美国2型糖尿病患者血浆致动脉粥样硬化指数(AIP)与肝脂肪变性和肝纤维化之间的关联：一项大型横断面研究

Association between the Atherogenic Index of Plasma (AIP) and Hepatic Steatosis and Fibrosis in American Patients with Type 2 Diabetes Mellitus: A Large Cross-Sectional Study

摘要: 目的：血浆致动脉粥样硬化指数(AIP)是反映脂质代谢的新指标。2型糖尿病(T2DM)是发生非酒精性脂肪肝(NAFLD)的高危因素。本研究的主要目的是探讨AIP与美国T2DM患者肝脏脂肪变性和肝纤维化之间的潜在相关性。方法：使用2017~2020年全国健康与营养检查调查(NHANES)的数据集进行横断面调查。构建三个模型，采用回归分析检验AIP与受控衰减参数(CAP)、肝脏硬度测量(LSM)以及NAFLD之间的线性关系，将AIP划分四个等级并进行趋势性检验。采用限制性立方样条图(RCS)来描述它们之间的非线性关系。以上所有统计分析都经过加权处理。结果：这项以美国T2DM患者为基础的研究纳入1170人。在多元线性回归和逻辑回归分析中，AIP*10与CAP [β (95% CI), 3.18 (0.41~5.96), P = 0.033]、NAFLD [OR (95% CI), 1.16 (1.02~1.33), P = 0.035]均呈显著正相关，趋势性检验存在统计学意义，但AIP与LSM [β (95% CI), 0.04 (−1.35~1.42), P = 0.947]的关系并不显著。RCS分析显示AIP和CAP之间呈S型非线性关系(P-overall < 0.001, P-non-linear = 0.036)，并且随着AIP的升高，男性比女性有更严重的肝脏脂肪变。结论：AIP与T2DM患者肝脏脂肪变性之间存在显著正相关，它或许可以成为预测NAFLD发生的一项无创指标。然而，并未发现AIP与肝纤维化之间存在任何关联。

Abstract: Purpose: Plasma atherogenic index (AIP) is a new index reflecting lipid metabolism. Type 2 diabetes mellitus (T2DM) is a high risk factor for non-alcoholic fatty liver disease (NAFLD). The main purpose of this study was to explore the potential correlation between AIP and hepatic steatosis and hepatic fibrosis in American patients with T2DM. Methods: A cross-sectional survey was conducted using the dataset of the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2020. Three models were constructed, and regression analysis was used to test the linear relationship between AIP and controlled attenuation parameter (CAP), liver stiffness measurement (LSM), and NAFLD. AIP was divided into four levels and trend tests were performed. Restricted cubic spline plots (RCS) were used to describe the nonlinear relationship between them. All the above statistical analyses were weighted. Results: This study based on T2DM patients in the United States included 1170 people. In the multiple linear regression and logistic regression analysis, AIP*10 showed a significant positive correlation with CAP [β (95% CI), 31.83 (4.10~59.56), P = 0.033] and NAFLD [OR (95% CI), 1.16 (1.02~1.33), P = 0.035], and the trend test was statistically significant, but the relationship with LSM [β (95% CI), 0.04 (−1.35~1.42), P = 0.947] was not significant. RCS analysis showed an S-shaped nonlinear relationship between AIP and CAP (P-overall < 0.001, P-non-linear = 0.036), and as AIP increased, males had more severe hepatic steatosis than females. Conclusions: This study highlighted a substantial positive relationship between AIP and hepatic steatosis in patients with T2DM, and suggests that it may be used as a noninvasive indicator to predict the occurrence of NAFLD. However, no association was found between AIP and liver fibrosis.