2022 年第 11 期 第 17 卷

2型糖尿病合并代谢相关脂肪性肝病患者血清总胆汁酸水平变化及其相关因素研究

Changes in the level of serum total bile acid and related factors in patients with type 2 diabetes mellitus complicated with metabolic associated fatty liver disease

作者：杜文晋1邢华冰1白秀平2

英文作者：Du Wenjin1 Xing Huabing1 Bai Xiuping2

单位：1山西医科大学第二临床医学院，太原030001；2山西医科大学第二医院内分泌科，太原030001

英文单位：1Second Clinical Medical College of Shanxi Medical University Taiyuan 030001 China; 2Department of Endocrinology Second Hospital of Shanxi Medical University Taiyuan 030001 China

关键词：2型糖尿病；代谢相关脂肪性肝病；胆汁酸；胰岛素抵抗；胆红素

英文关键词：Type2diabetesmellitus;Metabolicassociatedfattyliverdisease;Bileacids;Insulinresistance;Bilirubin

• 摘要：

• 目的 研究2型糖尿病（T2DM）合并代谢相关脂肪性肝病（MAFLD）患者血清总胆汁酸水平的变化，探讨可能与其相关的血清学指标。方法 回顾性分析2021年1—9月在山西医科大学第二医院内分泌科住院的164例T2DM患者的临床资料。按是否合并MAFLD分为单纯T2DM组（83例）和T2DM合并MAFLD组（81例），同时选取年龄及性别均匹配的健康体检者82例作为健康对照组。比较各组一般临床资料及总胆汁酸水平差异，分析血清总胆汁酸水平与T2DM患者各指标的相关性、T2DM合并MAFLD的危险因素及血清总胆汁酸预测糖尿病患者MAFLD患病风险的效能。结果 T2DM合并MAFLD组三酰甘油、血尿酸、丙氨酸转氨酶、总胆红素、空腹胰岛素水平、稳态模型胰岛素抵抗指数均高于单纯T2DM组，高密度脂蛋白胆固醇水平低于单纯T2DM组，差异均有统计学意义（均P<0.05)。单纯T2DM组总胆汁酸水平明显高于健康对照组［（4.2±2.4）μmol/L比（3.4±1.6）μmol/L］（P<0.05）；T2DM合并MAFLD组血清总胆汁酸水平［（5.2±2.8）μmol/L］明显高于单纯T2DM组（P<0.05）。相关性分析结果显示，T2DM患者总胆汁酸水平与三酰甘油、血尿酸、糖化血红蛋白、脂肪肝呈正相关（均P＜0.05）。Logistic回归分析结果显示体重指数、血尿酸、总胆红素为T2DM患者发生MAFLD的独立危险因素（均P<0.05），而总胆汁酸并非T2DM合并MAFLD的独立危险因素（P>0.05）。受试者工作特征曲线分析结果显示，血清总胆汁酸预测T2DM患者MAFLD患病风险的曲线下面积为0.593，95%置信区间：0.505～0.682，P=0.039，敏感度为54.3%，特异度为71.1%。结论 T2DM合并MAFLD患者血清总胆汁酸水平明显升高，T2DM患者脂肪肝与血清总胆汁酸水平相关，但总胆汁酸并不是糖尿病患者发生MAFLD的独立危险因素。

• Objective To investigate changes in the level of serum total bile acid(TBA) in patients with type 2 diabetes mellitus(T2DM) complicated with metabolic associated fatty liver disease(MAFLD), and to explore the possible serological indicators. Methods The clinical data of 164 patients with T2DM admitted to Department of Endocrinology, Second Hospital of Shanxi Medical University from January to September 2021 were analyzed retrospectively. According to whether they were combined with MAFLD, patients were divided into simple T2DM group(83 cases) and T2DM with MAFLD group(81 cases). At the same time, 82 healthy physical examiners matched in age and gender were selected as the healthy control group. The general clinical data and the serum level of TBA of each group were compared. The correlation between serum level of TBA and various indicators of T2DM patients, the risk factors of T2DM complicated with MAFLD, and the efficacy of serum TBA in predicting the risk of MAFLD in diabetic patients were analyzed. Results Levels of triglyceride, blood uric acid, alanine aminotransferase, total bilirubin, fasting insulin and homeostasis model assessment of insulin resistance index in T2DM with MAFLD group were higher than those in simple T2DM group, and the level of high-density lipoprotein cholesterol was lower than that in simple T2DM group(all P<0.05). The level of TBA in simple T2DM group was significantly higher than that in healthy control group［(4.2±2.4)μmol/L vs (3.4±1.6)μmol/L］（P<0.05）; serum level of TBA in T2DM with MAFLD group［(5.2±2.8)μmol/L］ was significantly higher than that in simple T2DM group(P<0.05). Correlation analysis showed that the level of TBA was positively correlated with triacylglycerol, blood uric acid, glycosylated hemoglobin and fatty liver in patients with T2DM(all P<0.05). Logistic regression analysis showed that body mass index, blood uric acid and total bilirubin were independent risk factors for MAFLD in patients with T2DM(all P<0.05), while TBA was not(P>0.05). The receiver operating characteristic curve analysis showed that the area under the curve of TBA predicting the risk of MAFLD in T2DM patients was 0.593, 95% confidence interval: 0.505-0.682, P=0.039, the sensitivity was 54.3%, and the specificity was 71.1%. Conclusions Serum level of TBA is significantly elevated in T2DM patients with MAFLD, and it is associated with fattyt liver in T2DM patients. However, TBA is not an independent risk factor for the development of MAFLD in patients with diabetes mellitus.