| 陈军.硫氧还蛋白相互作用蛋白联合瞬时弹性成像技术对2型糖尿病伴NAFLD肝纤维化的诊断价值[J].浙江中西医结合杂志,2021,31(10): |
| 硫氧还蛋白相互作用蛋白联合瞬时弹性成像技术对2型糖尿病伴NAFLD肝纤维化的诊断价值 |
| Diagnostic value of thioredoxin interacting protein combined with transient elastography in type 2 diabetes mellitus with NAFLD hepatic fibrosis |
| 投稿时间：2021-01-07 修订日期：2021-09-07 |
| DOI： |
| 中文关键词: 【关键词】硫氧还蛋白相互作用蛋白 瞬时弹性成像技术 2型糖尿病 非酒精性脂肪性肝病 肝纤维化 |
| 英文关键词:Key words:Thioredoxin interacting protein transient elastography type 2 diabetes mellitus nonalcoholic fatty liver disease liver fibrosis |
| 基金项目:浙江省医药卫生科技计划项目,2020KY770 |
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| 中文摘要: |
| 【摘要】目的：探讨硫氧还蛋白相互作用蛋白(TXNIP)联合瞬时弹性成像(Fibrotouch)技术对2型糖尿病伴非酒精性脂肪性肝病(NAFLD)肝纤维化的诊断价值。方法：收集2017年6月至2019年6月于我院收治的172例2型糖尿病合并NAFLD肝纤维化患者，基于肝脏瞬时弹性成像技术，根据肝脏硬度值（LSM）值的不同分为非显著肝纤维化（LSM＜13.9kPa）A组和显著肝纤维化（LSM≥13.9kPa）B组，各86例，对两组患者的TXNIP水平进行比较。采用ROC曲线检测TXNIP联合瞬时弹性成像技术对2型糖尿病伴NAFLD肝纤维化的诊断意义。结果：B组患者TXNIP、LSM和LDL-c值显著高于A组，差异均具有统计学意义(P<0.05)；两组性别、年龄、BMI、TG、TC、HDL-c、HbA1c、HOMA-IR比较，差异均无统计学意义(P>0.05)。Pearson相关分析显示，血清TXNIP与年龄( r = 0.42，P = 0.13)、性别( r = 0.37，P = 0.21)、BMI ( r = 0.26，P = 0.37)、HDL-c(r = 0.30， P = 0.26)、TG(r = 0.45，P = 0.11)、TC( r = 0.53，P = 0.24) 、HbA1c ( r = 039，P = 0.10)无相关性，而与 LDL-c(r = 0.24，P = 0.008 )、HOMA-IR( r = 0.23，P = 0.00)、LSM ( r = 0.18，P = 0.017)呈正相关。以TXNIP为因变量，以LDL-c、HOMA-IR、LSM为自变量，进行多元逐步回归分析，结果显示HOMA-IR、LSM与TXNIP独立相关，回归方程?=0.42+0.02XLSM +0.01XHOMA-IR(P<0.05)， 提示HOMA-IR、LSM是TXNIP水平的独立影响因素。以2型糖尿病伴NAFLD肝纤维化为因变量， 以TXNIP、LSM、HOMA-IR为自变量，进行Logistic回归分析，然后以预测概率做ROC曲线，得到TXNIP、LSM、HOMA-IR联合诊断2型糖尿病伴NAFLD肝纤维化的敏感度和特异度达到93%和72%。结论：采用TXNIP联合Fibrotouch技术作为2型糖尿病伴NAFLD肝纤维化患者的早期诊断指标和方法，有利于对病人的病情进行综合分析判断，并且能够比较客观地反映疾病的进展情况，及时有效地对患者进行早期干预，值得临床推荐应用。 |
| 英文摘要: |
| Abstract Objective:To investigate the value of TXNIP combined with fibrotouch in the diagnosis of liver fibrosis in type 2 diabetes mellitus with nonalcoholic fatty liver disease (NAFLD). Methods:172 patients with type 2 diabetes mellitus and NAFLD liver fibrosis admitted to our hospital from June 2017 to June 2019 were divided into non significant liver fibrosi(LSM < 13.9kpa) group A and significant liver fibrosiss (LSM ≥ 13.9kpa) group B according to different liver hardness (LSM) values based on the liver transient elastic imaging technology. The TXNIP levels of the two groups were compared. The significance of TXNIP combined with transient elastography in the diagnosis of type 2 diabetes mellitus with NAFLD fibrosis was detected by ROC curve.Results:The TXNIP, LSM and LDL-C values in group B were significantly higher than those in group A (P < 0.05); there was no significant difference in gender, age, BMI, TG, TC, HDL-C, HbA1c and HOMA-IR between the two groups (P > 0.05). Pearson correlation analysis showed that serum txnipp was not associated with age (r = 0.42, P = 0.13), gender (r = 0.37, P = 0.21), BMI (r = 0.26, P = 0.37), HDL-C (r = 0.30, P = 0.26, P = 0.30, P = 0.26), TG (r = 0.45, P = 0.11, P = 0.11), TC (r = 0.53, P = 0.53, P = 0.24, P = 0.24), HbA1c (r = 039, P = 0.10), but was not associated with LDL-C (r = 0.24, P = 0.008), homa- IR (R = 0.0.23, P = 0.0.23, P = 0.008), homa- IR (R P = 0.00), LSM (r = 0.18, P= 0.017). With TXNIP as the dependent variable and LDL-C, HOMA-IR and LSM as the independent variables, the results showed that HOMA-IR and LSM were independently correlated with TXNIP. The regression equation ? = 0.42 + 0.02xlsm + 0.01xhoma-ir (P < 0.05) suggested that HOMA-IR and LSM were independent factors of TXNIP. The sensitivity and specificity of TXNIP, LSM and HOMA-IR were 93% and 72%, respectively.Conclusion:Using TXNIP and fibrotouch technology as the early diagnosis index and method of patients with type 2 diabetes mellitus and NAFLD liver fibrosis is conducive to the comprehensive analysis and judgment of patients' condition, and can objectively reflect the progress of the disease, timely and effective early intervention for patients, which is worthy of clinical recommendation. |
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