2型糖尿病患者25(OH)D和SUA/SCr与合并非酒精性脂肪肝的相关性

doi:10.3969/j.issn.1004-583X.2024.08.005

摘要/Abstract

摘要：

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者25羟基维生素D[25-hydroxyvitamin D, 25(OH)D]水平、血尿酸和血肌酐比值(serum uric acid and serum creatinine ratio, SUA/SCr)与合并非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)的关联。方法采用横断面研究,选取2022年1月1日至2023年3月31日在重庆大学附属三峡医院内分泌与代谢科住院的T2DM患者404例,依据是否合并NAFLD分为合并组(n=219)和单纯组(n=185)。收集两组临床资料,分析25(OH)D、SUA/SCr与其他临床资料的相关性。应用logistic回归模型评估NAFLD的危险因素。绘制受试者工作特征曲线评价25(OH)D、SUA/SCr对NAFLD的预测价值。结果与单纯组相比,合并组体重、体重指数、收缩压、舒张压、甘油三酯、总胆固醇、谷丙转氨酶、γ-谷氨酰转移酶(γ-glutamyl transferase, GGT)、血尿酸(serum uric acid,SUA)、胰岛素抵抗指数和SUA/SCr均升高,而年龄、病程、高密度脂蛋白胆固醇和25(OH)D均降低。Spearman相关性分析表明,25(OH)D与体重指数、糖化血红蛋白呈负相关,与血肌酐呈正相关;SUA/SCr与年龄、病程、收缩压、高密度脂蛋白胆固醇呈负相关,与低密度脂蛋白胆固醇、甘油三酯、总胆固醇、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、γ-谷氨酰转移酶、胰岛素抵抗指数均呈正相关。Logistic回归分析显示,SUA/SCr>4.64、GGT是T2DM患者合并NAFLD的危险因素,而病程、25(OH)D是其保护因素。受试者工作特征曲线进一步提示,25(OH)D联合SUA/SCr在T2DM合并NAFLD的预测中具有一定的价值。结论 T2DM合并NAFLD患者的25(OH)D水平较低,而SUA/SCr较高,两指标联合对T2DM患者合并NAFLD具有预测价值。

关键词: 糖尿病, 2型, 非酒精性脂肪性肝病, 25(OH)D, SUA/SCr

Abstract:

Objective To explore the correlation of 25 hydroxyvitamin D [25(OH)D] level and serum uric acid and serum creatinine ratio (SUA/SCR) with type 2 diabetes mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD). Methods A cross-sectional study involving 404 T2DM patients admitted to the Department of Endocrinology and Metabolism, Three Gorges Hospital Affiliated to Chongqing University from January 1, 2022 to March 31, 2023. They were assigned into the combined group (T2DM combined with NAFLD, n=219) and simple group (T2DM, n=185) based on the comorbidity of NAFLD. Clinical data were collected to analyze the correlation of 25(OH)D and SUA/SCr with other clinical data. Logistic regression was performed to evaluate the risk factors of NAFLD. The receiver operating characteristic (ROC) curves were plooted to evaluate the predictive value of 25(OH)D and SUA/SCr in T2DM combined with NAFLD.Results Compared with those of the simple group, patients in the combined group showed significantly higher body weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), total cholesterol (TC), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), SUA, insulin resistance index, and SUA/SCr, but significantly lower age, disease duration, high-density lipoprotein cholesterol (HDL-C), and 25(OH)D (P<0.05). Spearman correlation analysis showed that 25(OH)D was negatively correlated with BMI and glycated hemoglobin (HbA₁c), and positively correlated with SCr. SUA/SCr was negatively correlated with age, disease duration, SBP and HDL-C, and positively correlated with low-density lipoprotein cholesterol (LDL-C), TG, TC, aspartate aminotransferase (AST), ALT, GGT, and insulin resistance index. Logistic regression analysis showed that SUA/SCr>4.64 and GGT were risk factors for NAFLD in T2DM patients, while disease duration and 25(OH)D were protective factors. ROC curves further suggested that 25(OH)D combined with SUA/SCr had a high value in predicting NALFD in T2DM patients. Conclusion Serum 25(OH)D level decreases in T2DM patients combined with NAFLD, while SUA/SCr increases. 25(OH)D combined with SUA/SCr has a predictive value in diagnosing NAFLD in T2DM patients.

Key words: diabetes mellitus, type 2, non-alcoholic fatty liver disease, 25-hydroxyvitamin D, the ratio of serum uric acid to serum creatinine (SUA/SCr)

中图分类号:

R587.1

熊璐, 郭莲. 2型糖尿病患者25(OH)D和SUA/SCr与合并非酒精性脂肪肝的相关性[J]. 临床荟萃, 2024, 39(8): 706-711.

Xiong Lu, Guo Lian. Correlation of 25(OH)D and SUA/SCr with type 2 diabetes mellitus combined with non-alcoholic fatty liver disease[J]. Clinical Focus, 2024, 39(8): 706-711.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.08.005

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I8/706

图/表 6

表1 两组一般资料和实验室资料比较

Tab.1 General and laboratory data between groups

项目	单纯组( $n$ =185)	合并组( $n$ =219)	$t$ /χ²值	$P$ 值
男性[例(%)]	94(50.8)	125(57.1)	1.59	0.21
年龄(岁)	61.16±11.78	57.06±14.11	3.89	<0.05
体重(kg)	60.00(52.00, 67.00)	68.00(60.00, 75.00)	7.24	<0.01
BMI(kg/m²)	23.15(21.48, 25.10)	25.69(23.53, 27.76)	7.41	<0.01
病程(年)	8.00(1.00, 12.00)	4.00(0.25, 10.00)	3.91	<0.01
收缩压(mmHg)	126.00(113.50, 138.00)	130.00(118.00, 142.00)	2.41	<0.05
舒张压(mmHg)	77.00(70.00, 88.00)	83.00(74.00, 90.00)	3.49	<0.01
HbA₁c(%)	9.52±2.47	9.74±2.23	4.79	0.35
LDL-C(mmol/L)	2.78(1.99, 3.41)	2.85(2.12, 3.54)	0.77	0.44
HDL-C(mmol/L)	1.26(1.06, 1.47)	1.05(0.82, 1.25)	6.26	<0.01
TC(mmol/L)	4.69(3.88, 5.40)	4.78(4.04, 5.83)	2.05	<0.05
TG(mmol/L)	1.55(1.12, 2.62)	2.34(1.57, 4.46)	6.50	<0.01
25(OH)D(ng/ml)	16.32(11.75, 23.34)	14.41(8.65, 19.60)	3.33	<0.01
AST(U/L)	17.00(13.35, 22.65)	17.50(13.80, 22.60)	0.62	0.53
ALT(U/L)	16.10(12.05, 24.25)	19.20(14.80, 24.60)	2.71	<0.01
GGT(U/L)	19.00(13.00, 31.50)	27.00(19.00, 45.00)	5.64	<0.01
FPG(mmol/L)	8.55(6.70, 11.11)	8.67(7.14, 11.73)	1.00	0.32
HOMA-IR	1.15(0.86, 1.56)	4.87(2.83, 9.84)	1.26	<0.01
SCr(μmol/L)	65.00(56.00, 82.00)	69.00(58.00, 83.00)	1.66	0.10
SUA(μmol/L)	242.00(203.00, 313.00)	338.00(279.00, 402.00)	9.28	<0.01
SUA/SCr	3.72(3.06, 4.58)	4.65(3.75, 5.73)	6.83	<0.01

表1 两组一般资料和实验室资料比较

Tab.1 General and laboratory data between groups

项目	单纯组( $n$ =185)	合并组( $n$ =219)	$t$ /χ²值	$P$ 值
男性[例(%)]	94(50.8)	125(57.1)	1.59	0.21
年龄(岁)	61.16±11.78	57.06±14.11	3.89	<0.05
体重(kg)	60.00(52.00, 67.00)	68.00(60.00, 75.00)	7.24	<0.01
BMI(kg/m²)	23.15(21.48, 25.10)	25.69(23.53, 27.76)	7.41	<0.01
病程(年)	8.00(1.00, 12.00)	4.00(0.25, 10.00)	3.91	<0.01
收缩压(mmHg)	126.00(113.50, 138.00)	130.00(118.00, 142.00)	2.41	<0.05
舒张压(mmHg)	77.00(70.00, 88.00)	83.00(74.00, 90.00)	3.49	<0.01
HbA₁c(%)	9.52±2.47	9.74±2.23	4.79	0.35
LDL-C(mmol/L)	2.78(1.99, 3.41)	2.85(2.12, 3.54)	0.77	0.44
HDL-C(mmol/L)	1.26(1.06, 1.47)	1.05(0.82, 1.25)	6.26	<0.01
TC(mmol/L)	4.69(3.88, 5.40)	4.78(4.04, 5.83)	2.05	<0.05
TG(mmol/L)	1.55(1.12, 2.62)	2.34(1.57, 4.46)	6.50	<0.01
25(OH)D(ng/ml)	16.32(11.75, 23.34)	14.41(8.65, 19.60)	3.33	<0.01
AST(U/L)	17.00(13.35, 22.65)	17.50(13.80, 22.60)	0.62	0.53
ALT(U/L)	16.10(12.05, 24.25)	19.20(14.80, 24.60)	2.71	<0.01
GGT(U/L)	19.00(13.00, 31.50)	27.00(19.00, 45.00)	5.64	<0.01
FPG(mmol/L)	8.55(6.70, 11.11)	8.67(7.14, 11.73)	1.00	0.32
HOMA-IR	1.15(0.86, 1.56)	4.87(2.83, 9.84)	1.26	<0.01
SCr(μmol/L)	65.00(56.00, 82.00)	69.00(58.00, 83.00)	1.66	0.10
SUA(μmol/L)	242.00(203.00, 313.00)	338.00(279.00, 402.00)	9.28	<0.01
SUA/SCr	3.72(3.06, 4.58)	4.65(3.75, 5.73)	6.83	<0.01

表2 25(OH)D与其他临床指标的相关性分析

Tab.2 Correlation analysis of 25(OH)D with other clinical indicators

	性别	年龄 (岁)	体重 (kg)	BMI (kg/m²)	病程 (年)	收缩压 (mmHg)	舒张压 (mmHg)	HbA₁c (%)	LDL-C (mmol/L)	HDL-C (mmol/L)
$r$ 值	-0.08	0.04	-0.03	-0.10	0.06	-0.02	0.05	-0.10	-0.01	0.05
$P$ 值	0.11	0.41	0.51	0.04	0.20	0.70	0.33	0.04	0.83	0.33
	TC (mmol/L)	TG (mmol/L)	AST (U/L)	ALT (U/L)	GGT (U/L)	FPG (mmol/L)	HOMA-IR	SCr (μmol/L)	SUA (μmol/L)	SUA/SCr
$r$ 值	-0.03	-0.06	0.06	0.03	-0.01	-0.08	-0.03	0.11	0.02	-0.03
$P$ 值	0.59	0.21	0.25	0.50	0.78	0.11	0.55	0.03	0.64	0.56

表2 25(OH)D与其他临床指标的相关性分析

Tab.2 Correlation analysis of 25(OH)D with other clinical indicators

	性别	年龄 (岁)	体重 (kg)	BMI (kg/m²)	病程 (年)	收缩压 (mmHg)	舒张压 (mmHg)	HbA₁c (%)	LDL-C (mmol/L)	HDL-C (mmol/L)
$r$ 值	-0.08	0.04	-0.03	-0.10	0.06	-0.02	0.05	-0.10	-0.01	0.05
$P$ 值	0.11	0.41	0.51	0.04	0.20	0.70	0.33	0.04	0.83	0.33
	TC (mmol/L)	TG (mmol/L)	AST (U/L)	ALT (U/L)	GGT (U/L)	FPG (mmol/L)	HOMA-IR	SCr (μmol/L)	SUA (μmol/L)	SUA/SCr
$r$ 值	-0.03	-0.06	0.06	0.03	-0.01	-0.08	-0.03	0.11	0.02	-0.03
$P$ 值	0.59	0.21	0.25	0.50	0.78	0.11	0.55	0.03	0.64	0.56

表3 SUA/SCr与其他临床指标的相关性分析

Tab.3 Correlation analysis between SUA/SCr and other clinical indicators

	性别		年龄 (岁)		体重 (kg)		BMI (kg/m²)		病程 (年)		收缩压 (mmHg)		舒张压 (mmHg)		HbA₁c (%)		LDL-C (mmol/L)
$r$ 值	0.07		-0.34		0.06		0.05		-0.18		-0.10		0.10		0.04		0.10
$P$ 值	0.16		<0.01		0.30		0.29		<0.01		<0.05		<0.05		0.44		0.04
		HDL-C (mmol/L)		TC (mmol/L)		TG (mmol/L)		AST (U/L)		ALT (U/L)		GGT (U/L)		FPG (mmol/L)		HOMA-IR
$r$ 值		-0.14		0.10		0.74		0.10		0.10		0.13		0.02		0.16
$P$ 值		0.01		0.04		<0.01		0.05		0.04		0.01		0.71		<0.01

表3 SUA/SCr与其他临床指标的相关性分析

Tab.3 Correlation analysis between SUA/SCr and other clinical indicators

	性别		年龄 (岁)		体重 (kg)		BMI (kg/m²)		病程 (年)		收缩压 (mmHg)		舒张压 (mmHg)		HbA₁c (%)		LDL-C (mmol/L)
$r$ 值	0.07		-0.34		0.06		0.05		-0.18		-0.10		0.10		0.04		0.10
$P$ 值	0.16		<0.01		0.30		0.29		<0.01		<0.05		<0.05		0.44		0.04
		HDL-C (mmol/L)		TC (mmol/L)		TG (mmol/L)		AST (U/L)		ALT (U/L)		GGT (U/L)		FPG (mmol/L)		HOMA-IR
$r$ 值		-0.14		0.10		0.74		0.10		0.10		0.13		0.02		0.16
$P$ 值		0.01		0.04		<0.01		0.05		0.04		0.01		0.71		<0.01

表4 T2DM患者合并NAFLD的多因素logistic回归分析

Tab.4 Multivariate logistic regression analysis for NAFLD in T2DM patients

指标	β	标准误	$O R$ 值	$P$ 值	95% $C I$
指标	β	标准误	$O R$ 值	$P$ 值	下限	上限
SUA/SCr>4.46	1.424	0.513	4.16	<0.01	1.52	11.35
病程	-0.097	0.040	0.91	0.014	0.84	0.98
25(OH)D	-0.15	0.000	0.86	<0.01	0.80	0.92
GGT	0.014	0.044	1.02	0.044	1.00	1.03

表4 T2DM患者合并NAFLD的多因素logistic回归分析

Tab.4 Multivariate logistic regression analysis for NAFLD in T2DM patients

指标	β	标准误	$O R$ 值	$P$ 值	95% $C I$
指标	β	标准误	$O R$ 值	$P$ 值	下限	上限
SUA/SCr>4.46	1.424	0.513	4.16	<0.01	1.52	11.35
病程	-0.097	0.040	0.91	0.014	0.84	0.98
25(OH)D	-0.15	0.000	0.86	<0.01	0.80	0.92
GGT	0.014	0.044	1.02	0.044	1.00	1.03

图1 25(OH)D、SUA/SCr及两者联合预测T2DM患者合并NAFLD的ROC曲线

Fig.1 ROC curve of 25(OH)D, SUA/SCr, and their combination in predicting T2DM patients complicated with NAFLD

表5 25(OH)D、SCr/SUA及两者联合对T2DM患者合并NAFLD的预测价值

Tab.5 Predictive value of 25 (OH) D, SCr/SUA, and their combination for T2DM patients complicated with NAFLD

变量	曲线下面积	敏感度	特异度	截断值	$P$ 值	95% $C I$
变量	曲线下面积	敏感度	特异度	截断值	$P$ 值	下限	上限
25(OH)D	0.596	28.3%	88.6%	9.00	<0.01	0.547	0.645
SUA/SCr	0.697	51.1%	78.9%	4.46	<0.01	0.650	0.742
25(OH)D联合SUA/SCr	0.714	67.1%	65.9%	0.13	<0.01	0.667	0.757

表5 25(OH)D、SCr/SUA及两者联合对T2DM患者合并NAFLD的预测价值

Tab.5 Predictive value of 25 (OH) D, SCr/SUA, and their combination for T2DM patients complicated with NAFLD

变量	曲线下面积	敏感度	特异度	截断值	$P$ 值	95% $C I$
变量	曲线下面积	敏感度	特异度	截断值	$P$ 值	下限	上限
25(OH)D	0.596	28.3%	88.6%	9.00	<0.01	0.547	0.645
SUA/SCr	0.697	51.1%	78.9%	4.46	<0.01	0.650	0.742
25(OH)D联合SUA/SCr	0.714	67.1%	65.9%	0.13	<0.01	0.667	0.757

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