老年非酒精性脂肪性肝病合并2型糖尿病患者血清TyG、内脏/皮下脂肪面积比和心脏代谢指数变化及其临床意义探讨  

Clinical implication of serum TyG,visceral/subcutaneous fat area ratio and cardiac metabolic index in elderly patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus

作　　者：李艳敏 张维 胡彦彦 齐蕾[2] Li Yanmin;Zhang Wei;Hu Yanyan(Department of Endocrinology,Oil-field General Hospital,Puyang 457001,Henan Province,China)

机构地区：[1]濮阳油田总医院内分泌科,河南省濮阳市457001 [2]郑州大学第一附属医院内分泌科

出　　处：《实用肝脏病杂志》2024年第5期697-700,共4页Journal of Practical Hepatology

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20190028)。

摘　　要：目的探讨老年非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者血清三酰甘油葡萄糖乘积指数(TyG)、内脏/皮下脂肪面积比(VSR)和心脏代谢指数(CMI)变化及其临床意义。方法2021年1月~2022年12月我院诊治的老年NAFLD合并T2DM患者98例和老年NAFLD患者98例,常规检测空腹三酰甘油和空腹血糖,计算TyG指数。使用内脏脂肪检测装置测量内脏脂肪面积(VFA)和皮下脂肪面积(SFA),计算VSR。常规检测腰高比(WHR),计算CMI。采用多因素Logistic回归分析影响合并T2DM的危险因素。结果NAFLD合并T2DM组空腹血糖(FBG)、糖化血红蛋白(HbA1C)、胰岛素抵抗指数(HOMA-IR)和血清TG水平分别为(9.3±0.7)mmol/L、(9.1±1.6)%、(5.7±0.8)和(3.7±0.5)mmol/L,均显著高于NAFLD组【分别为(5.8±0.5)mmol/L、(6.1±1.2)%、(3.9±0.4)和(1.9±0.3)mmol/L,P<0.05】,而HDL-C为(1.2±0.2)mmol/L,显著低于NAFLD组【(1.5±0.4)mmol/L,P<0.05】;TyG、VSR和CMI分别为(10.8±1.5)%、(0.9±0.2)%和(1.2±0.3)%,显著高于NAFLD组【(8.7±0.4)%、(0.3±0.1)%和(0.6±0.2)%,P<0.05】;多因素Logistic回归分析显示,TyG(OR=3.124,95%CI:1.101~8.862)、VSR(OR=2.601,95%CI:1.035~6.535)和CMI(OR=2.832,95%CI:1.061~7.561)升高均为影响老年NAFLD合并T2DM的独立危险因素(P<0.05);37例重度NAFLD合并T2DM患者TyG、VSR和CMI分别为(12.4±1.9)%、(1.2±0.3)%和(1.7±0.4)%,均显著高于61例轻中度NAFLD患者【分别为(9.7±0.6)%、(0.7±0.1)%和(0.9±0.2)%,P<0.05】。结论在老年NAFLD患者,检测并计算TyG、VSR和CMI可帮助筛查T2DM,值得深入研究。Objective The aim of this study was to explore the clinical implication of serum triglyceride-glucose index(TyG),visceral/subcutaneous fat area ratio(VSR)and cardiac metabolic index(CMI)in elderly patients with non-alcoholic fatty liver disease(NAFLD)and type 2 diabetes mellitus(T2DM).Methods A total of 98 elderly patients with NAFLD and concomitant T2DM and another 98 elderly patients with NAFLD were enrolled in our hospital between January 2021 and December 2022,and routine biochemical parameters were determined for calculation of TyG and CMI.The VSR was obtained from calculation of body fat detected by special apparatus.The multivariate Logistic regression analysis was applied for risk factor finding.Results The fasting blood glucose,glycosylated hemoglobin,the HOMA-IR and serum triglyceride level in NAFLD patients with T2DM were(9.3±0.7)mmol/L,(9.1±1.6)%,(5.7±0.8)and(3.7±0.5)mmol/L,all significantly higher than[(5.8±0.5)mmol/L,(6.1±1.2)%,(3.9±0.4)and(1.9±0.3)mmol/L,respectively,P<0.05],while serum high-density lipoprotein cholesterol level was(1.2±0.2)mmol/L,significantly lower than[(1.5±0.4)mmol/L,P<0.05]in patients with NAFLD;the TyG,VSR and CMI were(10.8±1.5)%,(0.9±0.2)%and(1.2±0.3)%,all much higher than[(8.7±0.4)%,(0.3±0.1)%and(0.6±0.2)%,respectively,P<0.05]in patients with NAFLD;the multivariate Logistic regression analysis showed that the TyG(OR=3.124,95%CI:1.101-8.862),the VSR(OR=2.601,95%CI:1.035-6.535)and CMI(OR=2.832,95%CI:1.061-7.561)elevation were all the independent risk factors for T2DM in elderly patients with NAFLD(P<0.05);the TyG,VSR and CMI in 37 patients with severe NAFLD and concomitant 2DM were(12.4±1.9)%,(1.2±0.3)%and(1.7±0.4)%,all much higher than[(9.7±0.6)%,(0.7±0.1)%and(0.9±0.2)%,respectively,P<0.05]in 61 patients with mild to moderate NAFLD and T2DM.Conclusion The detection and calculation of relatively simple TyG, VSR and CMI might be help for screening T2DM in elderly patients with NAFLD, and needs further investigation.

关 键 词：非酒精性脂肪性肝病 2型糖尿病 三酰甘油葡萄糖乘积指数 内脏/皮下脂肪面积比 心脏代谢指数 

分 类 号：R587.1[医药卫生—内分泌] R575.5[医药卫生—内科学]