2型糖尿病患者肝肾回声比值与血清学指标的相关性

目的以肝肾回声比值预测肝脏脂肪含量，探讨2型糖尿病（T2DM）患者肝脏脂肪含量与血清学指标的相关性。 方法收集2011年1月至2012年9月青岛大学附属医院就诊的T2DM患者120例。所有患者均行常规超声检查，获取肝右肾矢状切面图，利用NIHimage图像分析软件计算肝肾回声比值；于超声检查后24 h内检测受试者相关血清学指标。采用Spearman秩相关分析法分析T2DM患者肝肾回声比值与血清学指标的相关性；以肝肾回声比值为因变量，三酰甘油（TG，X₁）、总胆固醇（TC，X₂）、高密度脂蛋白胆固醇（HDL-C，X₃）、低密度脂蛋白胆固醇（LDL-C，X₄）、丙氨酸氨基转移酶（ALT，X₅）、天冬氨酸氨基转移酶（AST，X₆）、γ-谷氨酰转移酶（γ-GT，X₇）、碱性磷酸酶（ALP，X₈）浓度为自变量作多元线性回归分析，分析T2DM患者肝肾回声比值的影响因素；绘制肝肾回声比值诊断T2DM患者TG浓度增高（>1.92 mmol/L）的操作者工作特性（ROC）曲线。 结果T2DM患者肝肾回声比值与TG、AST、ALT、γ-GT浓度均呈正相关（r=0.420，P=0.000；r=0.383，P=0.000；r=0.309，P=0.001；r=0.253，P=0.005），与糖化血红蛋白、TC、HDL-C、LDL-C、ALP、血尿酸浓度均无相关性（r=0.0.067，P=0.368；r=0.145，P=0.115；r=-0.148，P=0.106；r=0.002，P=0.986；r=0.160，P=0.081；r=0.064，P=0.489）；仅TG浓度（X₁）与T2MD患者肝肾回声比值有线性回归关系，回归方程为：Y=1.245+0.062X₁；ROC曲线显示，肝肾回声比值诊断T2DM患者TG浓度增高（>1.92 mmol/L）的最佳界值为1.236，曲线下面积为0.677，敏感度为86.7%，特异度为45.3%。 结论肝肾回声比值可作为预测肝脏脂肪含量的可靠指标；T2DM患者肝脏脂肪含量与TG、ALT、AST、γ-GT浓度具有相关性；TG浓度的升高可反映T2MD患者肝脏内脂肪含量的增加，且肝肾回声比值达到1.236时T2MD患者TG浓度易出现异常。

Relationship between sonographic hepatorenal ratio and serum markers in type 2 diabetes mellitus patients

ObjectiveTo explore the relationship between serum markers and liver fat content predicted by hepatorenal ratio in type 2 diabetic mellitus (T2DM) patients. MethodsA total of 120 T2DM patients were recruited from January 2011 to September 2012 in the Affiliated Hospital of Qingdao University. The sagittal liver-right kidney diagrams of the patients were obtained by two-dimensional ultrasonic examination, and the hepatorenal ratio were analyzed by NIHimage. Then, the related serum markers were tested 24 hours later. The relationship between hepatorenal ratio and serum markers was analyzed by Spearman rank correlation on the patients of T2DM. Then, the affective factors on the hepatorenal ratio were analysed by multivariate linear regression analysis, with hepatorenal ratio as dependent variable, and the concentration of triglyceride (TG, X₁) , total cholesterol (TC, X₂), high density lipoprotein cholesterol (HDL-C, X₃), low density lipoprotein cholesterol (LDL-C, X₄), alanine aminotransferase (ALT, X₅), aspartate aminotransferase (AST, X₆), glutamyltransferase (γ-GT, X₇) , and alkaline phosphatase (ALP, X₈) as independent variables. The receiver operating characteristic curve (ROC) was drawn to diagnose the point of the hepatorenal ratio when the TG began to increase (>1.92 mmol/L). ResultsThere was positive correlation between hepatorenal ratio and TG, AST, ALT, γ-GT (r=0.420, P=0.000; r=0.383, P=0.000; r=0.309, P=0.001; r=0.253, P=0.005), while no correlation between hepatorenal ratio and glycosylated hemoglobin, TC, HDL-C, LDL-C, ALP or blood uric acid (BUA) (r=0.0.067, P=0.368; r=0.145, P=0.115; r=-0.148, P=0.106; r=0.002, P=0.986; r=0.160, P=0.081; r=0.064, P=0.489) were found; the linear regression analysis showed that TG level (X₁) was the only markers which had correlation with hepatorenal ratio in the T2MD patients with the regression equation of Y=1.245+0.062X. The ROC curve analysis showed that the optimal cutoff value for hepatorenal ratio to in diagnosinge increased TG (>1.92 mmol/L) was 1.236 in T2DM patients, and the area under the curve was 0.677. The sensitivity and specificity were 86.7% and 45.3% respectively. ConclusionsHepatorenal ratio can be a reliable indicator to predict liver fat content, which has correlation with TG, ALT, AST and γ-GT. The increased TG level can reflect the increasing fat content in the liver, and TG begin to increase when the hepatorenal ratio reach 1.236.