2型糖尿病合并代谢相关脂肪性肝病患者的TG/HDL-C与肝脏脂肪变相关性研究

Study on the Correlation of TG/HDL-C with Hepatic Steatosis in Patients with Type 2 Diabetes Mellitus Combined with Metabolism-Related Fatty Liver Disease

摘要: 目的：探究2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)患者的TG/HDL-C与肝脏脂肪变相关性。方法：选取2023年9月至2024年8月于石家庄市人民医院内分泌科住院接受治疗27~75岁T2DM合并MAFLD患者共186例。根据代表肝脏脂肪变性的严重程度的受控衰减参数(CAP)水平(S0: CAP < 238 dB/m, S1: 238 dB/m ≤ CAP < 260 dB/m, S2: 260 dB/m ≤ CAP < 292 dB/m, S3: CAP ≥ 292 dB/m)将患者分为非重度肝脏脂肪变组80例和重度肝脏脂肪变组106例，所有受试者均测量甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、TG/HDL-C、谷丙转氨酶(ALT)、谷草转氨酶(AST)、体质量指数(BMI)、瞬时弹性成像参数CAP值(dB/m)等指标。结果：(1) 重度脂肪变组BMI、FPG、FINS、FCP、HOMA-IR、HbA1c、TC、TG、LDL-C、ALT、AST、γ-GGT、TG/HDL-C、CAP均高于非重度脂肪变组，差异均有统计学意义(P < 0.05)。(2) 对各指标行Pearson/Spearman相关性分析显示，CAP与FINS、FCP、HOMA-IR、TG、ALT、AST、γ-GGT、BMI、TG/HDL-C等均呈正相关(r值分别为0.407、0.392、0.422、0.547、0.381、0.433、0.368、0.538、0.568)。(3) 行二元Logistic多因素回归分析得出：TG/HDL-C、LDL-C、BMI、ALT是T2DM合并MAFLD患者肝脏脂肪变的独立危险因素(TG/HDL-C 95%置信区间1.726 (1.238, 2.407)，P = 0.001)。(4) 将TG/HDL-C、TG、LDL-C、ALT代入ROC曲线分析，曲线下面积分别为：0.753、0.747、0.609、0.695。其中TG/HDL-C敏感度54.7%，特异度86.3%，TG、TG/HDL-C均能预测T2DM合并MAFLD患者的重度肝脏脂肪变性，但TG/HDL-C预测价值更优(P = 0.000)，具有统计学意义。

Abstract: Objective: To investigate the correlation between TG/HDL-C and hepatic steatosis in patients with type 2 diabetes mellitus (T2DM) combined with metabolism-associated fatty liver disease (MAFLD). Methods: A total of 186 patients with T2DM combined with MAFLD aged 27-75 years who were hospitalized in the Department of Endocrinology of Shijiazhuang People’s Hospital from September 2023 to August 2024 were selected. The patients were categorized into 80 cases in the non-severe hepatic steatosis group and 106 cases in the severe hepatic steatosis group according to the level of controlled attenuation parameter (CAP), which represents the severity of hepatic steatosis (S0: CAP < 238 dB/m, S1: 238 dB/m ≤ CAP < 260 dB/m, S2: 260 dB/m ≤ CAP < 292 dB/m, and S3: CAP ≥ 292 dB/m). The steatosis group consisted of 106 cases, and triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), TG/HDL-C, alanine aminotransferase (ALT), alanine transaminase (AST), body mass index (BMI), and CAP value of transient elastography parameter (dB/m) were measured in all the subjects. Results: (1) BMI, FPG, FINS, FCP, HOMA-IR, HbA1c, TC, TG, LDL-C, ALT, AST, γ-GGT, TG/HDL-C, and CAP were higher in the severe steatosis group than those in the non-severe steatosis group, and the differences were statistically significant (P < 0.05). (2) The correlation analyses of each index showed that the Pearson/Spearman correlation analysis showed that the BMI, body mass index (AST), transient elastography parameter CAP value (dB/m), and other indexes were higher. Spearman correlation analysis showed that CAP was positively correlated with FINS, FCP, HOMA-IR, TG, ALT, AST, γ-GGT, BMI, and TG/HDL-C (r-values of 0.407, 0.392, 0.422, 0.547, 0.381, 0.433, 0.368, 0.538, respectively, 0.568). (3) Binary logistic multifactorial regression analysis was performed to conclude that TG/HDL-C, LDL-C, BMI, and ALT were independent risk factors for hepatic steatosis in patients with T2DM combined with MAFLD (TG/HDL-C 95% confidence interval 1.726 (1.238, 2.407), P = 0.001). (4) Substituting TG/HDL-C, TG, LDL-C, and ALT into the ROC curve analysis, the areas under the curve were 0.753, 0.747, 0.609, and 0.695, respectively of which the sensitivity of TG/HDL-C was 54.7% and specificity 86.3%, both TG and TG/HDL-C could predict severe hepatic steatosis in patients with T2DM combined with MAFLD, but the predictive value of TG/HDL-C was superior (P = 0.000), which was statistically significant.