中性粒细胞/淋巴细胞对2型糖尿病合并非酒精性脂肪肝的预测价值

邢曙光 马珺珂 任慧 孙军

【摘要】 目的：探讨中性粒细胞/淋巴细胞（NLR）在2型糖尿病（T2DM）合并非酒精性脂肪肝（NAFLD）患者中的临床价值。方法：选取2018年9月-2020年8月于锦州市中心医院就诊的T2DM患者110例。根据超声检查有无脂肪肝将患者分为T2DM合并NAFLD组（T2DM+NAFLD组）56例和T2DM不合并NAFLD组（T2DM组）54例。比较两组临床资料，多因素logistic回归分析T2DM合并NAFLD的影响因素，采用ROC曲线分析NLR在T2DM合并NAFLD患者中的临床价值。结果：T2DM+NAFLD组HbA1c、FBG、HOMA-IR、TG、TC、ALT、AST、WBC、NLR均高于T2DM组，HDL-C低于对照组，差异均有统计学意义（P<0.05）。logistic回归分析结果显示，FBG、TC、ALT、NLR是T2DM合并NAFLD的独立危險因素，HDL-C为T2DM合并NAFLD的保护因素（P<0.05）。ROC曲线分析结果显示，NLR诊断T2DM合并NAFLD的AUC为0.790，最佳诊断点为2.39，灵敏度和特异度分别为60.7%、86.8%。结论：T2DM合并NAFLD患者中NLR显著增高，是其发病的独立危险因素且对其具有良好预测价值。

【关键词】 中性粒细胞/淋巴细胞 2型糖尿病 非酒精性脂肪肝

[Abstract] Objective： To investigate the clinical value of neutrophil / lymphocyte （NLR） in patients with type 2 diabetes mellitus （T2DM） and nonalcoholic fatty liver disease （NAFLD）. Method： A total of 110 T2DM patients treated in Jinzhou Central Hospital from September 2018 to August 2020 were selected. According to the presence or absence of fatty liver by ultrasonography， the patients were divided into 56 cases in T2DM with NAFLD group （T2DM + NAFLD group） and 54 cases in T2DM without NAFLD group （T2DM group）. The clinical data of the two groups were compared， the influencing factors of T2DM combined with NAFLD were analyzed by multivariate logistic regression， and the clinical value of NLR in patients with T2DM combined with NAFLD was analyzed by ROC curve. Result： HbA1c， FBG， HOMA-IR， TG， TC， ALT， AST， WBC and NLR in T2DM+NAFLD group were higher than those in T2DM group， and HDL-C was lower than that in control group， the differences were statistically significant （P<0.05）. logistic regression analysis showed that FBG， TC， ALT and NLR were independent risk factors for T2DM combined with NAFLD， and HDL-C was a protective factor for T2DM combined with NAFLD （P<0.05）. ROC curve analysis results showed that the AUC of NLR for diagnosing T2DM combined with NAFLD was 0.790， the optimal diagnostic point was 2.39， and the sensitivity and specificity were 60.7% and 86.8%， respectively. Conclusion： NLR is significantly increased in T2DM patients with NAFLD， which is an independent risk factor and has good predictive value.

[Key words] Neutrophil/lymphocyte ratio Type 2 diabetes mellitus Nonalcoholic fatty liver disease

First-author’s address： Graduate School of Jinzhou Medical University， Jinzhou 121000， China

doi：10.3969/j.issn.1674-4985.2021.25.036

非酒精性脂肪肝（nonalcoholic fatty liver disease， NAFLD）是一种代谢紊乱的多系统疾病，与高血糖、高血脂、肥胖等多种代谢性疾病密切相关，且相互影响[1-2]。与非糖尿病NAFLD患者相比，伴有2型糖尿病（type 2 diabetes mellitus， T2DM）的NAFLD患者病情更加严重，且促进向非酒精性脂肪性肝炎（nonalcoholic steatohepatitis， NASH）进展，增加肝脏纤维化和肝细胞癌（hepatocellular carcinoma， HCC）的患病风险[3]。因此较早发现、较早干预可以延缓患者病情的进展、减少相关疾病的发生率有重要意义。目前肝活检仍然是NAFLD诊断的金标准，但由于肝脏活检为有创性检查，可导致某些并发症，且存在抽样误差，因此临床难以广泛展开，在早期诊断NAFLD方面还缺少有效的、高特异性的方法。近年来，中性粒细胞/淋巴细胞（neutrophil/lymphocyte ratio， NLR）作为一种炎症指标受……