2型糖尿病患者肝脏脂肪变性及肝纤维化患病率调查及影响因素分析  

Prevalence and risk factors of liver steatosis and fibrosis in patients with type 2 diabetes mellitus

作　　者：张晓艳 禹何恺 韩晶[1] 孙卫霞 ZHANG Xiaoyan;YU Hekai;HAN Jing;SUN Weixia(Department of Endocrinology,Zhongda Hospital,Southeast University,Nanjing,Jiangsu 210002,China)

机构地区：[1]东南大学附属中大医院内分泌科,江苏南京210002

出　　处：《中国临床研究》2025年第4期549-553,共5页Chinese Journal of Clinical Research

基　　金：国家自然科学基金面上项目(82170845);江苏省重点研发计划项目(BE2022853);东南大学环境医学工程教育部重点实验室开放课题(2024EME001)。

摘　　要：目的 统计2型糖尿病(T2DM)患者肝脏脂肪变性和肝纤维化的发生情况,并探讨与之相关的影响因素。方法 回顾性纳入2022年11月至2024年1月,于东南大学附属中大医院住院的T2DM患者697例。采用超声瞬时弹性成像检查评估肝脂肪变性和纤维化,采用多因素logistic回归分析肝脂肪变性和纤维化的影响因素。结果 T2DM患者肝脂肪变性患病率为77.6%(541/697),其中中重度肝脂肪变性占54.1%;共有36.0%(251/697)的患者出现肝纤维化,6.3%(44/697)的患者诊断为肝硬化。身体质量指数(BMI)(OR=1.407, 95%CI:1.287~1.539)、三酰甘油(OR=1.393, 95%CI:1.084~1.791)、高密度脂蛋白胆固醇(OR=0.414, 95%CI:0.189~0.907)是T2DM患者肝脏脂肪变性的独立影响因素(P<0.05);BMI为T2DM患者肝纤维化的独立影响因素(OR=1.153, 95%CI:1.088~1.221,P<0.01)。结论 T2DM患者肝脂肪变性和纤维化的患病率较高,高BMI是T2DM患者肝纤维化和肝脏脂肪变性的危险因素,血脂控制不佳也是肝脏脂肪变性的主要危险因素。Objective To summarize the occurrence of hepatic steatosis and hepatic fibrosis in patients with type 2 diabetes mellitus(T2DM),and to exploretherelated influencingfactors.MethodsA retrospectivestudy was conducted on 697 T2DM patients hospitalized in Zhongda Hospital,Southeast University from November 2022 to January 2024.Liver steatosis and fibrosis were assessed using ultrasonic transient elastography,and multivariate logistic regression analysis was performed to identify the influencing factors of liver steatosis and fibrosis.ResultsThe prevalence of hepatic steatosis in T2DM patients was 77.6%(541/697),with moderate to severe steatosis accounting for 54.1%;36.0%(251/697)of patients presented with liver fibrosis,and 6.3%(44/697)were diagnosed with liver cirrhosis.Body mass index(BMI)(OR=1.407,95%CI:1.287-1.539),triglyceride(OR=1.393,95%CI:1.084-1.791),high density lipoprotein cholesterol(HDL-C)(OR=0.414,95%CI:0.189-0.907)were independent influencing factors for liver steatosis in T2DM patients(P<0.05);BMI was an independent influencing factor for liver fibrosis in T2DM patients(0R=1.153,95%CI:1.088-1.221,P<0.01).Conclusion The prevalence of liver steatosis and fibrosis is high in T2DM patients,with high BMI being the main risk factors for liver steatosis and fibrosis in T2DM patients,and poor blood lipid control being also the main risk factor for liver steatosis.

关 键 词：2型糖尿病 非酒精性脂肪肝 肝脏脂肪变性 肝纤维化 肝硬化 血脂 

分 类 号：R587[医药卫生—内分泌]