2型糖尿病合并非酒精性脂肪性肝病患者血清网膜素、视黄醇结合蛋白4和Ⅰ型原胶原氨基端前肽水平及意义分析*

目的 探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者血清网膜素、视黄醇结合蛋白-4(RBP4)和Ⅰ型原胶原氨基端前肽(PINP)水平变化及其临床意义。方法 2019年6月～2021年12月我院诊治的T2DM合并NAFLD患者102例(轻度39例,中度34例,重度29例)和T2DM患者98例,使用超声检查行脂肪肝分度,采用ELISA法检测血清网膜素、RBP4和PINP水平,应用受试者工作特征曲线(ROC)评估各指标诊断NAFLD严重程度的效能。结果 T2DM合并NAFLD患者血清网膜素和PINP水平分别为(45.4±12.4)ng/mL和(29.6±6.2)ng/mL,显著低于T2DM患者【分别为(68.3±15.6)ng/mL和(35.8±7.3)ng/mL,P＜0.05】,而血清RBP4水平为(26.6±5.1)mg/L,显著高于T2DM患者【(20.1±4.6)mg/L,P＜0.05】;重度NAFLD患者血清网膜素和PINP水平分别为(40.7±4.9)ng/mL和(25.8±3.7)ng/mL,显著低于中度患者【分别为(45.2±5.6)ng/mL和(29.9±4.0)ng/mL,P＜0.05】或轻度患者【分别为(49.1±6.2)ng/mL和(32.2±3.3)ng/mL,P＜0.05】,而血清RBP4水平为(30.3±3.0)mg/L,显著高于中度患者【(26.5±2.8)mg/L,P＜0.05】或轻度患者【(23.9±3.1)mg/L,P＜0.05】;联合血清网膜素、RBP4和PINP诊断T2DM合并重度NAFLD的曲线下面积(AUC)为0.856,其灵敏度、特异度和准确度分别为86.2%、79.5%和81.4%,显著高于三项指标单独评估(其AUC分别为0.744、0.752和0.704,P＜0.05)。结论 T2DM合并NAFLD患者血清网膜素和PINP水平显著降低,而RBP4水平显著升高,利用这些指标的变化规律可能能帮助临床判断合并脂肪肝的程度,值得进一步研究。

Implications of serum omentin,retinol-binding protein-4 and propeptide of type I procollagen in patients with diabetes mellitus type 2 and non-alcoholic fatty liver diseases

Objective The aim of this study was to explore the implications of serum omentin, retinol-binding protein-4 (RBP-4) and propeptide of type I procollagen (PINP) in patients with diabetes mellitus type 2 (T2DM) and non-alcoholic fatty liver diseases (NAFLD). Methods A total of 102 patients with T2DM and NAFLD (with mild steatosis in 39 cases, moderate in 34 cases and severe in 29 cases) and 98 patients with T2DM were enrolled in our hospital between June 2019 and December 2021. The hepatic steatosis was evaluated by ultrasonography, and serum omentin, RBP4 and PINP levels were detected by ELISA. The diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUC). Results Serum omentin and PINP levels in patients with T2DM and NAFLD were (45.4±12.4) ng/mL and (29.6±6.2) ng/mL, significantly lower than (68.3±15.6) ng/mL and (35.8±7.3) ng/mL, respectively, P<0.05], while serum RBP4 level was(26.6±5.1)mg/L, significantly higher than (20.1±4.6)mg/L, P＜0.05] in patients with T2DM; serum omentin and PINP levels in patients with severe NAFLD were (40.7±4.9)ng/mL and (25.8±3.7)ng/mL, significantly lower than (45.2±5.6)ng/mL and (29.9±4.0)ng/mL, respectively, P＜0.05] in patients with moderate NAFLD or (49.1±6.2)ng/mL and (32.2±3.3)ng/mL, respectively, P＜0.05] in patients with mild NAFLD, while serum RBP4 level was (30.3±3.0)mg/L, significantly higher than (26.5±2.8)mg/L, P＜0.05] in patients with moderate NAFLD or (23.9±3.1)mg/L, P＜0.05] in patients with mild NAFLD; the AUC was 0.856 by serum omentin, RBP4 and PINP level combination in predicting severe NAFLD in patients with T2DM and NAFLD, with the sensitivity, specificity and accuracy of 86.2%, 79.5% and 81.4%. Conclusion Serum omentin and PINP levels decrease and serum RBP4 level increase in patients with T2DM and NAFLD, which might help predicting hepatic steatosis and needs further clinical investigation.