胰岛素抵抗指数预测2型糖尿病患者非酒精性脂肪性肝病的潜力。

The potential of insulin resistance indices to predict non-alcoholic fatty liver disease in patients with type 2 diabetes.

作者信息

Tian Jie, Cao Yutian, Zhang Wenhui, Wang Aiyao, Yang Xinyi, Dong Yinfeng, Zhou Xiqiao

机构信息

School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.

Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.

出版信息

BMC Endocr Disord. 2024 Dec 4;24(1):261. doi: 10.1186/s12902-024-01794-z.

DOI:10.1186/s12902-024-01794-z

PMID:39633354

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11616383/

Abstract

BACKGROUND

The triglyceride-glucose (TyG) index and related parameters, as well as the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), have been developed as insulin resistance markers to identify individuals at risk for non-alcoholic fatty liver disease (NAFLD). However, its use for predicting NAFLD in patients with type 2 diabetes mellitus (T2DM) remains unclear. In this study, we aimed to observe the performance of insulin resistance indices in diagnosing NAFLD combined with T2DM and to compare their diagnostic values in clinical practice.

PATIENTS AND METHODS

Overall, 268 patients with T2DM from the Endocrinology Department of Jiangsu Provincial Hospital of Traditional Chinese Medicine were enrolled in this study and divided into two groups: an NAFLD group (T2DM with NAFLD) and a T2DM group (T2DM without NAFLD). General information and blood indicators of the participants were collected, and insulin resistance indices were calculated based on these data. Receiver operating characteristic (ROC) analysis was conducted to calculate the area under the curve (AUC) for insulin resistance-related indices, aiming to assess their ability to discriminate between T2DM patients with and without NAFLD.

RESULTS

ROC analysis revealed that among the five insulin resistance-related indices, four parameters (TyG, TyG-body mass index [BMI], TyG-waist circumference [WC], and TyG- (waist-hip ratio [WHR]) exhibited high predictive performance for identifying NAFLD, except for HOMA-IR (AUCs:0.710,0.738,0.737 and 0.730, respectivly). TyG-BMI demonstrated superior predictive value, especially in males. For males, the AUC for TyG-BMI was 0.764 (95% confidence interval [CI] 0.691-0.827). The sensitivity and specificity for male NAFLD were 90.32% and 47.89%, respectively. Moreover, in the Generalized linear regression models, there were positive associations of TyG, TyG-BMI, TyG-WC, TyG-WHR, and HOMA-IR with controlled attenuation parameter (CAP), with β values of 21.30, 0.745, 0.247, and 2.549 (all P < 0.001), respectively.

CONCLUSION

TyG-BMI is a promising predictor of NAFLD combined with T2DM, particularly in lean male patients.

摘要

背景

甘油三酯-葡萄糖（TyG）指数及相关参数，以及胰岛素抵抗的稳态模型评估（HOMA-IR），已被开发作为胰岛素抵抗标志物，用于识别非酒精性脂肪性肝病（NAFLD）风险个体。然而，其在2型糖尿病（T2DM）患者中预测NAFLD的应用仍不明确。在本研究中，我们旨在观察胰岛素抵抗指数在诊断合并T2DM的NAFLD中的表现，并比较它们在临床实践中的诊断价值。

患者与方法

本研究共纳入江苏省中医院内分泌科的268例T2DM患者，分为两组：NAFLD组（合并NAFLD的T2DM）和T2DM组（不合并NAFLD的T2DM）。收集参与者的一般信息和血液指标，并基于这些数据计算胰岛素抵抗指数。进行受试者工作特征（ROC）分析，以计算胰岛素抵抗相关指数的曲线下面积（AUC），旨在评估它们区分合并和不合并NAFLD的T2DM患者的能力。

结果

ROC分析显示，在五个胰岛素抵抗相关指数中，四个参数（TyG、TyG-体重指数[BMI]、TyG-腰围[WC]和TyG-腰臀比[WHR]）在识别NAFLD方面表现出较高的预测性能，HOMA-IR除外（AUC分别为0.710、0.738、0.737和0.730）。TyG-BMI显示出更高的预测价值，尤其是在男性中。对于男性，TyG-BMI的AUC为0.764（95%置信区间[CI] 0.691-0.827）。男性NAFLD的敏感性和特异性分别为90.32%和47.89%。此外，在广义线性回归模型中，TyG、TyG-BMI、TyG-WC、TyG-WHR和HOMA-IR与受控衰减参数（CAP）呈正相关，β值分别为21.30、0.745、0.247和2.549（均P<0.001）。