| Object:Fasting C-peptide combined with FIB-4 index was used to evaluate liver fibrosis progression in patients with type 2 diabetes mellitus(T2DM)complicated with nonalcoholic fatty liver disease(NAFLD).Methods:From May 2016 to July 2017,550 patients with a diagnosis of T2 DM and NAFLD were recruited at the physical examination center of China-Japan Lianyi Hospital,Jilin University.Record general patient data,including age,gender,height,weight,waist circumference,smoking history,medication history,blood pressure,platelet count,fasting plasma glucose(FBG),fasting C-peptide,total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),uric acid(URIC),a-lanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyl Transferase(GGT)and calculate the body mass index BMI and FIB-4 index of each patient.All patients meeting the inclusion criteria were subjected to FibroScan examination,patients with <5.8 kPa(F0 and F1),were excluded based on the result of liver tissue hardness(LSM)measured by FibroScan examination,all other patients were divided into non-progressive liver fibrosis(F2)and progressive liver fibrosis(≥F3).The general characteristics of the two groups of patients were compared and analyzed,and multi-factor logistic regression analysis was performed to screen out independent risk factors for progressive fibrosis in patients with T2 DM and NAFLD;and to evaluate the AUROC value of fasted C-peptide combined with FIB-4 index in assessing liver fibrosis in patients with T2 DM and NAFLD,AUROC> 0.7 is considered clinically signific-ant,and 0.8-0.9 is considered to have high diagnostic value.Result:1.The average age of patients with progressive fibrosis in patients with T2 DM and NAFLD,was 51(49,55)years,significantly greater than that of non-progressive liver fibrosis(50,47,53)years,P<0.05.The mean AST level of patients with progressive liver fibrosis was 28.9(25.7,35.05)IU/L,which was significantly higher than that of non-progressive liver fibrosis 27.05(22.2,32.8)IU/L,P<0.05;The average FIB-4 index in the hepatic fibrosis group was 0.97(0.75,1.34),which was significantly higher than that in the nonprogressive hepatic fibrosis group 0.85(0.62,1.19),P < 0.05.On the level of fasting C-peptide,the progressive liver fibrosis group was 2.64±0.66,which was significantly higher than that of the non-progressive liver fibrosis group(2.33±0.79,P<0.05).2.Fasting C-peptide and FIB-4 index can still be used as independent risk factors for progressive fibrosis in T2 DM patients with NAFLD.Among them,the risk of progressive liver fibrosis increased by 2.14 times for every 1 unit of FIB-4 index(P<0.05);the risk of progressive liver fibrosis increased by 1.77 for every 1 unit of fasting C peptide.Times(P < 0.05).3.To assess the value of fasting C-peptide combined with FIB-4 serological diagnosis model for the evaluation of progressive hepatic fibrosis in patients with T2 DM and NAFLD using the area under the receiver operating characteristic curve.The results showed that the fasting C-peptide combined with FIB-4 index evaluating the area under the ROC curve of progressive liver fibrosis in T2 DM patients with NAFLD is approximately 0.730,which has certain clinical significance.Conclusion:1.About 9.16% of T2 DM patients with NAFLD is FibroScan-proven progressive liver fibrosis,indicating that this population is a high-risk group with progressive liver fibrosis.2.Fasting serum C-peptide levels in patients with advanced liver fibrosis were significantly higher in patients with T2 DM and NAFLD than those in patients with non-progressive liver fibrosis,and fasting serum C-peptide levels were associated with progressive liver fibrosis and was independent risk factor in T2 DM patients with NAFLD.3.C-peptide combined with FIB-4 serological diagnosis model can be used as a tool to evaluate the progression of liver fibrosis in T2 DM patients with NAFLD. |
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