2型糖尿病患者肝脏受控衰减参数与血清25-羟维生素D的相关性

凡军芳; 胡静; 耿旭; 庄兰艮; 时照明

doi:10.16766/j.cnki.issn.1674-4152.001919

2型糖尿病患者肝脏受控衰减参数与血清25-羟维生素D的相关性

doi: 10.16766/j.cnki.issn.1674-4152.001919

1.
蚌埠医学院第一附属医院内分泌科，安徽蚌埠 233004
2.
淮南市第一人民医院内分泌科，安徽淮南 232007
3.
蚌埠医学院第一附属医院心血管内科，安徽蚌埠 233004

基金项目:

国家级创新计划 202010367016

详细信息

通讯作者:
时照明，E-mail: szm1997@163.com

中图分类号: R587.1 R575.5
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出版历程
- 收稿日期: 2020-12-25
- 网络出版日期: 2022-02-16

Correlation between liver-controlled attenuation parameters and serum 25-hydroxyvitamin D level in patients with type 2 diabetes

1.
Department of Endocrinology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨2型糖尿病(type 2 diabetes mellitus, T2DM)患者肝脏受控衰减参数(controlled attenuation parameters, CAP)值与血清25-羟维生素D[25(OH)D]的相关性。方法选取2019年5月—2020年7月在蚌埠医学院第一附属医院就诊的T2DM患者160例，依据CAP数值大小分为无NAFLD组(43例)、轻度NAFLD组(35例)、中度NAFLD组(35例)和重度NAFLD组(47例)。分别测定VAT、SAT、25(OH)D和其他生化指标，比较各组间生化指标的差异，采用logistic回归分析，Pearson或Spearman进行相关性分析，ROC曲线分析CAP预测T2DM患者维生素D缺乏的最佳阈值。结果无NAFLD组25(OH)D显著高于中度和重度NAFLD组，轻度和中度NAFLD组25(OH)D显著高于重度NAFLD组(均P < 0.05)；CAP与25(OH)D、HDL-C呈负相关(r=-0.436、-0.193，均P < 0.05)，CAP与WHR、BMI、VAT、SAT、TC、TG、FINS、HOMA-IR、FFA、CRP、γ-GT、ALT呈正相关(r=0.276~0.447，均P < 0.05)；25(OH)D与CAP、VAT、FBG、TC、TG、FFA、HOMA-IR、ALT、CRP、γ-GT呈负相关(r=-0.436~-0.156，均P < 0.05)。Logistic回归分析发现FFA和25(OH)D是T2DM发生NAFLD的影响因素，ROC曲线显示以CAP在265 dB/m为诊断界值预测维生素D缺乏的敏感性为0.776，特异性为0.637。结论 T2DM患者肝脏脂肪含量与血清25(OH)D负相关，25(OH)D是T2DM发生NAFLD的保护因素。
- 2型糖尿病 /
- 受控衰减参数 /
- 非酒精性脂肪肝 /
- 25-羟维生素D
Abstract: Objective This study aimed to investigate the correlation between controlled attenuation parameters (CAP) of the liver and serum 25-hydroxyvitamin D[25(OH)D] in patients with type 2 diabetes mellitus (T2DM). Methods A total of 160 patients with T2DM who were admitted to the First Affiliated Hospital of Bengbu Medical College from May 2019 to July 2020 were selected. On the basis of the CAP value, the patients were divided into the following groups: without NAFLD (43 patients), with mild NAFLD (35 patients), with moderate NAFLD (35 patients) and with severe NAFLD (47 patients). Vat, SAT, 25(OH)D and other biochemical indexes were measured, and differences in biochemical indexes amongst the groups were compared. Logistic regression analysis and Pearson or Spearman correlation analysis were performed, and ROC curve was used to analyse the optimal threshold of CAP for predicting vitamin D deficiency in patients with T2DM. Results 25(OH)D in the non-NAFLD group was significantly higher than that in the moderate and severe NAFLD groups, and 25(OH)D in the mild and moderate NAFLD groups was significantly higher than that in the severe NAFLD group (all P < 0.05). CAP was negatively correlated with 25(OH)D and HDL-C (r=-0.436, -0.193, all P < 0.05), whereas CAP was positively correlated with WHR, BMI, VAT, SAT, TC, TG, FINS, HOMA-IR, FFA, CRP, γ-GT and ALT (r= 0.276-0.447, all P < 0.05). 25(OH)D was negatively correlated with CAP, VAT, FBG, TC, TG, FFA, HOMA-IR, ALT, CRP and γ-GT (r=-0.436--0.156, all P < 0.05). Logistic regression analysis showed that FFA and 25(OH)D were the influencing factors for the development of NAFLD in T2DM. ROC curve showed that CAP265 dB/m as the diagnostic threshold had a sensitivity of 0.776 and a specificity of 0.637 for predicting vitamin D deficiency. Conclusion Liver fat content is negatively correlated with serum 25(OH)D in patients with T2DM, and 25(OH)D is a protective factor for NAFLD in T2DM.
- Diabetes mellitus, type2 /
- Controlled attenuation parameter /
- Non-alcoholic fatty liver disease /
- 25-hydroxy vitamin D

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图 1 CAP预测T2DM患者血清维生素D缺乏的ROC曲线

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表 1 4组T2DM患者一般资料和生化指标比较[M(P₂₅, P₇₅)]

组别	例数	性别(男/女，例)	年龄(x±s, 岁)	BMI(x±s)	WHR	VAT(x±s, cm²)	SAT(x±s, cm²)	25(OH)D(x±s, ng/mL)
无NAFLD组	43	21/22	52.98±9.86	22.31±3.25	0.90(0.86, 0.92)	57.11±33.25	140.81±54.81	29.54±8.37
轻度NAFLD组	35	20/15	57.63±7.48	24.23±2.59^c	0.93(0.90, 0.95)^c	75.43±38.06^c	182.01±54.85^c	26.59±8.85
中度NAFLD组	35	19/16	53.80±13.87	25.48±2.43^c	0.94(0.92, 0.96)^c	89.05±29.11^c	197.34±40.87^c	23.65±9.94^c
重度NAFLD组	47	26/21	54.83±12.04	25.70±3.28^cd	0.93(0.91, 0.96)^c	93.67±25.21^cd	211.68±53.31^cd	19.18±7.65^cdf
统计量		0.630^a	1.238^b	11.765^b	27.365^e	11.737^b	15.304^b	11.611^b
P值		0.889	0.298	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	FBG(mmol/L)	HbA1c(x±s, %)	FINS(mIU/L)	HOMA-IR	TC(x±s, mmol/L)	HDL-C(mmol/L)	LDL-C(x±s, mmol/L)
无NAFLD组	43	6.80(5.11, 8.40)	10.05±1.96	3.97(2.00, 7.87)	1.30(0.79, 2.39)	3.94±0.93	0.97(0.86, 1.10)	2.67±0.82
轻度NAFLD组	35	7.60(5.75, 8.90)	9.53±2.74	5.84(3.05, 8.50)	1.74(1.06, 3.07)	4.03±1.53	0.99(0.78, 1.15)	2.37±1.15
中度NAFLD组	35	8.34(5.29, 10.59)	10.36±2.32	5.49(2.12, 9.26)	1.92(0.94, 3.30)	4.82±1.47^cd	0.88(0.77, 1.03)	2.56±0.81
重度NAFLD组	47	7.01(5.84, 8.22)	9.07±1.80^cf	8.54(5.18, 12.40)^c	2.79(1.38, 4.11)^c	5.05±1.46^cd	0.89(0.77, 1.06)	2.63±0.89
统计量		3.749^e	2.804^b	13.170^e	11.340^e	7.059^b	6.523^e	0.775^b
P值		0.290	0.042	0.004	0.010	< 0.001	0.089	0.509

组别	例数	TG(mmol/L)	FFA(mmol/L)	ALT(U/L)	AST(U/L)	γ-GT(U /L)	CRP(mg/L)
无NAFLD组	43	1.42(0.92, 2.17)	0.46(0.38, 0.57)	15(12, 19)	19(17, 23)	16(12, 25)	0.90(0.50, 1.30)
轻度NAFLD组	35	1.30(1.01, 2.04)	0.54(0.41, 0.70)	15(11, 18)	20(17, 21)	19(14, 34)	1.20(0.50, 2.57)
中度NAFLD组	35	2.10(1.55, 3.14)^cd	0.62(0.47, 0.85)^c	19(12, 34)	21(19, 27)	27(18, 55)^c	1.50(0.60, 3.03)^c
重度NAFLD组	47	2.10(1.48, 3.37)^cd	0.65(0.47, 0.92)^c	23(16, 36)^cd	20(18, 27)	27(19, 40)^c	1.70(0.90, 2.78)^c
统计量		19.596^e	24.165^e	20.036^e	6.621^e	14.189^e	17.157^e
P值		< 0.001	< 0.001	< 0.001	0.085	0.003	0.001
注：^a为χ²值，^b为F值；与无NAFLD组比较，^cP < 0.05；与轻度NAFLD组比较，^dP < 0.05；^e为H值；与中度NAFLD组比较，^fP < 0.05。

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表 2 CAP与各指标的相关性分析

统计量	WHR	BMI	VAT	SAT	25(OH)D	TC	TG	FINS	HOMA-IR	HDL-C	FFA	CRP	γ-GT	ALT
r值	0.392	0.454	0.447	0.474	-0.436	0.295	0.328	0.276	0.283	-0.193	0.337	0.369	0.281	0.313
P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	0.015	< 0.001	< 0.001	< 0.001	< 0.001

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表 3 25(OH)D与各指标的相关性分析

统计量	CAP	VAT	FBG	TC	TG	FFA	HOMA-IR	ALT	γ-GT	CRP
r值	-0.436	-0.158	-0.241	-0.223	-0.215	-0.223	-0.168	-0.175	-0.156	-0.208
P值	< 0.001	0.047	0.002	0.005	0.006	0.005	0.034	0.027	0.049	0.008

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表 4 T2DM患者发生NAFLD风险的影响因素

变量	B	SE	Wald χ²	P值	OR值	95% CI
常数项Constant	-16.077	7.407	4.711	0.030	< 0.001
25(OH)D	-0.103	0.034	9.020	0.003	0.902	0.844~0.965
FFA	6.498	1.836	12.531	< 0.001	663.772	18.176~24 239.753

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