The impact of different glucose metabolism status on nonalcoholic fatty liver disease in obese patients #br#
CHEN Youwei1,2, KANG Xing2, YAN Yu2, YU Hang2, CHEN Sihan2,SUN Xitai1,2
1. Nanjing University Medical School, Nanjing Jiangsu 210008; 2. Bariatric Surgery and Metabolism Disease Center, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Jiangsu 210008, China
Abstract：Objective： To explore the effect of different glucose metabolism status on nonalcoholic fatty liver disease (NAFLD) in patients with obesity. Methods： A total of 111 obese patients with NAFLD who underwent bariatric surgery from July 2018 to July 2021 were enrolled. All patients were divided into type 2 diabetes group and non-type 2 diabetes group according to different glucose metabolism status. The basic information and incidence of pathological changes of NAFLD of two groups were compared. Spearman correlation analysis was applied to investigate the correlation between glucose metabolism parameters and different pathological changes of NAFLD. The collinearity of data was analyzed by lasso regression. Univariate and multivariate logistic regression were used to analyze the impact factors associated with non-alcoholic steatohepatitis （NASH）. Receiver operating characteristic （ROC） curve was used to evaluate the predictive value of impact factors in NASH. Results： The scores of liver steatosis and NAFLD activity in type 2 diabetes group were significantly higher than that of non-type 2 diabetes group (P<0.05). Comparing with non type 2 diabetes group, the hepatic steatosis in type 2 diabetes group were more severe and the incidence of NASH and hepatic fibrosis even higher, the difference was statistically significant (P<0.05). The fasting insulin, fasting C-peptide, HbA1c, and homeostasis model assessment of insulin resistance （HOMA-IR） were positively correlated with degree of liver steatosis, while there was no correlation with the degree of liver lobule inflammation, ballooning degeneration and hepatic fibrosis. Univariate logistic regression analysis showed that BMI, fasting blood glucose, fasting C-peptide, HbA1c and HOMA-IR were all impact factors of NASH. Lasso regression variables were selected as following: BMI, HbA1c, fasting Cpeptide, fasting blood glucose. Then the forward LR and forward conditional method of multivariate were used to control confounding factors and showed that fasting Cpeptide was an independent risk factor for NASH. ROC showed that the area under the curve of fasting C-peptide predicting NASH is 0.754 (95％CI： 0.609-0.899， P=0.001). Conclusion： When obesity patients have glucose metabolism disorder, the liver steatosis of NAFLD will be more severe, and promote the transformation from non-alcoholic fatty liver to NASH and hepatic fibrosis. In addition, with the increase of fasting C-peptide, the risk of NASH would be also increased.
［Key words］obesity; non-alcoholic fatty liver disease; type 2 diabetes; fasting C-peptide
通讯作者:
孙喜太，副教授，E-mail： sunxitai@hotmail.com
作者简介: 陈有为（1995—），男，硕士研究生
引用本文:
陈有为， 康星， 严雨，等. 肥胖患者不同糖代谢状态对非酒精性脂肪性肝病严重程度的影响[J]. 江苏大学学报:医学版, 2023, 33(03): 231-238.
CHEN Youwei, KANG Xing, YAN Yu, et al. The impact of different glucose metabolism status on nonalcoholic fatty liver disease in obese patients #br#. Journal of Jiangsu University(Medicine Edition), 2023, 33(03): 231-238.
