身体形态指数与新诊2型糖尿病合并非酒精性脂肪肝的关系

doi:10.3969/j.issn.1004-583X.2021.02.010

摘要/Abstract

摘要：

目的剖析身体形态指数(a body shape index, ABSI) 与新诊2型糖尿病(type 2 diabetes mellitus, T2DM)合并非酒精性脂肪肝(non-alcoholic fatty liver disease, NAFLD)的联系。方法回顾性研究江苏大学附属医院住院新诊T2DM患者107例,按照腹部彩色超声结果分为两组:新诊2型糖尿病合并非酒精性脂肪肝(试验组)57例,单纯新诊2型糖尿病(T2DM组)50例;并选取健康人(对照组)48例。记录所有研究对象临床基线资料如身高、体重、腰围(WC)、臀围并计算ABSI、腰臀比(waist hip rate, WHR)、体重指数(body mass index, BMI)、腰高比(waist height rate, WHtR);检测相关生化指标。比较3组间的差异,同时比较ABSI与代谢指标等的关系。结果试验组ABSI大于健康对照组及T2DM组。试验组空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)、尿酸、白细胞、中性粒细胞/淋巴细胞比值( NLR)、WC、WHR、BMI、WHtR均高于对照组及T2DM组,高密度脂蛋白胆固醇(HDL-C)显著低于其余两组;随着ABSI水平升高,空腹血糖、餐后2小时血糖、LDL-C、TG、TC、HOMA-IR及 NLR显著升高, 且呈正相关,HDL-C水平显著降低,呈负相关。logistic 回归分析示ABSI是新诊T2DM合并NAFLD的危险因素。ROC曲线显示ABSI对新诊2型糖尿病人群中发生NAFLD有一定预测价值,ROC曲线下面积为0.78。结论新诊T2DM合并NAFLD患者ABSI明显增加,其与胰岛素抵抗、NLR水平密切相关,ABSI是T2DM合并NAFLD的危险因素,为临床NAFLD的早期筛查及防治提供新的思路。

关键词: 糖尿病, 2型, 身体形态指数, 非酒精性脂肪肝

Abstract:

Objective To analyze the relationship between a body shape index (ABSI) and newly-diagnosed type 2 diabetes mellitus(T2DM) complicated with non-alcoholic fatty liver disease(NAFLD). Methods A retrospective study included 107 newly-diagnosed T2DM patients complicated with NAFLD treated in Affiliated Hospital of Jiangsu University. According to the results of abdominal color ultrasonography, those patients were divided into the experimental group (n=57) with T2DM complicated with NAFLD patients and T2DM group (n=50) with signal newly-diagnosed T2DM patients. Additionally, 48 healthy controls were selected into the control group (n=48). The clinical baseline data including height, weight, waist circumference(WC), and hip circumference(HC) were recorded for all participants to calculate ABSI, waist hip rate(WHR), body mass index(BMI), waist height rate(WHtR). And, the relevant biochemical indicators were measured. All the clinical parameters were compared among three groups. The relationship between ABSI and metabolic indexes was analyzed. Results Compared with T2DM group and control group, the levels of ABSI, fasting insulin, HOMA-IR, low-density lipoprotein cholesterin(LDL-C), triacylglycerol(TG), total cholesterol(TC), uric acid(UA), white blood cell(WBC), neutrophils/lymphocytes ratio(NLR), WC, WHR, BMI, and WHtR in experimental group were higher, while the level of high-density lipoprotein cholesterin (HDL-C) was lower. Furthermore, with the increase of ABSI level, the levels of fasting blood-glucose(FBG), 2-hour post-meal blood glucose(2 hPG), LDL-C, TG, TC, HOMA-IR, and NLR were remarkably elevated, which had a positive correlation. However, the level of HDL-C was decreased, which meant a negative correlation. The logistic regression analysis showed that ABSI was a risk factor for the newly-diagnosed T2DM complicated with NAFLD. The ROC curve indicated that ABSI had a certain value in predicting the NAFLD development in newly-diagnosed T2DM patients. The area under the ROC curve was 0.78. Conclusion The ABSI which has a close relation to insulin resistance and NLR level can be significantly increased and serve as a risk factor in patients with newly-diagnosed T2DM complicated with NAFLD. And it can provide a new clinical idea for the prevention and early screening of NAFLD.

Key words: diabetes mellitus, type 2, a body shape index, non-alcoholic fatty liver disease

中图分类号:

R587.1

叶菁菁, 秦瑜, 赵丽, 杨玲. 身体形态指数与新诊2型糖尿病合并非酒精性脂肪肝的关系[J]. 临床荟萃, 2021, 36(2): 144-148.

Ye Jingjing, Qin Yu, Zhao Li, Yang Ling. Relationship between a body shape index and newly-diagnosed type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease[J]. Clinical Focus, 2021, 36(2): 144-148.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.02.010

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I2/144

图/表 4

参考文献 22

[1]	Bedossa P. Pathology of non-alcoholic fatty liver disease[J]. Liver Int, 2017,37(1):85-89. doi: 10.1111/liv.2017.37.issue-S1 URL
[2]	Lebeaupin C, Vallée D, Hazari Y, et al. Endoplasmic reticulum stress signalling and the pathogenesis of non-alcoholic fatty liver disease[J]. J Hepatol, 2018,69(4):927-947. doi: 10.1016/j.jhep.2018.06.008 URL
[3]	程梦凡, 吴乃君, 王雪莲. 2 型糖尿病合并非酒精性脂肪肝患者内脏脂肪指数相关研究[J]. 华北理工大学学报(医学版), 2020,22(3):173-177.
[4]	Jensen Benjamin Ah, Marette Andre. Microbial translocation in type 2 diabetes: when bacterial invaders overcome host defence in human obesity[J]. Gut, 2020,69(10):1724-1726. doi: 10.1136/gutjnl-2020-321288 pmid: 32518079
[5]	Dhana K, Kavousi M, Ikram MA, et al. Body shape index in comparison with other anthropometric measures in prediction of total and cause-specific mortality[J]. J Epidemiol Community Health, 2016,70(1):90-96. doi: 10.1136/jech-2014-205257 URL
[6]	Singh S, Allen AM, Wang Z, et al. Fibrosis progression in non alcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies[J]. Clin Gastroenterol Hepato, 2015,3(4):643-654.
[7]	Pais R, Barritt AS, Calmus Y, et al. NAFLD and liver transplantation: Current burden and expected challenges[J]. J Hepatol, 2016,65(6):1245-1257. doi: 10.1016/j.jhep.2016.07.033 URL
[8]	Motta BM, Grander C, Gögele M, et al. Microbiota, type 2 diabetes and non-alcoholic fatty liver disease: protocol of an observational study[J]. J Transl Med, 2019,17(1):408. doi: 10.1186/s12967-019-02130-z URL
[9]	Rhee EJ. Nonalcoholic fatty liver disease and diabetes:an epidemiological perspective[J]. Endocrinol Metab, 2019,34(3):226. doi: 10.3803/EnM.2019.34.3.226 URL
[10]	Cruz MA, Cruz JF, Macena LB, et al. Association of the nonalcoholic hepatic steatosis and its degrees with the values of liver enzymes and homeostasis model assessment-insulin resistance index[J]. Gastroenterology Res, 2015,8(5):260-264. doi: 10.14740/gr685w URL
[11]	刘婷, 王臣廷, 刘美晓, 等. 2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化与血尿酸水平的关系[J]. 临床肝胆病杂志, 2020,36(6):1320-1324.
[12]	Kim D, Chung GE, Kwak MS, et al. Body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease: Prospective cohort study[J]. J Hepatology, 2016,14(4):132-138.
[13]	Xu C, Ma Z, Wang Y, Liu X, Tao L, et al. Visceral adiposity index as a predictor of NAFLD: A prospective study with 4-year follow-up[J]. Liver Int, 2018,38(12):2294-2300. doi: 10.1111/liv.2018.38.issue-12 URL
[14]	Wang F, Chen Y, Chang Y, et al. New anthropometric indices or old ones: which perform better in estimating cardiovascular risks in Chinese adults[J]. BMC Cardiovasc Disord, 2018,18(1):14. doi: 10.1186/s12872-018-0754-z URL
[15]	Motamed N, Rabiee B, Hemasi GR, et al. Body roundness index and waist-to-height ratio are strongly associated with non-alcoholic fatty liver disease: A population-based study[J]. Hepat Mon, 2016,16(9):e39575.
[16]	Zhao W, Tong JJ, Cao YT, et al. A linear relationship between a body shape index and risk of incident type 2 diabetes: A secondary analysis based on a retrospective cohort study in Japan[J]. Diabetes Metab Syndr Obes, 2020,13:2139-2146. doi: 10.2147/DMSO.S256031 URL
[17]	DAI W, YE L, LIU A, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a meta-analysis[J]. Medicine(Baltimore), 2017,96(39):e8179.
[18]	Do T, Marieg, Heloise D, et al. Glucocorticoid-induced insulin resistance is related to macrophage visceral adipose tissue infiltration[J]. J Steroid Biochem Mol Biol, 2019,185:150-162. doi: 10.1016/j.jsbmb.2018.08.010 URL
[19]	侯海青, 蔡美娟, 王文, 等. 代谢综合征对非酒精性脂肪肝患者肝脏脂肪含量的影响及相关因素[J]. 中国老年学杂志, 2019,39(1):86-89.
[20]	郑海兰, 李凡, 丁维, 等. 中性粒细胞 /淋巴细胞比值与 2 型糖尿病合并非酒精性脂肪肝的相关性分析[J]. 安徽医学, 2020,41(5):562-565.
[21]	邓桂娟, 程晓光, 尹潞, 等. 中老年高血压人群肥胖与骨质疏松相关性研究[J]. 中国循环志, 2019,34(11):1091-1097.
[22]	Misuzu F, Yasunori S, Kengo N, et al. Predictive power of a body shape index for development of diabetes, hypertension, and dyslipidemia in japanese adults: Aretrospective cohort study[J]. PLoS One, 2015,10(6):e0128972. doi: 10.1371/journal.pone.0128972 URL

项目	对照组	T2DM组	试验组	F值	P值
例数	48	50	57	-	-
男/女(例)	26/22	33/17	33/24	-	-
年龄(岁)	50.51±10.76	51.78±11.52	51.53±13.77	2.900	>0.05
收缩压(mmHg)	126.92±14.14	127.36±15.1	130.32±14.24	0.870	>0.05
舒张压(mmHg)	80.73±11.60	76.52±13.17	82.54±9.79^c	3.760	<0.05
空腹血糖(mmol/L)	5.25±0.51	12.04±2.99^b	12.33±3.18^b	118.660	<0.01
餐后2小时血糖(mmol/L)	6.27±1.09	22.21±5.70^b	22.71±4.62^b	231.980	<0.01
空腹胰岛素(mIU/L)	4.47±1.40	4.47±2.57	6.93±2.31^{a, c}	6.260	<0.01
HOMA-IR	1.05±0.37	2.31±1.09^a	3.76±4.06^{b, c}	14.820	<0.01
LDL-C(mmol/L)	2.27±1.02	2.84±1.26^a	3.35±0.89^{b, c}	9.060	<0.01
TG(mmol/L)	1.26±0.36	1.74±0.92	2.50±1.01^{b, d}	13.470	<0.01
HDL-C(mmol/L)	2.01±0.97	1.54±0.78^a	1.19±0.55^{b, c}	14.830	<0.01
TC(mmol/L)	4.60±0.49	4.82±1.02	5.19±0.76^{b, c}	7.740	<0.01
尿酸(μmol/L)	249.89±69.95	241.09±80.53	284.38±69.45^{a, d}	5.260	<0.01
白细胞(×10⁹/L)	5.87±1.17	5.84±1.26	6.51±1.42^{b, c}	4.800	<0.05
NLR	1.01±0.84	1.73±0.62^a	1.91±0.79^{b, d}	20.120	<0.01

项目	对照组	T2DM组	试验组	F值	P值
例数	48	50	57	-	-
男/女(例)	26/22	33/17	33/24	-	-
年龄(岁)	50.51±10.76	51.78±11.52	51.53±13.77	2.900	>0.05
收缩压(mmHg)	126.92±14.14	127.36±15.1	130.32±14.24	0.870	>0.05
舒张压(mmHg)	80.73±11.60	76.52±13.17	82.54±9.79^c	3.760	<0.05
空腹血糖(mmol/L)	5.25±0.51	12.04±2.99^b	12.33±3.18^b	118.660	<0.01
餐后2小时血糖(mmol/L)	6.27±1.09	22.21±5.70^b	22.71±4.62^b	231.980	<0.01
空腹胰岛素(mIU/L)	4.47±1.40	4.47±2.57	6.93±2.31^{a, c}	6.260	<0.01
HOMA-IR	1.05±0.37	2.31±1.09^a	3.76±4.06^{b, c}	14.820	<0.01
LDL-C(mmol/L)	2.27±1.02	2.84±1.26^a	3.35±0.89^{b, c}	9.060	<0.01
TG(mmol/L)	1.26±0.36	1.74±0.92	2.50±1.01^{b, d}	13.470	<0.01
HDL-C(mmol/L)	2.01±0.97	1.54±0.78^a	1.19±0.55^{b, c}	14.830	<0.01
TC(mmol/L)	4.60±0.49	4.82±1.02	5.19±0.76^{b, c}	7.740	<0.01
尿酸(μmol/L)	249.89±69.95	241.09±80.53	284.38±69.45^{a, d}	5.260	<0.01
白细胞(×10⁹/L)	5.87±1.17	5.84±1.26	6.51±1.42^{b, c}	4.800	<0.05
NLR	1.01±0.84	1.73±0.62^a	1.91±0.79^{b, d}	20.120	<0.01

项目	对照组	T2DM组	试验组	F值	P值
ABSI	0.075±0.005	0.082±0.004^b	0.085±0.004^{b, d}	22.700	<0.01
颈围(cm)	36.57±3.29	36.24±3.15	37.08±2.74	1.030	>0.05
WC(cm)	83.47±5.60	87.15±8.14^a	92.85±6.81^{b, d}	24.540	<0.01
WHR(cm)	0.88±0.10	0.92±0.058	0.98±0.25^{b, c}	5.650	<0.05
BMI(kg/m²)	23.66±3.01	24.56±3.34^a	25.01±2.84^{b, c}	5.110	<0.01
WHtR	0.50±0.04	0.52±0.04^a	0.56±0.05^{b, d}	23.750	<0.01

项目	对照组	T2DM组	试验组	F值	P值
ABSI	0.075±0.005	0.082±0.004^b	0.085±0.004^{b, d}	22.700	<0.01
颈围(cm)	36.57±3.29	36.24±3.15	37.08±2.74	1.030	>0.05
WC(cm)	83.47±5.60	87.15±8.14^a	92.85±6.81^{b, d}	24.540	<0.01
WHR(cm)	0.88±0.10	0.92±0.058	0.98±0.25^{b, c}	5.650	<0.05
BMI(kg/m²)	23.66±3.01	24.56±3.34^a	25.01±2.84^{b, c}	5.110	<0.01
WHtR	0.50±0.04	0.52±0.04^a	0.56±0.05^{b, d}	23.750	<0.01

临床指标	Q1(<0.079)	Q2(0.079~0.084)	Q3(≥0.084)	F值	P值
例数	51	52	52
收缩压(mmHg)	128.03±14.23	126.1±14.11	130.79±14.98	1.380	>0.05
舒张压(mmHg)	80.29±12.80	79.83±12.06	80.00±10.47	0.020	>0.05
FPG(mmol/L)	7.07±3.65	10.47±3.24^b	11.50±3.81^{b, c}	26.160	<0.01
2 hPG(mmol/L)	10.42±7.65	18.74±6.60^b	21.00±7.18^{b, c}	36.520	<0.01
HOMA-IR	1.28±0.73	2.42±1.14^b	3.64±1.29^{b, c}	10.560	<0.01
LDL-C(mmol/L)	2.38±1.15	3.05±1.14^b	3.15±0.97^b	7.620	<0.01
TG(mmol/L)	1.40±0.68	1.91±0.99^a	2.31±1.87^{b, c}	6.390	<0.01
HDL-C(mmol/L)	1.87±0.96	1.48±0.69^a	1.31±0.77^b	6.770	<0.01
TC(mmol/L)	4.57±0.71	5.06±0.74^a	5.09±0.93^b	6.190	<0.01
尿酸(μmol/L)	251.78±62.34	269.74±91.11	257.53±69.76	0.760	>0.05
NLR	1.12±0.83	1.74±0.67^b	1.84±0.86^b	12.450	<0.01