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血清碱性磷酸酶与2型糖尿病合并非酒精性脂肪肝病的相关性分析

钱方方 戴梅清 赵丽 邓霞 杨玲 贾珏 王济芳 王东 袁国跃

引用本文:
Citation:

血清碱性磷酸酶与2型糖尿病合并非酒精性脂肪肝病的相关性分析

DOI: 10.3969/j.issn.1001-5256.2023.01.013
基金项目: 

国家自然科学基金 81870548;

江苏省自然科学基金 BK20191222;

江苏省社会发展重点研发项目 BE2018692

伦理学声明:本研究于2018年12月17日经由江苏大学附属医院伦理委员会审批,批号:SWYXLL20181217-1。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:钱方方、戴梅清负责课题设计,资料分析,论文撰写;赵丽、邓霞、杨玲、贾珏、王济芳、王东参与收集数据,修改论文;袁国跃负责拟定写作思路,指导撰写文章及最后定稿。
详细信息
    通信作者:

    袁国跃,yuanguoyue@ujs.edu.cn (ORCID: 0000-0003-0822-6066)

Association between serum alkaline phosphatase and type 2 diabetes mellitus with nonalcoholic fatty liver disease

Research funding: 

National Natural Science Foundation of China 81870548;

Natural Science Foundation of Jiangsu Province BK20191222;

Social Development Project of Jiangsu Province BE2018692

More Information
  • 摘要:   目的  探讨血清碱性磷酸酶(ALP)与2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD) 的相关性。  方法  选取2016年7月—2018年12月于江苏大学附属医院内分泌科住院的599例T2DM患者为研究对象。根据是否合并NAFLD分为NAFLD组(286例)和非NAFLD组(313例),根据腹部超声检查结果将NAFLD患者分为轻度(111例)、中度(105例)、重度(70例)三组,比较各组间一般临床资料的差异。正态分布的计量资料两组间比较采用独立样本t检验,三组间比较采用方差分析;非正态分布计量资料两组间比较采用Mann-Whitney U检验;三组间比较使用Kruskal-Wallis H秩和检验,计数资料组间比较采用χ2检验。采用Pearson相关分析法和Spearman相关分析法分析ALP与临床指标的相关性。Logistic回归分析NAFLD的影响因素。  结果  NAFLD组高血压病史所占比例、收缩压、舒张压、BMI、腰围(WC)、空腹胰岛素(FIns)、空腹C肽、血尿酸、低密度脂蛋白胆固醇、TG、TC、稳态模型评估胰岛素抵抗指数(HOMA-IR)、ALT、AST、GGT、ALP均高于非NAFLD组(χ2= 7.864、t=-2.226、t=-3.800、t=-11.842、t=-9.150、Z=-6.173、t=-5.419、t=-4.957、t=-2.702、Z=-9.376、t=-3.016、Z=-5.794、Z=-6.737、Z=-4.389、Z=-7.764、t=-2.833,P值均<0.05)。NAFLD组年龄、高密度脂蛋白胆固醇均低于非NAFLD组(t=2.184、Z=-5.273,P值均<0.05)。NAFLD脂肪肝的严重程度(轻、中、重)与年龄(rs=0.140)、BMI(rs=0.239)、WC(rs=0.222)、FIns(rs=0.191)、HOMA-IR(rs=0.218)、ALT(rs=0.188)、AST(rs=0.279)、GGT(rs=0.202)、ALP(rs=0.361)呈正相关(P值均<0.05)。在T2DM合并NAFLD患者中,ALP与糖化血红蛋白(r=0.149)、空腹血糖(r=0.146)、HOMA-IR(rs=0.132)、TC(r=0.151)、ALT(rs=0.210)、AST(rs=0.192)、GGT(rs=0.297)呈正相关(P值均<0.05)。Logistic回归分析显示,ALP是T2DM患者发生NAFLD的影响因素(OR=1.013,95%CI:1.004~1.023,P<0.05)。  结论  血清ALP升高是T2DM合并NFALD的危险因素,且与高血糖、胰岛素抵抗、高血脂密切相关,可能在T2DM和NFALD疾病的发生发展中起一定作用。

     

  • 表  1  两组一般资料及生化指标比较

    Table  1.   Comparison of general data between groups

    项目 non-NAFLD组(n=313) NAFLD组(n=286) 统计值 P
    男性[例(%)] 179(57.2) 141(49.3) χ2= 3.737 0.053
    年龄(岁) 64.28±11.15 62.27±11.38 t=2.184 0.029
    病程(月) 120(36~192) 120(36~159) Z=-1.365 0.172
    BMI(kg/m2) 23.51±2.99 26.49±3.18 t=-11.842 <0.001
    吸烟史[例(%)] 67(21.4) 60(21.0) χ2=0.016 0.898
    高血压病史[例(%)] 174(55.6) 191(66.8) χ2=7.864 0.005
    SBP(mmHg) 133.63±15.27 136.44±15.58 t=-2.226 0.026
    DBP(mmHg) 78.62±8.77 81.47±9.58 t=-3.800 <0.001
    WC(cm) 87.46±9.88 94.54±8.98 t=-9.150 <0.001
    HbA1c(%) 8.89±2.13 8.93±1.73 t=-0.279 0.781
    FPG(mmol/L) 9.69±3.71 9.50±3.12 t=0.684 0.495
    FIns(μIU/L) 6.25(3.62~11.14) 10.05(5.41~16.72) Z=-6.173 <0.001
    FC-P(μg/L) 1.74±0.96 2.18±1.04 t=-5.419 <0.001
    SUA(μmol/L) 269.37±84.92 305.03±91.13 t=-4.957 <0.001
    LDL-C(mmol/L) 2.54±0.86 2.72±0.75 t=-2.702 0.007
    HDL-C(mmol/L) 1.09(0.88~1.34) 0.95(0.81~1.14) Z=-5.273 <0.001
    TG(mmol/L) 1.28(0.96~1.79) 1.86(1.43~2.69) Z=-9.376 <0.001
    TC(mmol/L) 4.61±1.10 4.86±0.98 t=-3.016 0.003
    HOMA-IR 2.77(1.41~4.44) 3.92(2.19~6.71) Z=-5.794 <0.001
    ALT(U/L) 14.80(11.05~21.90) 20.20(14.68~30.40) Z=-6.737 <0.001
    AST(U/L) 14.70(11.35~17.95) 16.90(12.38~23.33) Z=-4.389 <0.001
    GGT(U/L) 19.00(14.30~28.00) 27.60(20.00~43.55) Z=-7.764 <0.001
    ALP(U/L) 69.73±19.94 74.71±23.03 t=-2.833 0.005
    下载: 导出CSV

    表  2  轻中重度NAFLD患者临床资料比较

    Table  2.   Comparison of general data among groups in patients with NAFLD

    项目 轻度NAFLD组(n=111) 中度NAFLD组(n=105) 重度NAFLD组(n=70) 统计值 P
    男性[例(%)] 58(52.3) 56(53.3) 27(38.6) χ2=4.294 0.117
    年龄(岁) 60.5±10.6 63.0±12.0 64.1±11.4 F=2.538 0.081
    病程(月) 120(36~168) 108(29~144) 120(33~156) χ2=0.442 0.802
    BMI(kg/m2) 25.48±2.59 26.88±2.991) 27.52±3.831) F=10.731 <0.001
    SBP(mmHg) 136.16±15.64 134.51±14.55 139.76±16.66 F=2.429 0.090
    DBP(mmHg) 81.10±9.33 81.57±9.68 81.91±9.92 F=0.163 0.849
    WC(cm) 92.17±7.37 95.33±8.381) 97.12±11.141) F=7.502 0.001
    HbA1c(%) 8.79±1.72 8.90±1.67 9.22±1.85 F=1.388 0.251
    FPG(mmol/L) 9.35±3.04 9.28±3.12 10.06±3.21 F=1.551 0.214
    FIns(μIU/L) 7.38(4.61~14.94) 10.25(5.69~16.22) 11.65(7.53~19.62)1) χ2=10.512 0.005
    FC-P(μg/L) 2.12±1.07 2.19±1.00 2.28±1.05 F=0.524 0.593
    SUA(μmol/L) 293.99±82.32 321.08±88.00 298.46±105.81 F=2.654 0.072
    LDL-C(mmol/L) 2.76±0.73 2.66±0.77 2.76±0.77 F=0.603 0.548
    HDL-C(mmol/L) 0.95(0.82~1.14) 0.93(0.80~1.11) 0.99(0.82~1.21) χ2=1.749 0.417
    TG(mmol/L) 1.84(1.37~2.87) 1.77(1.47~2.59) 1.92(1.45~3.16) χ2=0.679 0.712
    TC(mmol/L) 4.83±0.96 4.74±0.91 5.10±1.08 F=2.956 0.054
    HOMA-IR 3.32(1.83~5.55) 3.90(2.34~6.51) 5.47(2.96~9.53)1) χ2=14.183 0.001
    ALT(U/L) 18.00(13.60~27.60) 22.00(15.10~31.30) 23.95(16.00~42.23)1) χ2=10.453 0.005
    AST(U/L) 14.00(11.50~18.40) 18.40(13.00~25.30)1) 20.05(14.25~27.08)1) χ2=22.423 <0.001
    GGT(U/L) 23.00(17.00~38.80) 27.90(21.05~39.50) 34.50(21.65~55.43)1) χ2=11.791 0.003
    ALP(U/L) 65.72±16.63 73.71±20.941) 90.44±26.581)2) F=29.920 <0.001
    注:与轻度NAFLD组比较,1)P<0.01;与中度NAFLD组比较,2)P<0.01。
    下载: 导出CSV

    表  3  NAFLD患者ALP与临床各指标的相关性分析

    Table  3.   Correlation analysis between ALP and clinical indicators in patients with NAFLD

    项目 rrs P
    HbA1c 0.149 0.012
    FPG 0.146 0.014
    HOMA-IR 0.132 0.025
    TC 0.151 0.011
    ALT 0.210 <0.001
    AST 0.192 0.001
    GGT 0.297 <0.001
    下载: 导出CSV

    表  4  Logistic回归分析NAFLD的影响因素

    Table  4.   Logistic regression analysis of the influencing factors for NAFLD

    因素 β SE Wald OR 95%CI P
    年龄 -0.030 0.010 8.527 0.971 0.951~0.990 0.003
    BMI 0.298 0.037 63.596 1.347 1.252~1.450 <0.001
    FC-P 0.267 0.111 5.807 1.307 1.051~1.624 0.016
    LDL-C 1.332 0.470 8.023 3.787 1.507~9.516 0.005
    TG 0.685 0.167 16.803 1.984 1.430~2.752 <0.001
    ALP 0.013 0.005 7.444 1.013 1.004~1.023 0.006
    下载: 导出CSV
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