2型糖尿病合并非酒精性脂肪性肝病的流行 特征及危险因素分析

Prevalence Characteristics and Risk Factor Analysis of Type 2 Diabetes Mellitus Combined with Nonalcoholic Fatty Liver Disease

摘要: 目的：探讨2型糖尿病(T2DM)患者合并非酒精性脂肪性肝病(NAFLD)的流行病学特征及相关危险因素，为临床开展早期筛查、干预与综合防控提供参考依据。方法：采用回顾性研究方法，选取2023年5月~2025年5月收治的1387例2型糖尿病患者作为研究对象，根据是否合并NAFLD分为T2DM合并NAFLD组(n = 790)与单纯T2DM组(n = 597)。收集并比较两组一般资料及临床检测指标，采用统计学方法分析组间差异及相关危险因素。结果：1387例T2DM患者中，NAFLD合并率为57%。与单纯T2DM组比较，T2DM合并NAFLD组在性别、年龄、糖尿病病程、胰岛素抵抗指数、BMI、腰围、高血压病史比例，以及空腹血糖、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、血清尿素、血尿酸等指标、民族构成比、SGLT-2抑制剂及GLP-1受体激动剂用药情况差异均具有统计学意义(P < 0.05)；只有糖化血红蛋白、碱性磷酸酶、肌酐没有统计学差异(P > 0.05)。多因素分析说明，性别为女性、超重或肥胖状态、腰围变大、高甘油三酯以及尿酸增高是T2DM合并NAFLD的独立危险因素(P < 0.05)，而糖尿病病程、高密度脂蛋白(HDL-C)、SGLT-2抑制剂及GLP-1受体激动剂是其保护因素(P < 0.05)。结论：T2DM患者NAFLD合并率比较高，女性、糖尿病病程短、BMI升高、腰围变大、血脂异常以及尿酸增高和该病的发生紧密相关，对上述危险因素进行针对性干预可降低合并症发生的风险。

Abstract: Objective: To investigate the epidemiological characteristics and related risk factors of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM), and to provide reference for clinical early screening, intervention, and comprehensive prevention and control. Methods: A retrospective study was conducted on 1387 patients with type 2 diabetes mellitus admitted from May 2023 to May 2025. They were divided into T2DM with NAFLD group (n = 790) and T2DM alone group (n = 597) according to the presence or absence of NAFLD. General data and clinical indicators were collected and compared between the two groups. Statistical methods were used to analyze inter-group differences and related risk factors. Results: The prevalence of NAFLD among 1387 T2DM patients was 57%. Compared with the T2DM alone group, the T2DM with NAFLD group showed statistically significant differences (P < 0.05) in gender, age, diabetes duration, insulin resistance index, BMI, waist circumference, history of hypertension, as well as fasting blood glucose, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), serum urea, serum uric acid, ethnic composition, and the use of SGLT-2 inhibitors and GLP-1 receptor agonists. No statistical differences were found in glycated hemoglobin, alkaline phosphatase, or creatinine (P > 0.05). Multivariate analysis indicated that female gender, overweight or obesity, increased waist circumference, hypertriglyceridemia, and elevated uric acid were independent risk factors for T2DM with NAFLD (P < 0.05), while diabetes duration, HDL-C, SGLT-2 inhibitors, and GLP-1 receptor agonists were protective factors (P < 0.05). Conclusion: The prevalence of NAFLD is relatively high in T2DM patients. Female gender, short diabetes duration, increased BMI, enlarged waist circumference, dyslipidemia, and elevated uric acid are closely associated with the occurrence of this comorbidity. Targeted interventions for these risk factors may reduce the risk of developing this complication.