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甘油三酯葡萄糖乘积指数与BMI对2型糖尿病合并非酒精性脂肪性肝病的预测价值

王东旭 南楠 邴浩 林连捷

引用本文:
Citation:

甘油三酯葡萄糖乘积指数与BMI对2型糖尿病合并非酒精性脂肪性肝病的预测价值

DOI: 10.3969/j.issn.1001-5256.2022.05.017
基金项目: 

辽宁省自然科学基金 (2014021083)

伦理学声明:本研究方案于2021年9月10日经由中国医科大学附属盛京医院医学伦理委员会审查,批号:2021PS694K。
利益冲突声明:本研究不存在研究者、伦理委员会、受试者及公开研究成果有关的利益冲突。
作者贡献声明:王东旭负责文章的构思与设计,数据收集与整理、统计学分析和撰写论文;南楠、邴浩参与数据的收集与整理;林连捷负责选题,指导撰写文章并最后定稿。
详细信息
    通信作者:

    林连捷,leanlj13@yeah.net

Value of triglyceride-glucose index and body mass index in predicting nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

Research funding: 

Natural Science Foundation of Liaoning Province (2014021083)

More Information
  • 摘要:   目的  探讨甘油三酯葡萄糖乘积指数(TyG)与BMI对2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的预测价值。  方法  回顾性分析2020年5月—2021年7月中国医科大学附属盛京医院诊治349例T2DM患者的临床资料,按照有无NAFLD分为T2DM合并NAFLD组(n=213)和单纯T2DM组(n=136)。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。采用logistic回归分析TyG及BMI与T2DM合并NAFLD的关系,受试者工作特征曲线(ROC曲线)评价TyG、BMI及TyG联合BMI对T2DM合并NAFLD的预测效能。采用Kappa系数分析预测结果的一致性。  结果  T2DM合并NAFLD组的BMI、舒张压、空腹血糖、糖化血红蛋白、ALT、AST、GGT、TG、TC、LDL-C、TyG均高于单纯T2DM组(P值均<0.05),T2DM合并NAFLD组的HDL-C低于单纯T2DM组(P<0.05),两组在收缩压、总胆红素、直接胆红素、间接胆红素间的差异均无统计学意义(P值均>0.05)。Logistic分析显示TyG(OR=6.513,95%CI:1.884~22.517,P=0.003)和BMI(OR=1.369,95%CI:1.191~1.575,P<0.001)为T2DM合并NAFLD的独立危险因素。ROC曲线显示,TyG预测T2DM合并NAFLD的曲线下面积(AUC)为0.875,最佳截断点9.41,敏感度、特异度、阳性预测值和阴性预测值分别为80.3%、80.1%、86.36%、72.19%;BMI预测T2DM合并NAFLD的AUC为0.787,最佳截断点24.22,敏感度、特异度、阳性预测值和阴性预测值分别为78.9%、64.0%、77.36%、64.23%;TyG联合BMI预测T2DM合并NAFLD的AUC、敏感度、特异度、阳性预测值和阴性预测值分别为0.910、81.2%、88.2%、91.53%、75.00%。TyG、BMI及TyG联合BMI预测T2DM合并NAFLD的Kappa系数分别为0.592、0.416、0.673。  结论  TyG和BMI可用来预测T2DM合并NAFLD的发生,二者联合可提高预测价值。

     

  • 图  1  TyG、BMI及TyG联合BMI预测T2DM合并NAFLD的ROC曲线

    Figure  1.  ROC curve of TyG, BMI and TyG combined with BMI for predicting T2DM combined with NAFLD

    表  1  两组一般资料的比较

    Table  1.   Comparison of general data between two groups

    指标 T2DM合并NAFLD组(n=213) 单纯T2DM组(n=136) 统计值 P
    BMI(kg/m2) 26.33(24.52~29.37) 23.23(21.92~25.39) Z=-9.044 <0.001
    收缩压(mmHg) 130.00(120.00~140.00) 130.00(120.00~140.00) Z=-1.729 0.084
    舒张压(mmHg) 80.00(80.00~90.00) 80.00(75.00~84.00) Z=-3.251 0.001
    FBG(mmol/L) 9.85(8.20~12.29) 7.96(6.36~9.68) Z=-6.126 <0.001
    HbA1c(%) 8.90(7.45~10.25) 7.35(6.50~9.05) Z=-5.075 <0.001
    ALT(U/L) 31.00(22.00~44.00) 21.00(13.00~26.00) Z=-7.820 <0.001
    AST(U/L) 22.00(17.00~29.00) 18.00(15.00~21.00) Z=-5.447 <0.001
    GGT(U/L) 36.00(24.00~56.00) 18.00(13.00~25.25) Z=-9.402 <0.001
    TBil(μmol/L) 10.25(8.30~13.40) 10.40(7.80~13.20) Z=-0.098 0.922
    DBil(μmol/L) 3.20(2.50~4.18) 3.30(2.53~4.38) Z=-1.129 0.259
    IBil(μmol/L) 7.25(5.40~9.20) 7.05(5.25~9.00) Z=-0.226 0.821
    TG(mmol/L) 2.42(1.74~3.63) 1.07(0.81~1.50) Z=-11.831 <0.001
    TC(mmol/L) 5.04(4.28~5.96) 4.21(3.86~4.70) Z=-7.188 <0.001
    HDL-C(mmol/L) 1.02(0.88~1.25) 1.16(1.02~1.37) Z=-4.897 <0.001
    LDL-C(mmol/L) 3.28(2.63~3.97) 2.87(2.63~3.87) Z=-4.042 <0.001
    TyG 9.98±0.79 8.87±0.61 t=13.832 <0.001
    下载: 导出CSV

    表  2  TyG、BMI与T2DM合并NAFLD的logistic回归分析

    Table  2.   Logistic regression analysis of TyG, BMI in T2DM combined with NAFLD

    指标 β 标准误 Wald值 OR 95%CI P
    校正前BMI 0.392 0.051 59.377 1.479 1.339~1.634 <0.001
    校正前TyG 2.439 0.269 82.237 11.459 6.764~19.411 <0.001
    校正后BMI 0.314 0.071 19.390 1.369 1.191~1.575 <0.001
    校正后TyG 1.874 0.633 8.766 6.513 1.884~22.517 0.003
    下载: 导出CSV

    表  3  TyG、BMI及TyG联合BMI对T2DM合并NAFLD的预测价值

    Table  3.   Predictive value of TyG, BMI and TyG combined BMI for T2DM combined with NAFLD

    指标 最佳截断点 AUC 95%CI 敏感度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%) Kappa系数
    BMI 24.22 0.787 0.740~0.834 78.9 64.0 77.36 64.23 0.416
    TyG 9.41 0.875 0.839~0.911 80.3 80.1 86.36 72.19 0.592
    TyG联合BMI 0.910 0.881~0.940 81.2 88.2 91.53 75.00 0.673
    下载: 导出CSV
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  • 收稿日期:  2021-09-15
  • 录用日期:  2021-10-29
  • 出版日期:  2022-05-20
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