新诊断 2 型糖尿病患者多种血脂和脂蛋白比值与非酒精性脂肪肝的相关性：一项回顾性研究。
Correlation of multiple lipid and lipoprotein ratios with nonalcoholic fatty liver disease in patients with newly diagnosed type 2 diabetic mellitus: A retrospective study.
机构信息
Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
出版信息
Front Endocrinol (Lausanne). 2023 Feb 17;14:1127134. doi: 10.3389/fendo.2023.1127134. eCollection 2023.
BACKGROUND AND OBJECTIVE
The diagnostic value of lipid and lipoprotein ratios for NAFLD in newly diagnosed T2DM remains unclear. This study aimed to investigate the relationships between lipid and lipoprotein ratios and the risk of NAFLD in subjects with newly diagnosed T2DM.
METHODS
A total of 371 newly diagnosed T2DM patients with NAFLD and 360 newly diagnosed T2DM without NAFLD were enrolled in the study. Demographics variables, clinical history and serum biochemical indicators of the subjects were collected. Six lipid and lipoprotein ratios, including triglycerides to high-density lipoprotein-cholesterol (TG/HDL-C) ratio, cholesterol to HDL-C (TC/HDL-C) ratio, free fatty acid to HDL-C (FFA/HDL-C) ratio, uric acid to HDL-C (UA/HDL-C) ratio, low-density lipoprotein-cholesterol to HDL-C (LDL-C/HDL-C) ratio, apolipoprotein B to apolipoprotein A1 (APOB/A1) ratio, were calculated. We compared the differences in lipid and lipoprotein ratios between NAFLD group and non-NAFLD group, and further analyzed the correlation and diagnostic value of these ratios with the risk of NAFLD in the newly diagnosed T2DM patients.
RESULTS
The proportion of NAFLD in patients with newly diagnosed T2DM increased progressively over the range Q1 to Q4 of six lipid ratios, including the TG/HDL-C ratio, TC/HDL-C ratio, FFA/HDL-C ratio, UA/HDL-C ratio, LDL-C/HDL-C ratio, and APOB/A1 ratio. After adjusting for multiple confounders, TG/HDL-C, TC/HDL-C, UA/HDL-C, LDL-C/HDL-C and APOB/A1 were all strongly correlated with the risk of NAFLD in patients with newly diagnosed T2DM. In patients with newly-onset T2DM, the TG/HDL-C ratio was the most powerful indicator for the diagnosis of NAFLD among all six indicators, with an area under the curve (AUC) of 0.732 (95% CI 0.696-0.769). In addition, TG/HDL-C ratio>1.405, with a sensitivity of 73.8% and specificity of 60.1%, had a good diagnostic ability for NAFLD in patients with newly diagnosed T2DM.
CONCLUSIONS
The TG/HDL-C ratio may be an effective marker to help identify the risk of NAFLD in patients with newly diagnosed T2DM.
背景与目的
脂质和脂蛋白比值对新诊断的 2 型糖尿病（T2DM）患者非酒精性脂肪性肝病（NAFLD）的诊断价值尚不清楚。本研究旨在探讨新诊断的 T2DM 患者中脂质和脂蛋白比值与 NAFLD 风险之间的关系。
方法
共纳入 371 例新诊断的 T2DM 合并 NAFLD 患者和 360 例新诊断的 T2DM 无 NAFLD 患者。收集受试者的人口统计学变量、临床病史和血清生化指标。计算了 6 种脂质和脂蛋白比值，包括甘油三酯与高密度脂蛋白胆固醇（TG/HDL-C）比值、胆固醇与高密度脂蛋白胆固醇（TC/HDL-C）比值、游离脂肪酸与高密度脂蛋白胆固醇（FFA/HDL-C）比值、尿酸与高密度脂蛋白胆固醇（UA/HDL-C）比值、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇（LDL-C/HDL-C）比值、载脂蛋白 B 与载脂蛋白 A1（APOB/A1）比值。比较了 NAFLD 组和非 NAFLD 组之间的脂质和脂蛋白比值差异，并进一步分析了这些比值与新诊断的 T2DM 患者 NAFLD 风险的相关性和诊断价值。
结果
随着 TG/HDL-C 比值、TC/HDL-C 比值、FFA/HDL-C 比值、UA/HDL-C 比值、LDL-C/HDL-C 比值和 APOB/A1 比值在 Q1 到 Q4 范围内的逐渐升高，新诊断的 T2DM 患者中 NAFLD 的比例也随之升高。校正多个混杂因素后，TG/HDL-C、TC/HDL-C、UA/HDL-C、LDL-C/HDL-C 和 APOB/A1 均与新诊断的 T2DM 患者 NAFLD 风险密切相关。在新诊断的 T2DM 患者中，TG/HDL-C 比值是所有 6 项指标中诊断 NAFLD 的最强指标，曲线下面积（AUC）为 0.732（95%CI：0.696~0.769）。此外，TG/HDL-C 比值>1.405，灵敏度为 73.8%，特异性为 60.1%，对新诊断的 T2DM 患者 NAFLD 具有良好的诊断能力。
结论
TG/HDL-C 比值可能是一种有效的标志物，有助于识别新诊断的 T2DM 患者的 NAFLD 风险。
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