Abstract
Background Type 2 diabetes mellitus(T2DM)is often associated with metabolic fatty liver disease(MAFLD),which significantly increases the risk of microanglopathy through the interaction of insulin resistance,abnormal lipid metabolism,chronic inflammation and other mechanisms.However,the quantitative analysis of related risk factors and the construction of predictive models are insufficient in existing studies.Identification of key biomarkers to guide early intervention is urgently needed.Objective To investigate the correlation factors and predictive value of microangiopathy in T2DM patients with MAFLD.Methods A retrospective analysis was conducted on the clinical data of patients with T2DM combined with MAFLD admitted to the Lu'an Hospital Affiliated to Anhui Medical University from January 2021 to August 2023.According to the medical record system,110 patients with microvascular complications and 110 patients without microvascular complications were selected as the modeling group at a 1∶1 ratio.Another 106 patients with T2DM combined with MAFLD during the same period were selected as the validation group.Patients with microvascular complications were assigned to the occurrence group(n=110),and those without microvascular complications were assigned to the non-occurrence group(n=110).General information and laboratory test results of the patients were collected through the medical record system.The non-alcoholic fatty liver fibrosis score(NFS),liver fibrosis 4-factor index(FIB-4),and triglyceride-glucose index(TyG)were calculated.Multivariate logistic regression analysis was performed on indicators with a variance inflation factor(VIF)<10 selected by collinearity analysis.The receiver operating characteristic(ROC)curve was constructed to evaluate the predictive effect of each indicator on the occurrence of microvascular complications in patients with T2DM combined with MAFLD.Results There were no significant differences in baseline data between the modeling cohort and the validation cohort(P>0.05).Among the patients with T2DM combined with MAFLD who developed microvascular complications,44(40.0%)had diabetic nephropathy,29(26.4%)had diabetic retinopathy,and 37(33.6%)had both diabetic nephropathy and diabetic retinopathy.Significant differences were observed in smoking history,duration of diabetes,C-reactive protein(CRP),TyG,triglycerides(TG),FIB-4,and NFS between the non-occurrence and occurrence groups(P<0.05).Multivariate logistic regression analysis showed that smoking history(OR=8.298,95%CI=1.957-35.175),long duration of diabetes(OR=2.638,95%CI=1.515-4.596),elevated CRP(OR=7.918,95%CI=4.013-15.624),elevated TyG(OR=1.533,95%CI=1.171-2.006),elevated TG(OR=2.055,95%CI=1.475-2.862),elevated FIB-4(OR=29.598,95%CI=9.179-95.437),and elevated NFS(OR=3.433,95%CI=2.113-5.576)were risk factors for microvascular complications in patients with T2DM combined with MAFLD(P<0.05).The areas under the ROC curve(AUC)for predicting microvascular complications in patients with T2DM combined with MAFLD based on CRP,TyG,duration of diabetes,smoking history,TG,NFS,and FIB-4 were 0.964(95%CI=0.944-0.984,P<0.001),0.620(95%CI=0.546-0.693,P=0.002),0.795(95%CI=0.737-0.853,P=0.001),0.605(95%CI=0.530-0.679,P=0.004),0.663(95%CI=0.592-0.735,P<0.001),0.730(95%CI=0.664-0.796,P<0.001),and 0.743(95%CI=0.678-0.808,P<0.001),respectively.The AUC(95%CI)of the predictive model based on the above indicators in the modeling cohort was 0.990(0.990-1.000),indicating good predictive value.Conclusion Clinically,the occurrence of microvascular complications in patients with T2DM combined with MAFLD can be effectively predicted by observing CRP,TyG,duration of diabetes,smoking history,TG,NFS,and FIB-4.This approach is conducive to identifying high-risk patients with microvascular complications among patients with T2DM combined with MAFLD.关键词
2型糖尿病/代谢相关脂肪性肝病/微血管病变/C反应蛋白/甘油三酯-葡萄糖指数/非酒精性脂肪肝纤维化评分/肝纤维化4因子指数Key words
Type 2 diabetes/Metabolic fatty liver disease/Microangiopathy/C-reactive protein/Triglyceride-glucose index/Non-alcoholic fatty liver fibrosis score/Fibrosis 4-factor index分类
医药卫生
