肌肉脂肪比值在2型糖尿病患者并发非酒精性脂肪肝中的临床意义

doi:10.3969/j.issn.2095-9400.2020.02.010

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摘要目的：探讨肌肉脂肪比值（SVR）在2型糖尿病（T2DM）患者并发非酒精性脂肪肝（NAFLD）中的临床意义。方法：收集2017年4月至8月于温州医科大学附属第二医院育英儿童医院就诊的394例T2DM患者，分为NAFLD组（159例）及非NAFLD组（235例），比较2组四肢骨骼肌质量、内脏脂肪面积、血糖、血脂等临床资料。采用Pearson相关分析方法分析SVR与代谢危险因素的关系，多因素logistic回归分析SVR对NAFLD发生的影响，ROC曲线分析SVR对NAFLD的预测价值。结果：NAFLD组与非NAFLD组比较，女性比例、体质量、体质量指数、腰围、内脏脂肪面积、体脂肪率、舒张压、血尿酸、糖化血红蛋白水平、总胆固醇、甘油三酯均显著增高，而SVR、四肢骨骼肌质量显著降低（P＜0.05）。Pearson相关分析显示男性组SVR与体质量指数、腰围、收缩压呈负相关（r=-0.365、-0.437、-0.117，P＜0.01），女性组SVR与体质量指数、腰围呈负相关（r=-0.190、-0.212，P＜0.01）。多因素logistic分析发现SVR是T2DM女性患者并发NAFLD的独立危险因素（OR= 4.21，95%CI=1.31～13.52，P=0.016）。ROC曲线分析显示SVR在男性组和女性组的AUC分别为0.66和0.63。结论：T2DM患者SVR水平与NAFLD的发生密切相关，可作为临床评估T2DM患者并发NAFLD的一项参考指标。

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关键词 ：糖尿病, 2型, 非酒精性脂肪肝, 四肢骨骼肌质量, 内脏脂肪面积, 肌肉脂肪比值

Abstract：Objective: To evaluate the muscle fat ratio in patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease (NAFLD). Methods: A total of 394 patients with type 2 diabetes mellitus from the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University from April to August 2017 were enrolled in this study. The patients were divided into two groups: complicated NAFLD group (n=159) and uncomplicated NAFLD group (n=235). The clinical date such as skeletal muscle mass, visceral fat area, blood glucose, blood lipid were compared between the two groups. Pearson correlation analysis was for analyzing the relationship between muscle fat ratio and metabolic risk factors, multivariate logistic regression for the effect of muscle fat ratio on the development of NAFLD, and ROC curve for the predictive value of muscle fat ratio for NAFLD. Results: Compared with uncomplicated NAFLD group, body mass, body mass index, waist circumference, visceral fat area, body fat percentage, diastolic blood pressure, blood uric acid, glycated hemoglobin level, TC and TG were significantly higher in complicated NAFLD group, while muscle fat ratio and limb skeletal muscle mass lower (P<0.05). Pearson correlation analysis revealed a negative correlation between muscle fat ratio and body mass index, waist circumference, and systolic blood pressure in the male group (r=
-0.365, -0.437, -0.117, P<0.01), and a negative correlation between muscle fat ratio and body mass index and waist circumference in the female group (r=-0.190, -0.212, P<0.01). Multivariate analysis revealed that muscle fat ratio was an independent risk factor for NAFLD in female with type 2 diabetes (OR=4.21, 95%CI=1.31-13.52, P=0.016). ROC curve analysis showed that the area under AUC curve of male group and female group was 0.66 and 0.63 respectively. Conclusion: The level of muscle fat ratio is closely related to the occurrence of NAFLD in type 2 diabetic patients, which can serve as an important reference index for clinical evaluation of type 2 diabetic patients complicated with NAFLD.

Key words： diabetes mellitus, type 2 non-alcoholic fatty liver skeletal muscle mass visceral fat area skeletal muscle mass to visceral fat area ratio

基金资助:温州市科技局科研基金资助项目（2018Y1074）。

通讯作者: 郑超，主任医师，硕士生导师，Email：zhengchao_3@163.com。

作者简介: 张帆（1983-），女，浙江温州人，护师。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.02.010 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I2/135

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