2型糖尿病合并痛风性关节炎患者单核细胞高密度脂蛋白胆固醇比值与非酒精性脂肪肝关系研究OA北大核心CSTPCD
Correlation analysis of monocyte/high-density lipoprotein cholesterol ratio and NAFLD in patients with type 2 diabetes mellitus and gouty arthritis
目的 探讨2型糖尿病(T2DM)合并痛风性关节炎(GA)患者单核细胞(MONO)高密度脂蛋白胆固醇(HDL-c)比值(MHR)与非酒精性脂肪肝(NAFLD)的关系,分析NAFLD发生的影响因素.方法 选取2019年12月至2022年12月在安徽中医药大学第一附属医院内分泌科住院治疗的T2DM合并GA患者214例,根据是否合并NAFLD分为NAFLD组、非NAFLD组,比较两组一般资料、理化指标,NAFLD组根据胰岛素抵抗指数(HOMA-IR)水平进行亚组分析;根据MHR三分位数分为Q1MHR、Q2MHR、Q3MHR三组,比较HOMA-IR水平的差异,以及各组NAFLD的发生率;logistic回归分析T2DM合并GA患者NAFLD的危险因素,受试者工作特征曲线(ROC)评估MHR在T2DM合并GA患者中NAFLD 的临床价值.结果 与非 NAFLD 组比较,NAFLD 组Fins、HOMA-IR、AST、ALT、TG、CRP、MONO、MHR 均升高(P＜0.05),HDL-c 降低(P＜0.05).NAFLD 组中,与 HOMA-IR＜2.5 亚组相比,HOMA-IR≥2.5 亚组 BMI、WHR、FPG、SUA、TC、TG、LDL-c、CRP、MONO、MHR水平升高(P＜0.05).根据MHR三分位数分组,HOMA-IR水平在Q3MHR[4.67(2.93,7.29)]亚组明显高于 Q1MHR[3.44(1.85,4.89)]、Q2MHR[4.15(2.13,6.03)]亚组(P＜0.05),NAFLD 发生率比较,Q3MHR亚组高于Q1MHR、Q2MHR亚组(74.51％比23.08％、39.22％,P＜0.05),Q2MHR亚组高于Q1MHR(39.22％比23.08％,P＜0.05).多因素logistic回归分析显示,LDL-c、CRP、MHR是T2DM合并GA患者发生NAFLD的危险因素(P＜0.05).ROC曲线结果显示,MHR预测T2DM合并痛风性关节炎患者发生NAFLD的曲线下面积(AUC)为0.759,灵敏度72.9％,特异度71.4％.结论 MHR与T2DM合并痛风性关节炎患者NAFLD发生相关,MHR对T2DM合并痛风性关节炎患者NAFLD发生有一定的预测价值.
Objective To investigate the relationship between the ratio of monocyte to high-density lipoprotein cholesterol(MHR)and non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM)and gouty arthritis(GA),and to analyze the influencing factors of NAFLD.Methods A total of 214 patients with T2DM and GA hospitalized in The First Clinical Medical School of Anhui University of Chinese Medicine from December 2019 to December 2022 were enrolled,who were divided into NAFLD group and non-NAFLD group according to whether they had NAFLD or not.General data and laboratory indicators of the two groups were compared.Subgroup analysis was performed in NAFLD group according to HOMA-IR level.They were divided into Qi MHR,Q2MHR and Q3MHR groups according to the MHR tertile,and the differences in HOMA-IR levels and the incidence of NAFLD among the Q1MHR,Q2MHR and Q3MH groups were compared.Logistic regression analysis was performed to analyze the risk factors of NAFLD in T2DM patients with GA,and Receiver Operating Characteristic Curve(ROC)was used to evaluate the clinical value of MHR in T2DM patients with GA.Results Compared with non-NAFLD group,Fins,HOMA-IR,AST,ALT,TG,CRP,MON and MHR in NAFLD group were increased(P＜0.05),while HDL-C decreased(P＜0.05).In NAFLD group,compared with HOMA-IR＜2.5 subgroup,BMI,WHR,FPG,SUA,TC,TG,LDL-c,CRP,MON and MHR levels in HOMA-IR≥2.5 subgroup were increased(P＜0.05).According to the MHR tertile,the level of HOMA-IR in Q3MHR[4.67(2.93,7.29)]subgroup was significantly higher than that in Q1MHR[3.44(1.85,4.89)]and Q2MHR[4.15(2.13,6.03)]subgroup(P＜0.05).The incidence of NAFLD in Q3MHR subgroup was higher than that in Q1MHR and Q2MHR subgroups(74.51％vs.23.08％,39.22％,P＜0.05)and Q2MHR subgroup was higher than Q1MHR subgroup(39.22％vs.23.08％,P＜0.05).Multivariate Logistic regression analysis showed that LDL-c,CRP and MHR were risk factors for NAFLD in T2DM patients with GA(P＜0.05).ROC curve results showed that the area under the curve(AUC)of MHR in predicting NAFLD in T2DM patients with GA was 0.759,with a sensitivity of 72.9％and a specificity of 71.4％.Conclusion MHR is correlated with the occurrence of NAFLD in patients with T2DM and GA.Moreover,MHR has some predictive value for the occurrence of NAFLD in T2DM patients with gouty arthritis.
石红宾;李中南;陈明月;彭甜甜;陈理;王玉
安徽中医药大学第一临床医学院安徽中医药大学第一附属医院,安徽合肥 230031
临床医学
2型糖尿病痛风性关节炎单核细胞高密度脂蛋白胆固醇比值非酒精性脂肪肝
type 2 diabetes mellitusgouty arthritismonocyte/HDL cholesterol rationon-alcoholic fatty liver disease
《中国实用内科杂志》 2024 (005)
397-402 / 6
国家中医临床研究基地业务建设科研专项立项课题(JDZX2012004);安徽省红十字会中医药传承创新发展研究项目(2022ZYZD01);安徽省名中医及基层名中医工作室建设项目[中发展(2020)10号]
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