人体测量指标对2型糖尿病患者非酒精性脂肪肝进展的预测作用
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摘要
目的:探讨人体测量学指标,包括体质指数、腰围、腰围/身高、腰臀比等,对住院2型糖尿病患者非酒精性脂肪性肝病(NAFLD)进展情况的预测作用。方法:连续纳入资料完整的住院2型糖尿病者535例,采集人口学资料、人体测量学指标和实验室化验数据。根据NAFLD进展情况,将其分为进展组和非进展组,分析两组临床特征。采用二分类logistic回归模型分析各指标与NAFLD进展的相关性;使用受试者工作曲线进行检验效力分析。结果:535例患者中,进展组患146例、非进展组389例。与非进展组相比,进展组年龄较小,体质指数、腰围、腰围/身高、腰臀比较大,三酰甘油、尿酸、丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平较高(P<0.05)。二分类logistic回归模型显示,体质指数、腰围、腰围/身高、腰臀比为2型糖尿病患者发生NAFLD的独立危险因素(P=0.000)。ROC曲线分析结果显示,体质指数、腰围、腰围/身高、腰臀比预测NAFLD进展的曲线下面积(AUC)分别为0.675、0.677、0.664、0.642,截断值分别为24.23kg/m2、93.5cm、0.57、0.89(P=0.000)。结论:体质指数、腰围、腰围/身高和腰臀比均可预测2型糖尿病患者NAFLD的发生。
Objective:To explore the role of anthropometric indicators(body mass index,waist circumference,waist circumference height ratio,waist-to-hip ratio,etc.)in predicting the progression of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus.Methods:A total of 535 consecutive patients with type 2 diabetes mellitus were enrolled,and demographic data,anthropometric indicators,and laboratory test data were collected.According to whether NAFLD presented or not,the patients were divided into the progression group and the non-progression group,and the clinical characteristics of the two groups were analyzed.The regression analysis was performed using the binary logistic regression model,and the test efficacy analysis was performed using the receiver operating characteristic curve(ROC).Results:Compared with the non-progression group(n=389),patients in fatty liver progression group(n=146)were younger,and the body mass index,waist circumference,waist circumference height ratio,waist-to-hip ratio,triglyceride,uric acid,alanine,and aspartate aminotransferase were significantly higher(P<0.05).The multiple regression analysis results showed that body mass index,waist circumference,waist circumference height ratio,waist-to-hip ratio were independent risk factors for the development of NAFLD in patients with type 2 diabetes respectively(P=0.000).ROC analysis showed that AUCs for body mass index,waist circumference,waist circumference height ratio,and waist-to-hip ratio were 0.675,0.677,0.664,and0.642,respectively,and the best cut-off points for predicting NAFLD were 24.23 kg/m2,93.5 cm,0.57,and 0.89,respectively(P=0.000).Conclusions:Body mass index,waist circumference,waist circumference height ratio,and waist-tohip ratio all can predict the progression of NAFLD in patients with type 2 diabetes.
Objective:To explore the role of anthropometric indicators(body mass index,waist circumference,waist circumference height ratio,waist-to-hip ratio,etc.)in predicting the progression of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus.Methods:A total of 535 consecutive patients with type 2 diabetes mellitus were enrolled,and demographic data,anthropometric indicators,and laboratory test data were collected.According to whether NAFLD presented or not,the patients were divided into the progression group and the non-progression group,and the clinical characteristics of the two groups were analyzed.The regression analysis was performed using the binary logistic regression model,and the test efficacy analysis was performed using the receiver operating characteristic curve(ROC).Results:Compared with the non-progression group(n=389),patients in fatty liver progression group(n=146)were younger,and the body mass index,waist circumference,waist circumference height ratio,waist-to-hip ratio,triglyceride,uric acid,alanine,and aspartate aminotransferase were significantly higher(P<0.05).The multiple regression analysis results showed that body mass index,waist circumference,waist circumference height ratio,waist-to-hip ratio were independent risk factors for the development of NAFLD in patients with type 2 diabetes respectively(P=0.000).ROC analysis showed that AUCs for body mass index,waist circumference,waist circumference height ratio,and waist-to-hip ratio were 0.675,0.677,0.664,and0.642,respectively,and the best cut-off points for predicting NAFLD were 24.23 kg/m2,93.5 cm,0.57,and 0.89,respectively(P=0.000).Conclusions:Body mass index,waist circumference,waist circumference height ratio,and waist-tohip ratio all can predict the progression of NAFLD in patients with type 2 diabetes.
引文
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[11]ESMAILLZADEH A,MIRMIRAN P,AZIZI F.Waist-tohip ratio is a better screening measure for cardiovascular risk factors than other anthropometric indicators in Tehranian adult men[J].Int J Obes Relat Metab Disord,2004,28(10):1325-1332.
[12]HEYMSFIELD S B,SCHERZER R,PIETROBELLI A,et al.Body mass index as a phenotypic expression of adiposity:quantitative contribution of muscularity in a population-based sample[J].Int J Obes(Lond),2009,33(12):1363-1373.
[13]SON Y J,KIM J,PARK H J,et al.Association of waistheight ratio with diabetes risk:A 4-year longitudinal retrospective study[J].Endocrinol Metab(Seoul),2016,31(1):127-133.
[14]YAJNIK C S,YUDKIN J S.The Y-Y paradox[J].Lancet,2004,363(9403):163.
[15]CHUNG W,PARK C G,RYU O H.Association of a new measure of obesity with hypertension and health-related quality of life[J].PLoS One,2016,11(5):e0155399.
[16]XU Z,QI X,DAHL A K,et al.Waist-to-height ratio is the best indicator for undiagnosed type 2diabetes[J].Diabet Med,2013,30(6):e201-e207.
[17]ASHWELL M,GUNN P,GIBSON S.Waist-to-height ratio is a better screening tool than waist circumference and BMIfor adult cardiometabolic risk factors:systematic review and meta-analysis[J].Obes Rev,2012,13(3):275-286.
[18]BROWNING L M,HSIEH S D,ASHWELL M.Asystematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes:0.5could be a suitable global boundary value[J].Nutr Res Rev,2010,23(2):247-269.
[19]RDHOLM K,CHALMERS J,OHKUMA T,et al.Use of the waist-to-height-ratio to predict cardiovascular risk in patients with diabetes:results from ADVANCE-ON[J].Diabetes Obes Metab,2018,20(8):1903-1910.
[2]TARGHER G,BERTOLINI L,RODELLA S,et al.Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2diabetic patients.[J].Diabetes Care,2007,30(8):2119-2121.
[3]ANSTEE Q M,TARGHER G,DAY C P.Progression of NAFLD to diabetes mellitus,cardiovascular disease or cirrhosis[J].Nat Rev Gastroenterol Hepatol,2013,10(6):330-344.
[4]孟琼,黄昊,傅晓东.西格列汀联合二甲双胍对2型糖尿病合并非酒精性脂肪肝患者的疗效观察[J].中国临床医学,2017,24(6):939-942.
[5]JGER S,JACOBS S,KRGER J,et al.Association between the fatty liver index and risk of type 2diabetes in the EPIC-Potsdam study[J].PLoS One,2015,10(4):e0124749.
[6]LIN M S,LIN T H,GUO S E,et al.Waist-to-height ratio is a useful index for nonalcoholic fatty liver disease in children and adolescents:a secondary data analysis[J].BMC Public Health,2017,17(1):851.
[7]MITSUHASHI K,HASHIMOTO Y,TANAKA M,et al.Combined effect of body mass index and waist-height ratio on incident diabetes;apopulation based cohort study[J].J Clin Biochem Nutr,2017,61(2):118-122.
[8]SHIL B C,SAHA M,AHMED F,et al.Nonalcoholic fatty liver disease:study of demographic and predictive factors[J].Euroasian J Hepatogastroenterol,2015,5(1):4-6.
[9]中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南(2010年修订版)[J].中华肝脏病杂志,2010,18(3):163-166.
[10]SCHNEIDER H J,GLAESMER H,KLOTSCHE J,et al.Accuracy of anthropometric indicators of obesity to predict cardiovascular risk[J].J Clin Endocrinol Metab,2007,92(2):589-594.
[11]ESMAILLZADEH A,MIRMIRAN P,AZIZI F.Waist-tohip ratio is a better screening measure for cardiovascular risk factors than other anthropometric indicators in Tehranian adult men[J].Int J Obes Relat Metab Disord,2004,28(10):1325-1332.
[12]HEYMSFIELD S B,SCHERZER R,PIETROBELLI A,et al.Body mass index as a phenotypic expression of adiposity:quantitative contribution of muscularity in a population-based sample[J].Int J Obes(Lond),2009,33(12):1363-1373.
[13]SON Y J,KIM J,PARK H J,et al.Association of waistheight ratio with diabetes risk:A 4-year longitudinal retrospective study[J].Endocrinol Metab(Seoul),2016,31(1):127-133.
[14]YAJNIK C S,YUDKIN J S.The Y-Y paradox[J].Lancet,2004,363(9403):163.
[15]CHUNG W,PARK C G,RYU O H.Association of a new measure of obesity with hypertension and health-related quality of life[J].PLoS One,2016,11(5):e0155399.
[16]XU Z,QI X,DAHL A K,et al.Waist-to-height ratio is the best indicator for undiagnosed type 2diabetes[J].Diabet Med,2013,30(6):e201-e207.
[17]ASHWELL M,GUNN P,GIBSON S.Waist-to-height ratio is a better screening tool than waist circumference and BMIfor adult cardiometabolic risk factors:systematic review and meta-analysis[J].Obes Rev,2012,13(3):275-286.
[18]BROWNING L M,HSIEH S D,ASHWELL M.Asystematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes:0.5could be a suitable global boundary value[J].Nutr Res Rev,2010,23(2):247-269.
[19]RDHOLM K,CHALMERS J,OHKUMA T,et al.Use of the waist-to-height-ratio to predict cardiovascular risk in patients with diabetes:results from ADVANCE-ON[J].Diabetes Obes Metab,2018,20(8):1903-1910.