摘要
目的探讨代谢相关脂肪性肝纤维化中高风险的2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)患者的临床特征及其影响因素。方法收集2022年8月-2024年5月就诊于上海中医药大学附属第七人民医院内分泌科的495例T2DM合并MAFLD患者的临床资料进行回顾性分析。根据肝纤维化4项(FIB-4)指数将患者分为代谢相关脂肪性肝纤维化低风险组(简称低风险组,n=311)与代谢相关脂肪性肝纤维化中高风险组(简称中高风险组,n=184)。比较两组患者临床特征及实验室检查指标的差异,采用单因素及多因素二元logistic回归分析筛选T2DM合并MAFLD患者代谢相关脂肪性肝纤维化中高风险的影响因素。采用受试者操作特征(ROC)曲线及曲线下面积(AUC)评估上述危险因素对T2DM合并MAFLD患者面临代谢相关脂肪性肝纤维化中高风险的预测价值。结果与低风险组比较,中高风险组患者的年龄和高血压占比、冠心病占比,以及谷草转氨酶(AST)、血尿素氮(BUN)、肌酐(Cr)水平较高(P<0.05),男性占比,血小板计数(PLT)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA_(1c))、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))水平及甲状腺反馈分位数指数(TFQI)较低(P<0.05)。单因素二元logistic回归分析显示,男性(P=0.020)、HbA_(1c)(P=0.014)、BUN(P<0.001)、Cr(P<0.001)、TC(P=0.001)、LDL-C(P<0.001)、FT_(3)(P<0.001)、FT_(4)(P<0.001)、TFQI(P=0.039)是T2DM合并MAFLD患者代谢相关性脂肪性肝纤维化中高风险的影响因素;多因素二元logistic回归分析显示,BUN(OR=1.165,95%CI 1.006~1.348,P=0.042)、Cr(OR=1.020,95%CI 1.005~1.036,P=0.008)是T2DM合并MAFLD患者代谢相关脂肪性肝纤维化中高风险的独立危险因素,而男性(OR=0.574,95%CI 0.339~0.972,P=0.039)、LDL-C(OR=0.659,95%CI 0.483~0.898,P=0.008)、FT_(3)(OR=0.590,95%CI 0.404~0.864,P=0.007)、FT_(4)(OR=0.863,95%CI 0.762~0.977,P=0.020)为其独立保护因素。ROC曲线分析结果显示,联合上述6个影响因素预测T2DM合并MAFLD患者具有代谢相关脂肪性肝纤维化中高风险的AUC为0.728(95%CI 0.682~0.774),敏感度为0.620,特异度为0.759。结论性别、BUN、Cr、LDL-C、FT_(3)、FT_(4)是T2DM合并MAFLD患者代谢相关脂肪性肝纤维化中高风险的独立影响因素。针对上述异常生化指标进行监测和及早干预,有利于延缓T2DM合并MAFLD患者肝纤维化的发生发展。
Objective To explore the clinical characteristics and influencing factors in type 2 diabetes mellitus(T2DM)patients with metabolic-associated fatty liver disease(MAFLD)who are at moderate-to-high risk of metabolic-associated fatty liver fibrosis.Methods A retrospective analysis was conducted on the clinical data of 495 T2DM patients with MAFLD who were treated in the Department of Endocrinology,the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,from August 2022 to May 2024.According to the fibrosis-4(FIB-4)index,the patients were divided into two groups:low risk group for metabolic-associated fatty liver fibrosis(n=311)and moderate-to-high risk group for metabolic-associated fatty liver fibrosis(n=184).Differences in clinical characteristics and laboratory test results between the two groups were compared.Univariate and multivariate binary logistic regression analyses were used to screen the influencing factors of moderate-to-high risk of metabolic-associated fatty liver fibrosis in T2DM patients with MAFLD.Receiver operating characteristic(ROC)curves and area under the curve(AUC)were employed to evaluate the predictive value of these factors for moderate-to-high risk of metabolic-associated fatty liver fibrosis in T2DM patients with MAFLD.Results Compared with low risk group,moderate-to-high risk group had significantly higher age,proportions of patients with a history of hypertension and coronary heart disease,as well as higher levels of aspartate aminotransferase(AST),blood urea nitrogen(BUN),and creatinine(Cr)(P<0.05).In contrast,moderate-to-high group had a lower proportion of male patients,and lower levels of platelet count(PLT),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),glycated hemoglobin(HbA_(1c)),free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),and thyroid feedback quantile-based index(TFQI)(P<0.05).Univariate binary logistic regression analysis showed that male(P=0.020),HbA_(1c)(P=0.014),BUN(P<0.001),Cr(P<0.001),TC(P=0.001),LDL-C(P<0.001),FT_(3)(P<0.001),FT_(4)(P<0.001),and TFQI(P=0.039)were influencing factors for moderate-to-high risk of metabolic-associated fatty liver fibrosis in T2DM patients with MAFLD.Multivariate binary logistic regression analysis revealed that BUN(OR=1.165,95%CI 1.006-1.348,P=0.042)and Cr(OR=1.020,95%CI 1.005-1.036,P=0.008)were independent risk factors for moderate-to-high risk of metabolic-associated fatty liver fibrosis in T2DM patients with MAFLD,while male(OR=0.574,95%CI 0.339-0.972,P=0.039),LDL-C(OR=0.659,95%CI 0.483-0.898,P=0.008),FT_(3)(OR=0.590,95%CI 0.404-0.864,P=0.007),and FT_(4)(OR=0.863,95%CI 0.762-0.977,P=0.020)were independent protective factors.ROC curve analysis showed that the AUC of the combined 6 influencing factors for predicting moderate-to-high risk of metabolic-associated fatty liver fibrosis in T2DM patients with MAFLD was 0.728(95%CI 0.682-0.774),with a sensitivity of 0.620 and a specificity of 0.759.Conclusions Gender,BUN,Cr,LDL-C,FT_(3),and FT_(4)are independent influencing factors for moderate-to-high risk of metabolic-associated fatty liver fibrosis in T2DM patients with MAFLD.Monitoring and early intervention for the above abnormal biochemical indices are beneficial in delaying the occurrence and development of liver fibrosis in T2DM patients with MAFLD.
作者
刘璇
李畅
张宏利
李晓华
Liu Xuan;Li Chang;Zhang Hong-Li;Li Xiao-Hua(Department of Endocrinology,the Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai 200120,China)
出处
《解放军医学杂志》
北大核心
2025年第11期1366-1373,共8页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金(82074178)
上海市卫生健康委员会“十四五”中医特色专科和中医急诊能力提升项目(ZYTSZK2-18)
上海市卫生健康委员会消渴病区域中西医结合诊疗服务体系建设
浦东新区卫生健康委员会临床特色学科建设(PWYts2021-13)
浦东新区卫生健康委员会领先人才培养计划项目(PWR12021-06)。
关键词
糖尿病
2型
代谢相关脂肪性肝病
代谢相关脂肪性肝纤维化
diabetes mellitus,type 2
metabolic-associated fatty liver disease
metabolic-associated fatty liver fibrosis
