| Objective:Nonalcoholic fatty liver disease(NAFLD)can progress from simple steatosis to nonalcoholic steatohepatitis(NASH),and further to liver fibrosis and hepatocellular carcinoma.Many studies have shown that type 2 diabetes mellitus(T2DM)can aggravate the course of NAFLD and double the risk of disease progression.The purpose of this study was to explore the risk factors and establish a predictive modelof nonalcoholic fatty liver disease in elderly patients with type 2 diabetes mellitus.Methods:A total of 1174 elderly patients with T2DM admitted to The Affiliated Hospital of Qingdao University from January 2015 to June 2019 were retrospectively analyzed.According to the development of NAFLD by abdominal ultrasound,they were divided into two groups,Non-NAFLD(599 T2DM patients without NAFLD)and NAFLD group(575 T2DM patients with NAFLD).The medical data platform and electronic medical record was used to retrospectively collect the data of all patients,including demographic data,laboratory examination,imaging data,etc.Univariate analysis was used to compare the data between the two groups.Data with statistically significant were included in the multivariate logistic regression analysis to screen out the independent risk factors related to NAFLD in elderly patients with type 2 diabetes.The diagnostic value of the predictive model was evaluated by receiver operating characteristic(ROC)curve.Results: The prevalence of NAFLD was 49% in the elderly patients with T2DM.Compared with the Non-NAFLD group,the proportion of women in NAFLD group was higher,waist circumference and body mass index(BMI)were increased,the proportion of overweight patients was significantly increased,and the prevalence of blood lipid and blood glucose metabolism disorder and metabolic syndrome were significantlyincreased.Waist circumference was closely related to the severity of fatty liver.Uric acid,alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT)and C-reactive protein were significantly increased in patients with severe fatty liver.Multivariate logistic regression analysis showed that fasting C-peptide(OR=1.354;95% CI=1.135-1.616;P=0.001),female patients(OR=2.064;95% CI=1.302-3.273;P= 0.002),overweight(OR=1.521;95% CI=1.032-2.241;P=0.034),obesity(OR =3.135;95% CI=1.942-5.509;P<0.001),triglyceride(OR=1.584;95% CI=1.227-2.045;P<0.001),uric acid(OR=1.003;95% CI=1.001-1.005;P=0.012),hemoglobin(OR=1.026;95% CI=1.012-1.041;P<0.001),albumin(OR=1.009;95%CI=1.039-1.162;P=0.001),metabolic syndrome(OR=1.634;95% CI=1.090-2.451;P=0.018)were the risk factors for elderly T2DM.High density lipoprotein cholesterol(OR=0.383;95% CI=0.188-0.781;P=0.008),serum potassium(OR=0.548;95% CI=0.328-0.916;P=0.022)were independent risk factors for NAFLD.According to the independent risk factors and protective factors,the probability regression equation was established to predict the occurrence of NAFLD.The maximum value of Jordan index was0.507,cut-off value was 0.438,sensitivity was 81.0%,specificity was 69.7%.Conclusion:1.The incidence of NAFLD in elderly patients with T2DM is 49.0%.2.Female gender,fasting C-peptide,overweight or obesity,triglyceride,uric acid,hemoglobin,albuminand metabolic syndrome were the independent risk factors of NAFLD;high density lipoprotein cholesteroland potassium were the protective factors of NAFLD.3.The predictive model based on the risk factors and protective factors has good distinguishing ability,and can provide reference value for clinicians. |
