Study On The Influencing Factors Of Combined Non-alcoholic Fatty Liver Disease And Tuberculosis In Type2 Diabetic Patients

Background In recent years,the prevalence of Type 2 Diabetes Mellitus(T2DM)has been on the rise with lifestyle changes and an aging population,and with the increasing prevalence of T2 DM,Nonalcoholic Fatty Liver Disease(NAFLD)are also rapidly increasing in prevalence.Although the pathogenesis of T2 DM and NAFLD has not been fully elucidated,insulin resistance underlies the co-morbidity of T2 DM and NAFLD,and both may mutually accelerate each other’s disease progression or serve as disease risk predictors of each other’s disease occurrence and progression.Therefore,there is increasing interest in the interplay between the two.Diabetes Mellitus is a common multimorbidity disease in China,and its co-morbidity with NAFLD is characterized by a rapid increase in incidence.Diabetes reduces immune function and increases the risk of bacterial infectious diseases,including tuberculosis caused by Mycobacterium tuberculosis infection.Studies have proven that 10-15% of TB cases are caused by diabetes,and the current treatment for TB is still anti-TB drugs.However,anti-TB drugs can cause damage to liver function,and in NAFLD patients,the liver itself is impaired due to the presence of NAFLD,the liver’s function of anabolic detoxification is greatly reduced,which increases the risk of treatment failure,recurrence and death in T2 DM combined with NAFLD with tuberculosis.Patients with liver damage due to antituberculosis drugs have atypical clinical presentation and no specific laboratory parameters,thus making early clinical diagnosis and treatment difficult.ObjectiveBy analyzing the prevalence of T2 DM combined NAFLD patients and their associated influencing factors,we are to provide theoretical basis and data support for further exploring the pathogenesis of T2 DM and NAFLD and its prevention and treatment measures.To analyze the prevalence status of tuberculosis occurring in T2 DM and NAFLD and its related influencing factors,and to provide new ideas for the early diagnosis and individualized intervention treatment of T2 DM combined with NAFLD tuberculosis.Methods(1)Using the convenient sampling method,346 T2 DM inpatients diagnosed from March 2017 to October 2018 at a second-class hospital in Kunshan City,Jiangsu Province were selected as the subjects of the study.Collect baseline data such as sex,age and height of patients;Multi-factor logistic regression was used to analyze the factors affecting the occurrence of T2 DM merged NAFLD.(2)Using the convenient sampling method,148 T2 DM combined NAFLD inpatients confirmed in October 2019-March 2020 at a second-class hospital in Kunshan City,Jiangsu Province were selected as the subjects of the study.Collect demographic characteristics such as sex,age,height,weight,occupation,history of environmental exposure such as smoking,tuberculosis exposure,dust exposure,history of diabetes,upper respiratory tract infections,bronchitis,or pneumonia.The influence factors of tuberculosis in T2 DM combined with NAFLD were analyzed by multi-factor logistic regression.Results 1(1)Among 346 patients with T2 DM,148 cases were combined with NAFLD,and the detection rate of NAFLD was 42.8%.(2)The weight,body mass index(BMI),fasting blood glucose(FBG),2h C-Peptide(CP)and alanine aminotransferase(ALT)in the T2 DM combined with NAFLD group were found were all significantly higher than those in the T2 DM group,and the differences were statistically significant(P all < 0.05).(3)Multi-factorial logistic regression analysis showed that BMI(OR=1.20,95%CI=1.02-1.40,P=0.024),FBG(OR=2.34,95%CI=1.80-3.06,P<0.001)and ALT(OR=1.14,95%CI=1.09-1.19,P<0.001)is an independent influencing factors for the occurrence of T2 DM combined with NAFLD.Results 2(1)20.3%(30)of the 148 patients with T2 DM combined with NAFLD had tuberculosis.(2)There were statistically significant differences between the T2 DM combined NAFLD and T2 DM combined with NAFLD and tuberculosisgroups in terms of gender,upper respiratory tract infection,bronchitis or pneumonia,history of tuberculosis exposure,dust exposure,and the distribution of smoking,drinking,weight,FBG,2h CP,ALT.(P all < 0.05).(3)Multi-factorial logistic regression analysis showed that FBG(OR=1.43,95%CI=1.16-1.77,P=0.001),TG(OR=1.26,95%CI=1.04-1.52,P=0.019),and history of tuberculosis exposure(OR=6.51,95%CI=1.74-24.42,P=0.005),smoking(OR=11.93,95%CI=3.21-44.27,P<0.001)were independent influential factors for T2 DM combined with NAFLD and tuberculosis.Conclusions(1)The detection rate of NAFLD is high in this T2 DM population and The prevalence of tuberculosis in this T2 DM combined with NAFLD population is high.(2)BMI,FBG,and ALT are independentinfluencing factors for the development of Type 2 Diabetes Mellitus combined with non-alcoholic fatty liver.Smoking,FBG,TG and combined exposure history are independent influencing factorsfor the development of T2 DM combined with NAFLD and tuberculosis.