基于腹部CT探讨Ⅱ型糖尿病首发急性胰腺炎患者肌脂分布特点的临床研究  

A Clinical Study on the Characteristics of Muscle Fat Distribution in Patients with First-episode Acute Pancreatitis of TypeⅡDiabetes Mellitus based on Abdominal CT

作　　者：倪艳辉 张小明 肖波[3] NI Yanhui;ZHANG Xiaoming;XIAO Bo(Department of Radiology,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China)

机构地区：[1]川北医学院附属医院放射科,南充637000 [2]医学影像四川省重点实验室,四川南充637000 [3]重庆医科大学附属璧山医院医学影像科,402760

出　　处：《临床放射学杂志》2025年第2期300-307,共8页Journal of Clinical Radiology

基　　金：2024年重庆市科卫联合医学科研项目(编号:2024MSXM165)。

摘　　要：目的通过早期腹部CT定量评估L 3椎体水平肌脂成分联合临床实验室检查对Ⅱ型糖尿病(T2DM)首发急性胰腺炎(AP)患者进行研究,旨在筛选出其危险因素。方法回顾性纳入T2DM首发AP患者241例,未发生AP的T2DM患者57例。搜集患者的性别、年龄、体重指数(BMI)、血脂、血糖等临床资料。使用Slice-O-Matic半自动分割腹部肌脂参数。分析T2DM患者首发AP的危险因素,绘制各危险因素及联合多因素的受试者工作特征(ROC)曲线,比较各危险因素及联合多因素的特异度、敏感度及受试者工作特征曲线曲线下面积(AUC)值。结果T2DM首发AP组患者年龄、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肌间脂肪面积(IMAT)更低,糖尿病病程更短,合并T2DM慢性并发症以及高血压的比例更低(P均<0.05);而T2DM首发AP组患者BMI、甘油三酯(TG)、总胆固醇(TC)、极低密度脂蛋白胆固醇(VLDL-C)、骨骼肌组织(SMT)、内脏脂肪组织(VAT)、皮下脂肪组织(SAT)、总脂肪组织(TAT)、骨骼肌密度(SMD)、内脏脂肪与总脂肪比值(VTR)、内脏脂肪/肌肉比值(VMR)、L 3水平骨骼肌指数(L 3-SMI)均更高,合并脂肪肝以及饮酒的比例更高(P均<0.05)。T2DM首发AP组与未发生AP组的T2DM组两组患者在性别、吸烟比例、T2DM急性并发症比例、平均血糖以及糖化血红蛋白(HbA1c)间差异无统计学意义(P均>0.05)。多因素Logistic回归分析BMI、TG、VAT是T2DM患者首发AP的独立危险因素(P均<0.05)。ROC曲线分析结果显示,BMI、TG以及VAT联合预测T2DM患者首发AP的AUC为0.937高于BMI、TG、VAT单独预测的AUC(0.841、0.814、0.831)。结论基于CT检查的腹部体脂分析联合实验室检查是早期评估T2DM首发AP的危险因素,T2DM患者应降低VAT,有助于降低其并发AP的风险。Objective Patients with type 2 diabetes mellitus(T2DM)are at greater risk of complications of acute pancreatitis(AP)with greater severity.Obesity is closely related to the development of T2DM and AP,and traditional methods such as body mass index(BMI)cannot distinguish fat distribution.Computed tomography(CT)is a routine imaging examination for AP patients on admission and can accurately quantify muscle fat parameters.In this study,we investigated patients with T2DM with first-onset AP by quantitatively assessing the muscle lipid composition at the lumbar 3 vertebral level by early abdominal CT in combination with clinical laboratory tests,with the aim of screening for risk factors to reduce the likelihood of AP in patients with T2DM.Methods 241 patients with first-onset AP in T2DM and 57 T2DM without AP were retrospectively included.Clinical data such as gender,age,BMI,lipids,and blood glucose were collected.The abdominal muscle fat area was semi-automatically segmented using Slice-O-Matic.Risk factors for the first-onset AP in T2DM were analyzed,receiver operating characteristic(ROC)curves for each risk factor and combined multi-factors were plotted,and specificity,sensitivity,and area under curve(AUC)values were compared.Results Patients in the T2DM first AP group had lower age,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and intermuscular adipose tissue(IMAT),shorter duration of diabetes mellitus,and a lower proportion of comorbid chronic complications of T2DM,as well as hypertension(P<0.05).While body mass index(BMI),triglycerides(TG),total cholesterol(TC),very low-density lipoprotein cholesterol(VLDL-C),skeletal muscle tissue(SMT),visceral adipose tissue(VAT),subcutaneous adipose tissue(SAT),total adipose tissue(TAT),skeletal muscle density(SMD),visceral fat-to total fat ratio(VTR),visceral fat-to-muscle ratio(VMR),and skeletal muscle index at the third lumbar vertebra(L3-SMI)were higher.The proportion of combined fatty liver and alcohol consumption was higher(P<0.0

关 键 词：急性胰腺炎 Ⅱ型糖尿病 CT 内脏脂肪 

分 类 号：R576[医药卫生—消化系统] R587.2[医药卫生—内科学] R816[医药卫生—临床医学]