Liu Jing, Wang Yueqiu, Zhou Xinghang, Wen Zaixin, Chen Yu, Sun Yiqiong, Su Shuaiying, Lin Weiwei, Shen Ruiting, Sun Xiaoyu, Li Hongru, Yu Xia, Zhang Mingchen
Cixi Biomedical Research Institute, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Endocrinology and Metabolism, Ningbo No.2 Hospital, Ningbo, Zhejiang, China.
Front Med (Lausanne). 2025 Aug 29;12:1623808. doi: 10.3389/fmed.2025.1623808. eCollection 2025.
This study aimed to determine the most efficacious insulin resistance (IR) indices to predict metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus (T2DM).
This cross-sectional study included 1,587 patients with T2DM. MASLD was defined by abdominal ultrasound findings. Liver fibrosis risk was assessed with FIB-4. All participants underwent a 100 g standard steamed bread meal test. We analyzed basal IR indices (HOMA-IR, QUICKI, IAI, Bennett ISI) and post-stimulation IR indices (ISI, ISI) to explore their associations with MASLD and liver fibrosis.
Participants were categorized into four groups according to IR indices quartiles. Among post-stimulation IR indices, MASLD detection rates in ISI Q1-Q4 groups were 65.7, 54.2, 37.0, and 22.2%, respectively. Logistic regression analysis revealed significantly increased odds ratios (ORs) for MASLD in ISI Q1-Q3 groups compared to the Q4 group (OR = 3.63, 2.53, and 1.53, respectively; all < 0.05). Similar results were observed across other IR indices (all < 0.05). There were no statistically significant differences in the detection rates of liver fibrosis or the ORs among the quartile groups of the IR indices (all > 0.05). ROC curve analysis showed that ISI had superior predictive power for MASLD in patients with T2DM (AUC = 0.701). Based on these findings, a risk prediction model for MASLD in the T2DM population was constructed using age, body mass index (BMI), alanine aminotransferase (ALT), triglycerides (TG), and 2-h postprandial C-peptide (2 h CP).
Among the IR indices, ISI demonstrated the strongest correlation and highest predictive value for MASLD in T2DM.
本研究旨在确定预测2型糖尿病（T2DM）患者代谢功能障碍相关脂肪性肝病（MASLD）的最有效胰岛素抵抗（IR）指标。
这项横断面研究纳入了1587例T2DM患者。MASLD由腹部超声检查结果定义。使用FIB-4评估肝纤维化风险。所有参与者均接受了100g标准馒头餐试验。我们分析了基础IR指标（HOMA-IR、QUICKI、IAI、Bennett ISI）和刺激后IR指标（ISI、ISI），以探讨它们与MASLD和肝纤维化的关联。
根据IR指标四分位数将参与者分为四组。在刺激后IR指标中，ISI Q1-Q4组的MASLD检出率分别为65.7%、54.2%、37.0%和22.2%。逻辑回归分析显示，与Q4组相比，ISI Q1-Q3组发生MASLD的比值比（OR）显著升高（分别为OR = 3.63、2.53和1.53；均P < 0.05）。在其他IR指标中也观察到类似结果（均P < 0.05）。IR指标四分位数组之间肝纤维化检出率或OR无统计学显著差异（均P > 0.05）。ROC曲线分析显示，ISI对T2DM患者的MASLD具有较好的预测能力（AUC = 0.701）。基于这些发现，使用年龄、体重指数（BMI）、丙氨酸氨基转移酶（ALT）、甘油三酯（TG）和餐后2小时C肽（2h CP）构建了T2DM人群中MASLD的风险预测模型。
在IR指标中，ISI与T2DM患者的MASLD相关性最强，预测价值最高。
