Risk Factor Analysis Of Liver Fibrosis In Patients With Type 2 Diabetes Mellitus Combined With Nonalcoholic Fatty Liver Disease

Purpose:Non-alcoholic fatty liver disease(NAFLD)and type 2 diabetes mellitus(T2DM)are frequently co-occurring diseases.Liver fibrosis(LF),with increasing incidence,has a prognostic value for NAFLD mortality.Our study aimed to investigate the relevant factors for LF in T2 DM individuals with NAFLD.Methods:A total of 565 T2 DM patients with NAFLD from Hebei General Hospital participated in the study.Patients underwent an abdominal ultrasound,a questionnaire and laboratory tests.The fibrosis-4 index(FIB-4)was used to evaluate LF,and LF was defined was FIB-4 ≥1.3.We also compared the aspartate aminotransferase-to-platelets ratio(APRI)and the nonalcoholic fatty liver disease fibrosis score(NFS)between the LF and non-LF groups.The clinical parameters of the LF group and non-LF group were compared.In addition,we performed a subgroup analysis according to the severity of LF and classified the LF components into F1-2(1.3 ≤ FIB-4 < 2.67)and F3-4(FIB-4 ≥ 2.67).Further investigation of the relevant factors for LF was conducted by correlation analysis and regression analysis.Results:1.General data and comparison of differences between groups:There was no significant difference between the two groups in terms of gender、DBP、BMI、duration of diabetes、TP、ALB、GLB、ALP、FBG、BUN、Scr、UA、TC、TG、HDL、HGB and HOMA-IR(p>0.05).Patients with LF had lower GFR、LDL、Hb Alc、and PLT than those without LF,and there was a statistical difference between the groups(p<0.05).Meanwhile,the age was older,and the levels of SBP、ALT、AST、GGT were higher in patients with LF compared to those without LF,and there was a statistical difference between the groups(p<0.05).Compared to the non-LF group,the other two LF scores,APRI and NFS in the LF group were higher,and there was a statistical difference between the groups(p<0.05).There were no difference was in the prevalence of obesity and hyperlipidemia between the LF and non-LF groups,while the proportion of hypertensive patients was higher in the LF group than that in the non-LF group,and there was a statistical difference between the groups(p<0.05).2.Comparison of Clinical Parameters in Patients with Different Degrees of LF :Based on the severity of LF patients,subgroup analysis was conducted to divide the LF group into F1-2(1.3 ≤ FIB-4<2.67)and F3-4(FIB-4 ≥2.67).ALT、AST and GGT in patients with F3-4 fibrosis were higher than those with F1-2 fibrosis,while platelet was lower,and there was a statistical difference between the groups(p<0.05).There were no group differences in terms of other clinical parameters.3.Spearman Correlation Analysis of the FIB-4 and Other Factors :FIB-4 was positively correlated with age、SBP、duration of diabetes、ALT、AST、GGT、APRI and NFS(p<0.05),while negatively correlated with GFR、TC、LDL and Hb A1 c.DBP、BMI、TP、GLB、ALP、BUN、Scr、UA、TG、HDL、FPG、HOMA-IR and HGB were not correlated with FIB-4.4.Logistic Regression Analysis of LF in T2 DM Patients Combined with NAFLD :LF was used as the dependent variable,with age、SBP、ALT、AST、GGT、GFR、LDL、PLT and Hb Alc as the independent variables.Age、SBP、ALT、GGT、LDL and PLT were all independently associated with LF in T2 DM patients with NAFLD according to the binary logistic regression analysis.The higher age、SBP、ALT and GGT are the risk factors of LF.Conclusion:1.Age、SBP、duration of diabetes、ALT、AST、GGT、APRI and NFS were positively correlated with FIB-4,while GFR、TC、LDL and Hb A1 c were negatively correlated with FIB-4.2.In patients with T2 DM combined with NAFLD,liver fibrosis was independently associated with patient age、SBP、ALT、GGT、LDL and PLT.The higher age、SBP、ALT and GGT are the risk factors of LF.