T2DM合并NAFLD病人FC-P、FINS、血糖指标表达及其与肝纤维化的关系

张菊香; 赵晓慧; 史艳春

doi:10.13898/j.cnki.issn.1000-2200.2021.06.025

T2DM合并NAFLD病人FC-P、FINS、血糖指标表达及其与肝纤维化的关系

Relationship between the expression levels of FC-P, FINS and blood glucose indexes, and liver fibrosis in T2DM patients complicated with NAFLD

摘要

摘要:
目的探究2型糖尿病（T2DM）合并非酒精性脂肪肝（NAFLD）病人空腹C肽（FC-P）、空腹胰岛素（FINS）、血糖指标空腹血糖（FPG）、糖化血红蛋白（HbA1c）表达情况及各指标与肝纤维化的关系。
方法选取T2DM并NAFLD病人126例为研究组，随机选取同期126例单纯T2DM病人为对照A组，126名健康体检者为对照B组。比较3组血清FC-P、FINS、FPG、HbA1c水平，并比较研究组不同NAFLD肝纤维化评分（NAFLDFS）病人上述指标水平，探讨血清FC-P、FINS、FPG、HbA1c对T2DM并NAFLD的预测价值，探究各指标与T2DM并NAFLD病人NAFLDFS分值的关系，并分析T2DM并NAFLD病人NAFLDFS>0.676的影响因素。
结果血清FC-P、FINS、FPG、HbA1c水平研究组>对照A组>对照B组（P < 0.01）；血清FC-P、FINS、FPG、HbA1c联合预测T2DM并NAFLD的受试者基本工作特征曲线下面积（AUC）为0.839，大于各指标单一预测的AUC（0.764、0.801、0.757、0.729），联合预测的最佳敏感度、特异度分别为75.40%、84.13%；随研究组病人NAFLDFS分值增高，其体质量指数（BMI）、病程、腰臀比、血清FC-P、FINS、FPG、HbA1c水平均逐渐增高（P < 0.01）；研究组病人血清FC-P、FINS、FPG、HbA1c表达水平与NAFLDFS分值间均呈正相关关系（P < 0.01）；经logistic回归分析发现，随着T2DM并NAFLD病人病程增加，血清FC-P、FINS、FPG、HbA1c水平升高，NAFLDFS>0.676的发生风险逐渐升高（P < 0.01）。
结论T2DM并NAFLD病人FC-P、FINS、血糖指标高表达与肝纤维化评分呈正相关关系，联合检测可为预测T2DM病人并发NAFLD的风险、评估肝纤维化程度、抑制病情进展提供指导性参考。

Abstract:
ObjectiveTo explore the serum levels of fasting C-peptide(FC-P), fasting insulin(FINS), blood glucose indexesfasting plasma glucose(FPG), glycosylated hemoglobin(HbA1c) in patients with type 2 diabetes mellitus(T2DM) complicated with non-alcoholic fatty liver disease(NAFLD), and relationship between each index and liver fibrosis.
MethodsOne hundred and twenty-six patients with T2DM complicated with NAFLD were set as the study group.One hundred and twenty-six patients with T2DM and 126 healthy medical examinees during the same period were divided into the control group A and control group B, respectively.The serum levels of FC-P, FINS, FPG and HbA1c among three groups were compared, and the above index levels of patients with different NAFLD fibrosis scores(NAFLDFS) in the study group were compared.The predictive value of serum levels of FC-P, FINS, FPG and HbA1c to T2DM patients complicated with NAFLD were investigated, the relationship between each index and NAFLDFS score in T2DM patients complicated with NAFLD were explored, and the influencing factors of T2DM patients complicated with NAFLDFS more than 0.676 were analyzed.
ResultsThe serum levels of FC-P, FINS, FPG and HbA1c in the study group, control group A and control group B gradually decreased(P < 0.01).The area under the curve(AUC) predicted by the serum levels combination of FC-P, FINS, FPG and HbA1c in T2DM patients complicated with NAFLD was 0.839, which was greater than the AUC predicted by each indicator alone(0.764, 0.801, 0.757 and 0.729, respectively).The best sensitivity and specificity of the combined prediction were 75.40% and 84.13%, respectively.With the increasing of NAFLDFS score, the body mass index, disease duration, waist-to-hip ratio, and serum levels of FC-P, FINS, FPG, and HbA1c gradually increased in the study group(P < 0.01).There was a positive correlation between the expression levels of serum FC-P, FINS, FPG and HbA1c, and NAFLDFS score in the study group(P < 0.01).The results of logistic regression analysis showed that with the disease course of T2DM patients complicated with NAFLD prolonging, the serum levels of FC-P, FINS, FPG and HbA1c increased, and the risk of NAFLDFS>0.676 gradually increased(P < 0.01).
ConclusionsThe high levels of FC-P, FINS and blood glucose indexes in T2DM patients complicated with NAFLD is positively correlated with the liver fibrosis score.The combined detection can predict the risk of NAFLD in T2DM patients, and provide the guiding reference in evaluating the degree of liver fibrosis, and inhibiting the progression of the disease.

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