非酒精性脂肪肝病合并2型糖尿病患者相关危险因素的分析及诊断模型的构建

Risk Factors and Diagnostic Model for Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes Patients

摘要: 背景和目的：非酒精性脂肪肝病(NAFLD)是一种普遍存在的肝脏疾病，而2型糖尿病(T2DM)是一种以胰岛素抵抗和胰岛素分泌不足为特点的慢性代谢性疾病。当这两者同时出现时，会加重病情并增加并发症的风险。本研究旨在通过分析临床常见的血清学指标，探讨NAFLD合并T2DM患者的相关危险因素，并构建相应的诊断模型。研究方法：本研究为回顾性研究，纳入2023年1月1日至2024年12月31日期间在安徽医科大学附属巢湖医院就诊并符合纳排标准的472例T2DM患者。我们分析了这些患者的临床常见血清学指标，筛选出独立危险因素，并构建相关的诊断模型。患者的基本信息通过电子病历系统收集，包括年龄、性别、吸烟史、高血压病史、体重、身高、体重指数(BMI)及常见血清学指标。结果：NAFLD合并T2DM患者的独立危险因素包括BMI (OR: 1.401; 95% CI: 1.180~1.662)、抗胰岛素抗体(OR: 0.983; 95% CI: 0.966~0.999)、抗胰岛细胞抗体(OR: 1.058; 95% CI: 1.024~1.094)、胆固醇(OR: 0.098; 95% CI, 0.033~0.286)、甘油三酯(OR: 3.896; 95% CI: 2.353~6.449)、高密度脂蛋白(OR: 6.905; 95% CI: 1.157~41.206)、低密度脂蛋白(OR: 17.474; 95% CI: 5.764~52.975)、尿素(OR: 0.815; 95% CI: 0.685~0.969)和谷丙转氨酶(OR: 1.044; 95% CI: 1.014~1.075)。这些因素与NAFLD的发病风险显著相关，其中甘油三酯的诊断价值最高(AUC = 0.804)，其次是BMI (AUC = 0.794)。研究构建的列线图诊断模型表现出优异的预测能力(AUC = 0.921)，灵敏度为84.42%，特异度为83.82%。结论：本研究强调代谢异常在NAFLD合并T2DM中的重要性，BMI、血脂(如甘油三酯、胆固醇和高密度脂蛋白)及肝功能指标(如谷丙转氨酶)均为重要的独立危险因素。构建的诊断模型为临床提供了有效的筛查工具，有助于早期识别高风险患者并优化管理策略。

Abstract: Background and Objective: Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disorder, while type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and impaired insulin secretion. The coexistence of NAFLD and T2DM exacerbates the condition and increases the risk of complications. This study aims to investigate the associated risk factors in patients with NAFLD complicated by T2DM through the analysis of common clinical serological indicators and to construct a corresponding diagnostic model. Methods: This retrospective study included 472 patients with type 2 diabetes mellitus (T2DM) treated at Chaohu Hospital Affiliated to Anhui Medical University between January 1, 2023, and December 31, 2024, who met the inclusion and exclusion criteria. Common clinical serological indicators were analyzed to identify independent risk factors, and relevant diagnostic models were developed. Basic patient information was collected via the electronic medical record system, including age, gender, smoking history, hypertension history, weight, height, body mass index (BMI), and common serological indicators. Results: Independent risk factors for NAFLD complicated by T2DM included BMI (OR: 1.401; 95% CI: 1.180~1.662), anti-insulin antibody (OR: 0.983; 95% CI: 0.966~0.999), anti-islet cell antibody (OR: 1.058; 95% CI: 1.024~1.094), cholesterol (OR: 0.098; 95% CI: 0.033~0.286), triglycerides (OR: 3.896; 95% CI: 2.353~6.449), high-density lipoprotein (OR: 6.905; 95% CI: 1.157~41.206), low-density lipoprotein (OR: 17.474; 95% CI: 5.764~52.975), urea (OR: 0.815; 95% CI: 0.685~0.969), and alanine aminotransferase (OR: 1.044; 95% CI: 1.014~1.075). These factors were significantly associated with the risk of developing NAFLD, with triglycerides exhibiting the highest diagnostic value (AUC = 0.804), followed by BMI (AUC = 0.794). The nomogram-based diagnostic model demonstrated excellent predictive power (AUC = 0.921), with a sensitivity of 84.42% and a specificity of 83.82%. Conclusion: This study underscores the critical role of metabolic abnormalities in patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Key parameters, including body mass index (BMI), blood lipids (e.g., triglycerides, cholesterol, and high-density lipoprotein), and liver function indicators (e.g., alanine aminotransferase), serve as significant independent risk factors. The diagnostic model developed herein offers a robust screening tool for clinical application, enabling early identification of high-risk patients and enhancing management strategies.