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2型糖尿病合并代谢相关脂肪性肝病患者的脂肪相关指标、四肢骨骼肌质量校正值与肝脏脂肪变性相关性分析
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Abstract:
目的：探究2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)患者的脂肪、四肢骨骼肌质量指数与肝脏脂肪变性程度的相关性。方法：选取2023年9月至2024年9月于石家庄市人民医院内分泌科住院接受治疗18~75岁T2DM合并MAFLD患者共200例。根据代表肝脏脂肪变性的严重程度的受控衰减参数(CAP)水平(S0: CAP < 238 dB/m, S1: 238 dB/m ≤ CAP < 260 dB/m, S2: 260 dB/m ≤ CAP < 292 dB/m, S3: CAP ≥ 292 dB/m)将患者分为非重度肝脏脂肪变组88例和重度肝脏脂肪变组112例，所有患者均测量内脏脂肪等级(VFG)、体质量指数(BMI)、体脂肪量(FM)、体脂肪率(BF%)、四肢骨骼肌质量(ASM)、脂肪质量指数(FMI)、四肢骨骼肌质量身高校正值(ASMI)、四肢骨骼肌质量体重校正值(ASM/W)、瞬时弹性成像参数CAP值(dB/m)等指标。结果：1) 重度肝脏脂肪变组VFG、BMI、BF%、FM、FMI、ASMI及HOMA-IR、TG、ALT等均高于非重度肝脏脂肪变组，而ASM/W明显低于非重度肝脏脂肪变组，差异均有统计学意义(P < 0.05)；2) 对各指标行Pearson/Spearman相关性分析显示，CAP与VFG、BMI、BF%、FM、FMI、ASMI、FINS、HOMA-IR、ALT等均呈正相关(r值分别为0.302、0.547、0.470、0.581、0.580、0.183、0.420、0.429、0.354，P < 0.05)，CAP与ASM/W呈负相关(r值为0.420，P < 0.05)；3) 进一步行多重线性回归分析显示ALT、FMI对T2DM合并MAFLD患者肝脏脂肪变有显著的正向影响关系(95%置信区间0.561 (3.101, 13.063)，P = 0.002)，ASM/W对T2DM合并MAFLD患者肝脏脂肪变有显著的负向影响关系(95%置信区间？0.428 (？28.467, ？9.336)，P = 0.000)；4) 将FMI、BMI、ASMI、ASM/W代入ROC曲线，其中FMI代表曲线下面积最高为0.752，敏感度70.5%、特异度70.5%。结论：T2DM合并MAFLD患者的ALT、BMI、BF%、FMI、ASM/W与CAP具有一定的相关性，ALT、BMI、BF%、FMI是其重度肝脏脂肪变性的危险因素，而ASM/W则是保护因素。其中FMI、BMI、ASM/W可成为T2DM合并MAFLD患者的重度肝脏脂肪变性的预测指标，且FMI预测程度优于BMI，ASM/W预测程度优于ASMI。
Objective: To investigate the correlation between fat, limb skeletal muscle mass index and liver steatosis in patients with type 2 diabetes mellitus (T2DM) and metabolic-associated fatty liver disease (MAFLD). Methods: A total of 200 patients with T2DM and MAFLD aged 18~75 years who were hospitalized in the Department of Endocrinology of Shijiazhuang People’s Hospital from September 2023 to September 2024 were selected. According to the level of controlled attenuation parameter (CAP) representing the severity of hepatic steatosis (S0: CAP < 238 dB/m, S1: 238 dB/m ≤ CAP < 260 dB/m, S2: 260 dB/m ≤ CAP < 292 dB/m, S3: CAP ≥ 292 dB/m), the patients were divided into 88 cases of non-severe hepatic steatosis group and 112 cases of severe hepatic steatosis group. All patients were measured visceral fat grade (VFG), body mass index (BMI), body fat mass (FM), body fat percentage (BF%), limb skeletal muscle mass (ASM), fat mass index (FMI), limb skeletal muscle mass positive college value (ASMI), limb skeletal muscle mass weight correction value (ASM/W), instantaneous elasticity imaging parameters CAP value (dB/m) and other indicators. Results: 1) VFG, BMI, BF %, FM, FMI, ASMI, HOMA-IR, TG and ALT in severe
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