目的 探讨2型糖尿病患者血糖目标范围内时间(time in range, TIR)与代谢相关脂肪性肝病(metabolic associated fatty liver disease, MAFLD)及进展期肝纤维化的相关性。 方法 本研究为回顾性研究，选取2019年10月至2022年4月河南省人民医院内分泌科494例2型糖尿病患者作为研究对象，TIR来自持续血糖监测数据，腹部超声诊断脂肪肝，瞬时弹性成像技术的肝脏硬度值评估肝纤维化。采用Pearson相关性分析及多元线性回归分析评估TIR与肝脏硬度值的相关性，采用logistic回归分析评估TIR与MAFLD及进展期肝纤维化患病风险的相关性。 结果 Pearson相关性分析显示，TIR与肝脏硬度值呈负相关(r＝－0.86, P<0.001)，稳态模型评估的胰岛素抵抗指数(HOMA-IR)与肝脏硬度值呈正相关(r＝0.48, P<0.001)；调整混杂因素后，多元线性回归分析显示，TIR负向预测肝脏硬度值(β＝－0.75, P<0.001)，HOMA-IR正向预测肝脏硬度值(β＝0.21, P＝0.025)；调整混杂因素后，logistic回归分析显示，与TIR Q4患者相比，TIR Q1患者MAFLD(OR＝1.96, 95%CI 1.07～3.62, P＝0.027)及进展期肝纤维化(OR＝3.82, 95%CI 1.17～12.50, P＝0.027)患病风险增加，HOMA-IR是MAFLD(OR＝1.22, 95%CI 1.04～1.43, P＝0.005)及进展期肝纤维化(OR＝1.26, 95%CI 1.03～1.54, P＝0.025)的独立危险因素。 结论 2型糖尿病患者中，低水平TIR、胰岛素抵抗是MAFLD及进展期肝纤维化的独立危险因素，TIR对MAFLD及进展期肝纤维化发生有显著的预测价值。 Objective To investigate the association of time in range with metabolic associated fatty liver disease(MAFLD) and advanced liver fibrosis in patients with type 2 diabetes. Methods This study was a retrospective study. A total of 494 type 2 diabetic patients were recruited in the Department of Endocrinololgy of Henan Provincial People′s Hospital from November 2019 to April 2022. Time in range(TIR) was calculated with continuous glucose monitoring data. Abdominal ultrasound scan was used to diagnose fatty liver. Liver stiffness measurement(LSM) by transient elastography was used to evaluate liver fibrosis. Pearson and multivariate linear regression analysis was used to evaluate the association between TIR and LSM. Multivariate logistic regression analysis was used to analyze the association of TIR with risk of MAFLD and advanced liver fibrosis. Results Pearson correlation analysis showed that LSM was negatively correlated with TIR(r=-0.86, P<0.001) and was positively correlated with homeostasis model assessment for insulin resistance(HOMA-IR r=0.48, P<0.001). After adjusting for confounding factors, multivariate linear regression analysis showed that TIR significantly negatively predicted LSM(β=-0.75, P<0.001), and HOMA-IR significantly positively predicted LSM(β=0.21, P=0.025). After adjusting for confounding factors, logistic regression analysis showed that compared with TIR Q4 patients, TIR Q1 patients had an increased risk of MAFLD(OR=1.96, 95%CI 1.07-3.62, P=0.027), advanced liver fibrosis(OR=3.82, 95%CI 1.17-12.50, P=0.027), and HOMA-IR was an independent risk factor for MAFLD(OR=1.22, 95%CI 1.04-1.43, P=0.005) and advanced liver fibrosis(OR=1.26, 95%CI 1.03-1.54, P=0.025). Conclusions TIR and insulin resistance are independent risk factors for MAFLD and advanced liver fibrosis in patients with type 2 diabetes. TIR has a significant predictive value for MAFLD and advanced liver fibrosis.
Association of time in range with metabolic associated fatty liver disease and liver fibrosis in patients with type 2 diabetes
Objective To investigate the association of time in range with metabolic associated fatty liver disease(MAFLD) and advanced liver fibrosis in patients with type 2 diabetes. Methods This study was a retrospective study. A total of 494 type 2 diabetic patients were recruited in the Department of Endocrinololgy of Henan Provincial People′s Hospital from November 2019 to April 2022. Time in range(TIR) was calculated with continuous glucose monitoring data. Abdominal ultrasound scan was used to diagnose fatty liver. Liver stiffness measurement(LSM) by transient elastography was used to evaluate liver fibrosis. Pearson and multivariate linear regression analysis was used to evaluate the association between TIR and LSM. Multivariate logistic regression analysis was used to analyze the association of TIR with risk of MAFLD and advanced liver fibrosis. Results Pearson correlation analysis showed that LSM was negatively correlated with TIR(r=-0.86, P<0.001) and was positively correlated with homeostasis model assessment for insulin resistance(HOMA-IR r=0.48, P<0.001). After adjusting for confounding factors, multivariate linear regression analysis showed that TIR significantly negatively predicted LSM(β=-0.75, P<0.001), and HOMA-IR significantly positively predicted LSM(β=0.21, P=0.025). After adjusting for confounding factors, logistic regression analysis showed that compared with TIR Q4 patients, TIR Q1 patients had an increased risk of MAFLD(OR=1.96, 95%CI 1.07-3.62, P=0.027), advanced liver fibrosis(OR=3.82, 95%CI 1.17-12.50, P=0.027), and HOMA-IR was an independent risk factor for MAFLD(OR=1.22, 95%CI 1.04-1.43, P=0.005) and advanced liver fibrosis(OR=1.26, 95%CI 1.03-1.54, P=0.025). Conclusions TIR and insulin resistance are independent risk factors for MAFLD and advanced liver fibrosis in patients with type 2 diabetes. TIR has a significant predictive value for MAFLD and advanced liver fibrosis.
Time in rangeMetabolic associated fatty liver diseaseAdvanced liver fibrosis
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