2型糖尿病合并非酒精性脂肪肝与缺血性脑血管病的关系分析

Analysis of the Relationship between Type 2 Diabetes Mellitus with Nonalcoholic Fatty Liver Disease and Ischemic Cerebrovascular Disease

摘要: 目的：为探究2型糖尿病合并非酒精性脂肪肝与缺血性脑血管病发生的相关性，为临床上预测缺血性脑血管病的发生提供依据。方法：选取2019年~2021年在青岛大学附属医院住院的435例2型糖尿病患者作为研究对象，根据是否合并NAFLD分为观察组(伴有NAFLD) 189例和对照组(不伴NAFLD) 246例。收集患者的一般资料、生化指标、影像学。采用多因素非条件Logistic回归分析2型糖尿病合并非酒精性脂肪肝发生缺血性脑血管病的危险因素，采用受试者工作特征(ROC)分析危险因素对T2DM合并NAFLD患者发生缺血性脑血管病的预测价值。结果：观察组缺血性脑血管病的发生率高于对照组(P = 0.001)；观察组年龄、低密度脂蛋白水平、C反应蛋白水平均高于观察组(P < 0.05)；观察组人群中，颈动脉粥样硬化形成组的缺血性脑血管病发生率大于颈动脉粥样硬化未形成组(P < 0.05)；高龄、吸烟、颈动脉斑块形成、糖化血红蛋白升高、空腹血糖升高、低密度脂蛋白升高以及C反应蛋白升高是2型糖尿病合并非酒精性脂肪肝患者发生缺血性脑血管病的危险因素(P均<0.05)；年龄、吸烟史、颈动脉斑块形成、糖化血红蛋白、低密度脂蛋白以及C反应蛋白单独应用预测2型糖尿病合并非酒精性脂肪肝患者发生缺血性脑血管病的ROC曲线下面积(AUC)分别为0.747、0.669、0.623、0.741、0.668和0.759，联合应用预测的AUC为0.900。结论：2型糖尿病合并非酒精性肝硬化患者与缺血性脑血管病的发生密切相关。七项危险因素联合预测2型糖尿病合并非酒精性脂肪肝发生缺血性脑血管病有一定的价值。

Abstract: Objective: To explore the correlation between type 2 diabetes mellitus with nonalcoholic fatty liver disease and ischemic analysis of the relationship between type 2 diabetes mellitus with nonalcoholic fatty liver disease and ischemic cerebrovascular disease cerebrovascular disease, and to provide a basis for clinical prediction of ischemic cerebrovascular disease. Methods: A total of 435 patients with type 2 diabetes who were hospitalized in the Affiliated Hospital of Qingdao University from 2019 to 2021 were selected as the research objects. According to whether they were combined with NAFLD, they were divided into observation group (with NAFLD) of 189 cases and control group (without NAFLD) of 246 cases. The general data, biochemical indexes and imaging of the patients were collected. Multivariate unconditional logistic regression was used to analyze the risk factors of ischemic cerebrovascular disease in patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease. Receiver operating characteristic (ROC) was used to analyze the predictive value of risk factors for ischemic cerebrovascular disease in patients with type 2 diabetes mellitus complicated with NAFLD. Results: The incidence of ischemic cerebrovascular disease in the observation group was higher than that in the control group (P = 0.001). The age, low density lipoprotein level and C-reactive protein level in the observation group were higher than those in the observation group (P < 0.05). In the observation group, the incidence of ischemic cerebrovascular disease in the carotid atherosclerosis formation group was higher than that in the non-carotid atherosclerosis formation group (P < 0.05). Advanced age, smoking, carotid plaque formation, elevated glycosylated hemoglobin, elevated fasting blood glucose, elevated low-density lipoprotein and elevated C-reactive protein were risk factors for ischemic cerebrovascular disease in patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease (all P < 0.05). The area under the ROC curve (AUC) of age, smoking history, carotid plaque formation, glycosylated hemoglobin, low-density lipoprotein and C-reactive protein alone in predicting ischemic cerebrovascular disease in patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease was 0.747, 0.669, 0.623, 0.741, 0.668 and 0.759, respectively. The AUC of combined prediction was 0.900. Conclusion: Patients with type 2 diabetes mellitus complicated with nonalcoholic cirrhosis are closely related to the occurrence of ischemic cerebrovascular disease. The combination of seven risk factors has certain value in predicting ischemic cerebrovascular disease in type 2 diabetes mellitus with nonalcoholic fatty liver disease.