The Clinical Characteristics And Risk Factors Of Type 2 Diabetes Mellitus Patients With Non-alcoholic Fatty Liver Disease

Objective:The clinical characteristics of type 2 diabetes mellitus（T2DM）with nonalcoholic fatty liver disease（NAFLD）were analyzed,the possible risk factors were discussed,and a prediction model was established to provide reference for early prevention,early diagnosis and treatment of NAFLD.Methods:The data of 650 patients with T2DM admitted to the first hospital of lanzhou university from December 2018 to December 2019 were divided into two groups for the study.The NAFLD group included 325 patients with NAFLD and the non-NAFLD group included 325 patients without NAFLD in the same period.Comparative analysis of two groups of patients with clinical features including demographic data,the general history,past medical history,family history,laboratory examination,OGTT and insulin and C peptide release test,diabetic chronic complications and so on,select independent risk factors associated with NAFLD and establish the forecast model,through draw ROC curve evaluation model predictive value.Results:1.Patients in the NAFLD group were often younger,had a short course of diabetes and were prone to cardiovascular and cerebrovascular accidents.BMI increased significantly,and overweight and obese patients were more.Obviously increase the cost of hospitalization and increase the medical burden;TG,TC,LDL-C and other non-high-density lipoprotein cholesterol were associated with NAFLD.Significantly higher ALB level is also a risk factor for NAFLD formation.FOL and Vit B₁₂ levels decreased significantly,while high levels of Vit B₁₂ reduced the risk of NAFLD formation.The level of HbA1c was significantly increased,and the blood glucose was more disordered after the glucose tolerance test.The sensitivity of insulin is low,IR is more significant.Serum GGT level was related to the severity of the disease.The more severe NAFLD was,the higher blood GGT level was.The dyslipidemia and IR of patients with moderate and severe NAFLD were more significant than those with mild NAFLD.2.Age,Vit B₁₂,and duration of diabetes mellitus were protective factors associated with the development of NAFLD.BMI,TG,ALB,history of cardiovascular and cerebrovascular diseases,2hPG,LDL-C,HOMA-IR and TC are independent risk factors related to the occurrence of diseases.3.Independent risk factors and protective factors were used to obtain the regression equation to predict the risk score of NAFLD:Logit（P）=-7.555+1.169×BMI₁（24-28）+2.210×BMI₂（>28）+0.344×TG-0.093×duration of diabetes+0.127×ALB+1.651×history of cardiovascular and cerebrovascular diseases-0.028×age-0.001×Vit B₁₂+0.086×2hPG+0.023×LDL-C+0.132×HOMA-IR+0.344×TC.The area under the ROC curve of this prediction model was 0.898（95%CI 0.874-0.922,P<0.000）,the maximum value of Jordan index was 0.668,the corresponding cut-off point was 0.404,the corresponding sensitivity was 89.5%,specificity was 77.2%,positive likelihood ratio was 3.925,negative likelihood ratio was 0.136.It shows that this multi-factor prediction model is of high value in predicting the occurrence of NAFLD,which has great application value in clinical work and can provide references for clinicians.Conclusion:1.NAFLD is more likely to occur in young patients with T2DM who have a short course of diabetes and a large BMI.When the combination occurs,the patients have a high index of transaminase,a more significant disorder of lipid metabolism in the body,a lower sensitivity of insulin,a more obvious IR,and a higher blood sugar level,which is prone to cardiovascular and cerebrovascular diseases.2.BMI,TG,ALB,history of cardiovascular and cerebrovascular diseases,2hPG,LDL-C,HOMA-IR and TC were independent risk factors associated with the development of NAFLD;Age,Vit B₁₂,and duration of diabetes mellitus are protective factors associated with the development of NAFLD.The prediction model based on these parameters has good prediction value.