非酒精性脂肪性肝病合并2型糖尿病患者外周血miR-17、miR-20a和miR-20b变化及其临床意义*

目的 探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者外周血miR-17、miR-20a和miR-20b变化及其临床意义。方法 2018年12月～2020年6月我院收治的T2DM患者46例和NAFLD合并T2DM患者50例(轻度19例、中度17例和重度14例)。采用实时荧光定量RT-PCR法检测血清miR-17、miR-20a和miR-20b mRNA水平。采用多因素Logistic回归分析NAFLD合并T2DM发生的独立危险因素,应用受试者工作特征曲线(ROC)下面积(AUC)分析各指标诊断严重NAFLD的效能。结果 NAFLD合并T2DM患者外周血miR-17、miR-20a和miR-20b mRNA水平分别为(5.6±1.3)、(3.8±0.9)和(1.8±0.5),显著高于T2DM患者【分别为(4.4±1.1)、(3.1±0.6)和(1.4±0.4),P<0.05】;重度NAFLD组血清miR-17、miR-20a和miR-20b mRNA水平分别为(6.0±1.1)、(4.0±0.8)和(1.9±0.5),显著高于中度患者【分别为(4.4±1.0)、(3.4±0.6)和(1.5±0.4),P<0.05】或轻度患者【分别为(4.1±0.6)、(2.8±0.8)和(1.2±0.3),P<0.05】;多因素Logistic回归分析显示,BMI、血清LDL-C、miR-17、miR-20a和miR-20b是NAFLD合并T2DM发生的独立危险因素(P<0.05);ROC分析结果显示,血清miR-17、miR-20a和miR-20b诊断严重NAFLD的AUC分别为0.75、0.74和0.70。结论 NAFLD合并T2DM患者外周血miR-17、miR-20a和miR-20b水平显著升高,可能参与了NAFLD的发病过程,对判断NAFLD的严重程度具有一定的意义。

Changes of serum miR-17, miR-20a and miR-20b levels in patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus

Objective The aim of this study was to explore the implications of serum micro RNA (miR)-17, miR-20a and miR-20b in patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus. Methods 46 patients with T2DM and 50 patients (mild in 19, moderate in 17 and severe in 14) with NAFLD and T2DM were admitted to our hospital between December 2018 and June 2020. Serum miR-17, miR-20a and miR-20b mRNA levels were detected by real-time fluorescent quantitative RT-PCR. Multivariate Logistic regression analysis was applied to analyze the independent risk factorsfor occurrence of T2DM with underlying NAFLD, and the area (AUC) under the receiver operating characteristic curve (ROC) was applied to analyze the diagnostic efficacy of each indicator for severe NAFLD. Results Serum miR-17, miR-20a and miR-20b mRNA levels in patients with NAFLD and T2DM were (5.6±1.3),(3.8±0.9) and (1.8±0.5), all significantly higher than in patients with T2DM; serum miR-17, miR-20a and miR-20b mRNA levels in patients with severe NAFLD were (6.0±1.1), (4.0±0.8) and (1.9±0.5), significantly higher than in patients with moderate NAFLD or in patients with mild NAFLD; multivariate Logistic regression analysis showed that the body mass index, serum LDL-C, miR-17, miR-20a and miR-20b levels were the independent risk factors for T2DM with underlying NAFLD (P<0.05); the ROC analysis demonstrated that the AUC were 0.75, 0.74 and 0.70 by serum miR-17, miR-20a and miR-20b in diagnosing severe NAFLD. Conclusion Serum miR-17, miR-20a and miR-20b levels in patients with NAFLD and T2DM significantly increase, which might be involved in the pathogenesis of NAFLD.