NFS,FIB-4 And MAFLD In T2DM Patients Correlation Study Of Diabetic Microangiopathy

Objective To investigate the correlation between nonalcoholic fatty liver fibrosis score(NFS),liver fibrosis 4 factor index(FIB-4)and diabetic microangiopathy in type 2 diabetes mellitus with metabolism-related fatty liver disease(MAFLD)Research object and method This study was conducted by standardized metabolic management center(MMC)to study 2773 patients with type 2 diabetes mellitus and fatty liver diseased in the First Hospital of Lanzhou University.They were divided into high fibrosis group(NFS≥0.676),intermediate group(-1.455≤NFS<0.676)and low fibrosis group(NFS<-1.455)according to NFS,and high fibrosis group(FIB-4≥1.30)and low fibrosis group(FIB-4<1.30)according to FIB-4.Diabetic kidney disease(DKD)was evaluated by UACR and eGFR,and diabetic retinopathy(DR)was evaluated by diabetic retinopathy.Chi-square test was used to investigate the prevalence of DKD and DR in different hepatic fibrosis groups.Binary logistic regression analysis was used to investigate whether NFS and FIB-4 were risk factors for DKD and DR.Results(1)The mean age of type 2 diabetes patients with MAFLD was(55.24±10.11)years old,including 1870 males(67.4%)and 903 females(32.6%).The prevalence rates of DKD and DR ware 27.9%and 42.2%,respectively.(2)In the general population,the proportions of eGFR<60(ml/min/1.73 m~2),albuminuria and DR were 2.1%,27.2%and 42.2%.With the aggravation of liver fibrosis,eGFR<60(ml/min/1.73 m~2),the prevalence of albuminuria,DR gradually increased.Among the three groups grouped by NFS,the prevalence rates of eGFR<60(ml/min/1.73 m~2),albuminuria and DR in the low-fibrosis group were 0.2%,24.0%and 31.1%,while those in the intermediate group were 1.8%,26.1%and 41.9%,respectively.In the high fibrosis group,it was 6.4%,37.7%and 57.6%,respectively,and the difference was statistically significant(P<0.05).Further multiple comparisons after the event showed that the prevalence of eGFR<60(ml/min/1.73 m~2)and DR in the intermediate group was higher than that in the low-fibrosis group but lower than that in the high-fibrosis group,and only the prevalence of albuminuria in the highfibrosis group was higher than that in the intermediate group,and there was no statistical significance between the prevalence of albuminuria in the intermediate group and the low-fibrosis group(P>0.05).In the two groups grouped with FIB-4,the prevalence of eGFR<60(ml/min/1.73 m~2),albuminuria and DR in the high fibrosis group was higher than that in the low fibrosis group(2.8%,29.3%,47.6%VS 1.3%,25.0%,36.5%),and the difference was statistically significant(P<0.05).(3)Binary logistic regression analysis showed that NFS was an independent risk factor for DKD and DR after adjusting for confounding factors(OR=1.133,95%CI:1.035-1.239,P=0.007;OR=1.177,95%CI:1.089-1.273,P=0.007).The risk of DKD increased by 15.3%and 20.3%for every 1 increased inNFS in people with insulin resistance and overweight(OR=1.153,95%CI:1.053-1.261,P=0.002;OR=1.203,95%CI:1.070-1.353,P=0.002);In overweight and obese people,the risk of DR increased by 41.2%and 29.2%for every increase of NFS(OR=1.412,95%CI:1.2631.579,P=0.000;OR=1.292,95%CI:1.119-1.491,P=0.000).(4)After adjusting for confounders,compared with the low fibrosis group,the intermediate group increased the risk of DR(OR=1.492,95%CI:1.189-1.879,P=0.000)and did not increase the risk of DKD(OR=1.079,95%CI:0.836-1.394,P=0.559),and the high fibrosis group increased the risk of both DKD and DR(OR=1.687,95%CI:1.201-2.368,P=0.003;OR=2.462,95%CI:1.809-3.352,P=0.000).(5)The effect of FIB-4 on DKD and DR was not a risk factor.Conclusion(1)The prevalence of MAFLD in type 2 diabetes mellitus is higher in this study.(2)NFS is a risk factor for DKD and DR in type 2 diabetes patients with MAFLD.The risk of DR increases with the degree of liver fibrosis,and high fibrosis increases the risk of DKD.(3)FIB-4 is not a risk factor for DKD and DR in type 2 diabetes patients with MAFLD.