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目的探讨血尿酸(UA)水平对2型糖尿病患者非酒精性脂肪性肝病(NAFLD)发生风险的预测价值。方法借助开滦集团研究资料(chicTR-TNC-11001489),采用前瞻性队列研究方法选取符合标准的研究对象共2 937例,按照血UA基线水平的四分位数将患者分为A组738例(≤216μmol/L),B组749例(216～μmol/L),C组722例(263～μmol/L),D组728(>316μmol/L)。观察2型糖尿病患者NAFLD发生情况及年龄、腰围(WC)、体质指数(BMI)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、空腹血糖(FPG)。2型糖尿病患者发生NAFLD的影响因素采用条件Logistic回归分析。结果 NAFLD发生率为28.9%(850/2 937),其中男性为28.1%(691/2 460),女性为33.3%(159/477),差异有统计学意义(χ2=5.34,P<0.05);A组NAFLD发生率为22.5%(166/738)、B组为28.8%(216/749)、C组为29.5%(213/722)、D组为35.0%(255/728),差异亦有统计学意义(χ2=28.15,P<0.01)。4组患者的性别构成、平均年龄、WC、BMI及TG、HDL-C、LDL-C、TC、FPG水平比较,差异均有统计学意义(P<0.01)。以A组为参照,单因素Logistic回归分析显示,B组、C组、D组发生NAFLD的OR值依次为1.37〔95%CI(1.11,1.77),P=0.005〕、1.44〔95%CI(1.14,1.83),P=0.002〕、1.86〔95%CI(1.48,2.34),P=0.000〕;引入性别、年龄因素后,B组、C组、D组发生NAFLD的OR值依次为1.45〔95%CI(1.15,1.84),P=0.002〕、1.52〔95%CI(1.20,1.93),P=0.001〕、2.03〔95%CI(1.60,2.57),P=0.000〕;进一步引入TG、TC、HDL-C、LDL-C、FPG及BMI后,B组、C组、D组发生NAFLD的OR值依次为1.36〔95%CI(1.06,1.74),P=0.016〕、1.37〔95%CI(1.07,1.74),P=0.012〕、1.68〔95%CI(1.31,2.17),P=0.000〕。结论 2型糖尿病患者NAFLD发生风险较大,血UA水平升高是其独立危险因素,具有一定的预测价值。
Objective To investigate the predictive value of serum uric acid (UA) in the risk of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetic patients. Methods A total of 2 937 eligible patients were selected by the prospective cohort study with the help of the KTR Group study data (chicTR-TNC-11001489). Patients were divided into group A (738 cases) according to the quartile of baseline UA level (≤216 μmol / L), 749 (216 μmol / L) in group B, 722 (263 μmol / L) in group C, and 728 (316 μmol / L) in group D. Observe the incidence of NAFLD and the changes of age, WC, BMI, TG, HDL-C and LDL-C in type 2 diabetic patients, , Total cholesterol (TC), fasting blood glucose (FPG). The influencing factors of NAFLD in patients with type 2 diabetes were analyzed by conditional Logistic regression. Results The incidence of NAFLD was 28.9% (850/2 937), with 28.1% (691/2 460) males and 33.3% (159/477 females), the difference was statistically significant (χ2 = 5.34, P <0.05) . The incidence of NAFLD in group A was 22.5% (166/738) in group A, 28.8% (216/749) in group B, 29.5% (213/722) in group C and 35.0% (255/728) in group D There was statistical significance (χ2 = 28.15, P <0.01). There were significant differences in gender composition, mean age, WC, BMI, TG, HDL-C, LDL-C, TC and FPG between the four groups (P <0.01). In group A, univariate logistic regression analysis showed that the OR of NAFLD in group B, C and D were 1.37 [95% CI (1.11, 1.77), P = 0.005], 1.44 [95% CI 1.14, 1.83, P = 0.002], 1.86 〔95% CI (1.48,2.34), P = 0.000〕. After introducing the sex and age factors, the OR of NAFLD in groups B, C and D were 1.45 95% CI (1.20, 1.93), P = 0.001], 2.03 [95% CI (1.60, 2.57), P = 0.000]; further introduction of TG, The OR of NAFLD in group B, group C and group D were 1.36 [95% CI (1.06,1.74), P = 0.016], 1.37 [95% CI (1.07, 1.74), P = 0.012], 1.68 [95% CI (1.31, 2.17), P = 0.000]. Conclusions Patients with type 2 diabetes have a higher risk of developing NAFLD. UA level is an independent risk factor for type 2 diabetes mellitus, which has some predictive value.