目的 探讨2型糖尿病(T2DM)合并代谢相关脂肪性肝病(MAFLD)与微量白蛋白尿(MAU)之间的关系.方法 选取2019年3月至2019年9月在秦皇岛市第一医院内分泌科住院的439例T2DM患者,根据是否合并MAFLD分为MAFLD组(n=297)和未合并MAFLD(non-MAFLD)组(n=142),同时根据尿白蛋白/肌酐比值(ACR)将患者分为MAU组(n=62)和非MAU组(n=377).分别比较两组患者的一般资料、实验室指标.多因素logistic回归分析T2DM患者发生MAFLD的影响因素及分析T2DM患者合并MAFLD发生MAU的危险因素.结果 与non-MAFLD组相比,T2DM合并MFLAD组患者的体重、体重指数(BMI)、腹内脂肪面积(VFA)、空腹血糖(FPG)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)、甘油三酯(TG)、稳态模型评估-胰岛素抵抗指数(HOMA-IR)、甘油三酯葡萄糖指数(TyG)及TG/HDL-C水平均显著升高(P均＜0.05).T2DM合并MAFLD 组发生 MAU 的比例明显高于 non-MAFLD 组(17.85％比 6.34％,x2=10.488,P=0.001).T2DM合并MAU组的病程、体重、VFA、HOMA-IR、估算的肾小球滤过率(eGFR)显著高于非MAU组(P均＜0.05),MAU 组发生 MAFLD 比例亦高于非 MAU 组(85.5％比 64.7％,x2=10.488,P=0.001).回归分析结果显示,病程、HOMA-IR及eGFR是T2DM合并MAFLD发生MAU的独立危险因素(OR=1.004、1.187、1.012,95％CI:1.001～1.007、1.082～1.303、1.004～1.019,P 均＜0.05).结论 T2DM患者合并MAFLD会增加发生MAU的风险.
Relationship between type 2 diabetes mellitus with metabolic associated fatty liver disease and mi-croalbuminuria
Objective To investigate the relationship between microalbuminuria(MAU)and type 2 diabetes mellitus(T2DM)with metabolic associated fatty liver disease(MAFLD).Methods A total of 439 patients with T2DM were divided into MAFLD group(n=297)and non-alcoholic fatty liver group(non-MAFLD group,n=142)according to whether they had MAFLD or not.They were also divided into MAU group(n=62)and non-MAU group(n=377)according to urinary albumin/creatinine ratio(ACR).The general data and laboratory indicators were compared.Multivariate logistic regression analysis was conducted to analyze the influencing factors of MAFLD in T2DM patients and the risk factors of microalbuminuria in T2DM patients with MAFLD.Results Compared with the non-MAFLD group,the T2DM patients with MAFLD had significantly higher body weight,body mass index(BMI),visceral fat area(VFA),fasting blood glucose(FPG),alanine aminotransferase(ALT),gamma-glutamyl transferase(GGT),triglycerides(TG),homeosta model assessment-insulin resistance index(HOMA-IR),triglyceride-glucose index(TyG),and TG/HDL-C levels(all P＜0.05).The proportion of patients with MAU in the T2DM with MAFLD group was significantly higher than that in the non-MAFLD group(17.85％vs.6.34％,x2=10.488,P=0.001).The disease duration,body weight,VFA,and HOMA-IR were significantly higher in the MAU group than those in the non-MAU group(all P＜0.05),and the proportion of patients with MAFLD in the MAU group was also higher than that in the non-MAU group(85.5％vs.64.7％,x2=10.488,P=0.001).The results of the regression analysis showed that disease duration,HOMA-IR,and eGFR were independent risk factors for the development of MAU in T2DM with MAFLD(OR=1.004,1.187,1.012;95％CI:1.001-1.007,1.082-1.303,1.004-1.019;allP＜0.05).Conclusion T2DM patients with MAFLD may have an increased risk of MAU.
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