HOMA⁃IR)(OR=3.931,95%CI:1.618~9.555)、甘油三酯(TG)/高密度脂蛋白胆固醇(HDL⁃C)(OR=4.063,95%CI:1.672~9.875)、TG⁃葡萄糖指数(TyG)(OR=3.999,95%CI:1.645~9.718)、TyG⁃体重指数(TyG⁃BMI)(OR=3.823,95%CI:1.573~9.291)、内脏脂肪指数(VAI)(OR=3.777,95%CI:1.554~9.180)水平是T2DM患者发生NAFLD的影响因素(P<0.05)。受试者操作特征(ROC)曲线分析结果显示,HOMA⁃IR、TG/HDL⁃C、TyG、TyG⁃BMI、VAI预测T2DM患者发生NAFLD的灵敏度分别为71.43%、74.79%、71.43%、73.95%、70.59%,特异度分别为70.73%、80.49%、73.17%、79.27%、70.73%,AUC分别为0.744、0.758、0.742、0.777、0.724。进展性肝纤维化组的HOMA⁃IR、TG/HDL⁃C、TyG、TyG⁃BMI水平均高于非进展性肝纤维化组(P<0.05)。结论HOMA⁃IR、TG/HDL⁃C、TyG、TyG⁃BMI、VAI与T2DM患者发生NAFLD有关,胰岛素抵抗替代指标预测T2DM患者发生NAFLD的效能良好,且胰岛素抵抗替代指标可能与NAFLD病情有关。Objective To investigate the value of proxies for insulin resistance in evaluating non⁃alcoholic fatty liver disease(NAFLD)in patients with non⁃obese type 2 diabetes mellitus(T2DM).Methods A total of 201 T2DM patients who were admitted to AoYang Hospital of Zhangjiagang from May 2020 to May 2022 were enrolled in this study.Among them,119 patients were combined with NAFLD,and 103 of the 119 patients had non⁃progressive liver fibrosis.General data of patients were collected.The factors affecting NAFLD in T2DM patients were analyzed.The value of insulin resistance proxies in predicting NAFLD in T2DM patients was investigated.Serum insulin resistance proxies were determined in NAFLD patients with different conditions.Results Logistic multivariate regression analysis showed that homeostasis model assessment of insulin resistance(HOMA⁃IR)(OR=3.931,95%CI:1.618-9.555),triglyceride(TG)/high density lipoprotein cholesterol(HDL⁃C)(OR=4.063,95%CI:1.672-9.875),TG⁃glucose index(TyG)(OR=3.999,95%CI:1.645-9.718),TyG⁃body mass index(TyG⁃BMI)(OR=3.823,95%CI:1.573-9.291),and visceral fat index(VAI)(OR=3.777,95%CI:1.554-9.180)were the influencing factors of NAFLD in T2DM patients(all P<0.05).Receiver operating character(ROC)curve showed that the sensitivities of HOMA⁃IR,TG/HDL⁃C,TyG,TyG⁃BMI and VAI in predicting NAFLD in T2DM patients was 71.43%,74.79%,71.43%,73.95%and 70.59%,specificity were 70.73%,80.49%,73.17%,79.27%and 70.73%,and AUC values were 0.744,0.758,0.742,0.777 and 0.724,respectively.The levels of HOMA⁃IR,TG/HDL⁃C,TyG and TyG⁃BMI in the progressive liver fibrosis group were higher than those in the non⁃progressive liver fibrosis group(all P<0.05).Conclusion Homa⁃IR,TG/HDL⁃C,TyG,TyG⁃BMI and VAI are associated with NAFLD in T2DM patients.Insulin resistance proxies show good efficacy in predicting NAFLD in T2DM patients,and it may be related to the severity of NAFLD.

关 键 词：2型糖尿病 胰岛素抵抗替代指标 非酒精性脂肪性肝病 

分 类 号：R587.1[医药卫生—内分泌]