空腹C肽评估NAFLD合并T2DM患者肝纤维化进展价值分析*

目的 探讨空腹C肽对非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者肝纤维化进展的评估价值。方法 在456例NAFLD合并T2DM患者中,经肝脏硬度检测(LSM),发现非进展性肝纤维化组415例和进展性肝纤维化组41例。采用Logistic回归分析影响肝纤维化进展的因素,并采用受试者工作特征曲线(ROC)评价空腹 C 肽对进展性肝纤维化的诊断价值。结果 进展性肝纤维化患者血清HDL-C、PLT计数、AST、空腹C肽和糖化血红蛋白(HbA1c)分别为(1.5±0.2)mmol/L、(259.3±50.3)×10⁹/L、(39.3±5.1)U/L、(2.7±0.8)ng/ml和(10.7±1.0)%,与非进展性肝纤维化组比,差异显著【分别为(1.4±0.3)mmol/L、(267.1±48.2)×10⁹/L、(26.1±4.1)U/L、(2.1±0.7)ng/ml和(8.1±1.1)%,P<0.05】;经Logistic回归分析发现,年龄【OR=0.915,95 %CI:0.841～0.995,P=0.038】、性别(OR=1.250,95% CI:1.005～1.554,P=0.045)、BMI(OR=1.117,95% CI:1.011～1.235,P=0.030)、HbA1c水平(OR=1.117,95% CI:1.011～1.235,P=0.030)和空腹C肽水平(OR=1.206,95% CI:1.068～1.361,P=0.003)是进展性肝纤维化发生的独立影响因素;经ROC曲线分析发现,空腹 C 肽诊断进展性肝纤维化的ROC下面积(AUC)为0.7(95% CI:0.7～0.81,P<0.05),即当空腹C肽水平为2.36 ng/mL时,其诊断的灵敏度为73.2%,特异度为67.0%。结论 利用空腹 C 肽水平诊断NAFLD合并T2DM患者进展性肝纤维化具有一定的诊断价值,值得临床进一步研究。

Clinical value of fasting C-peptide in assessing the progression of liver fibrosis in patients with NAFLD and T2DM

Objective The purpose of this study was to explore the clinical value of fasting C-peptide in assessing the progression of liver fibrosis in patients with non-alcoholic fatty liver disease(NAFLD)and type 2 diabetes mellitus(T2DM).Methods 456 patients with NAFLD and T2DM were recruited in this study,and all of them underwent liver stiffness measurement(LSM),which showed that 41 patients had progressive hepatic fibrosis(PHF,LSM>7.9 kPa)and 415 hadn’t(Nphf,LSM<7.9 kPa).The Logistic regression analysis was applied to explore the risk factors of liver fibrosis progression,and the receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of fasting C-peptide for progressive liver fibrosis in this setting.Results The blood HDL-C,PLT counts,serum AST,fasting C-peptide and HbA1c levels in patients with PHF were(1.5±0.2)mmol/L,(259.3±50.3)×10^9/L,(39.3±5.1)U/L,(2.7±0.8)ng/ml and(10.7±1.0)%,significantly different as compared to【(1.4±0.3)mmol/L,(267.1±48.2)×10^9/L,(26.1±4.1)U/L,(2.1±0.7)ng/ml and(8.1±1.1)%,respectively,P<0.05】in patients with nPHF;non-conditional univariate analysis and multivariate analysis showed that the ageOR=0.915,95%confidence interval(CI):0.841-0.995,P=0.038],gender(OR=1.250,95%CI:1.005-1.554,P=0.045),BMI(OR=1.117,95%CI:1.011-1.235,P=0.030),HbA1c level(OR=1.117,95%CI:1.011-1.235,P=0.030)and fasting C-peptide(OR=1.206,95%CI:1.068-1.361,P=0.003)were the risk factors,and the ROC analysis demonstrated that the area under ROC(AUC)for fasting C peptide was 0.7(95%CI:0.7-0.81,P<0.05),e.g.when serum fasting C-peptide level equal to 2.36 ng/mL as the cut-off-value,the sensitivity was 73.2%and the specificity was 67.0%.Conclusion The application of fasting C-peptide in the diagnosis of PHF in patients with NAFLD and T2DM is valuable,which warrants further investigation.