CAJ | 학술논문

目的：以肝肾回声比值预测肝脏脂肪含量，探讨2型糖尿病（T2DM）患者肝脏脂肪含量与血清学指标的相关性。方法收集2011年1月至2012年9月青岛大学附属医院就诊的T2DM患者120例。所有患者均行常规超声检查，获取肝右肾矢状切面图，利用NIHimage图像分析软件计算肝肾回声比值；于超声检查后24 h内检测受试者相关血清学指标。采用Spearman秩相关分析法分析T2DM患者肝肾回声比值与血清学指标的相关性；以肝肾回声比值为因变量，三酰甘油（TG，X1）、总胆固醇（TC，X2）、高密度脂蛋白胆固醇（HDL-C，X3）、低密度脂蛋白胆固醇（LDL-C，X4）、丙氨酸氨基转移酶（ALT，X5）、天冬氨酸氨基转移酶（AST，X6）、γ-谷氨酰转移酶（γ-GT，X7）、碱性磷酸酶（ALP，X8）浓度为自变量作多元线性回归分析，分析T2DM患者肝肾回声比值的影响因素；绘制肝肾回声比值诊断T2DM患者TG浓度增高（＞1.92 mmol/L）的操作者工作特性（ROC）曲线。结果 T2DM患者肝肾回声比值与TG、AST、ALT、γ-GT浓度均呈正相关（r=0.420，P=0.000；r=0.383，P=0.000；r=0.309，P=0.001；r=0.253，P=0.005），与糖化血红蛋白、TC、HDL-C、LDL-C、ALP、血尿酸浓度均无相关性（r=0.0.067，P=0.368；r=0.145，P=0.115；r=-0.148，P=0.106；r=0.002，P=0.986；r=0.160，P=0.081；r=0.064，P=0.489）；仅TG浓度（X1）与T2MD患者肝肾回声比值有线性回归关系，回归方程为：Y=1.245+0.062X1；ROC曲线显示，肝肾回声比值诊断T2DM患者TG浓度增高（＞1.92 mmol/L）的最佳界值为1.236，曲线下面积为0.677，敏感度为86.7%，特异度为45.3%。结论肝肾回声比值可作为预测肝脏脂肪含量的可靠指标；T2DM患者肝脏脂肪含量与TG、ALT、AST、γ-GT浓度具有相关性；TG浓度的升高可反映T2MD患者肝脏内脂肪含量的增加，且肝肾回声比值达到1.236时T2MD患者TG浓度易出现异常。目的：以肝腎迴聲比值預測肝髒脂肪含量，探討2型糖尿病（T2DM）患者肝髒脂肪含量與血清學指標的相關性。方法收集2011年1月至2012年9月青島大學附屬醫院就診的T2DM患者120例。所有患者均行常規超聲檢查，穫取肝右腎矢狀切麵圖，利用NIHimage圖像分析軟件計算肝腎迴聲比值；于超聲檢查後24 h內檢測受試者相關血清學指標。採用Spearman秩相關分析法分析T2DM患者肝腎迴聲比值與血清學指標的相關性；以肝腎迴聲比值為因變量，三酰甘油（TG，X1）、總膽固醇（TC，X2）、高密度脂蛋白膽固醇（HDL-C，X3）、低密度脂蛋白膽固醇（LDL-C，X4）、丙氨痠氨基轉移酶（ALT，X5）、天鼕氨痠氨基轉移酶（AST，X6）、γ-穀氨酰轉移酶（γ-GT，X7）、堿性燐痠酶（ALP，X8）濃度為自變量作多元線性迴歸分析，分析T2DM患者肝腎迴聲比值的影響因素；繪製肝腎迴聲比值診斷T2DM患者TG濃度增高（＞1.92 mmol/L）的操作者工作特性（ROC）麯線。結果 T2DM患者肝腎迴聲比值與TG、AST、ALT、γ-GT濃度均呈正相關（r=0.420，P=0.000；r=0.383，P=0.000；r=0.309，P=0.001；r=0.253，P=0.005），與糖化血紅蛋白、TC、HDL-C、LDL-C、ALP、血尿痠濃度均無相關性（r=0.0.067，P=0.368；r=0.145，P=0.115；r=-0.148，P=0.106；r=0.002，P=0.986；r=0.160，P=0.081；r=0.064，P=0.489）；僅TG濃度（X1）與T2MD患者肝腎迴聲比值有線性迴歸關繫，迴歸方程為：Y=1.245+0.062X1；ROC麯線顯示，肝腎迴聲比值診斷T2DM患者TG濃度增高（＞1.92 mmol/L）的最佳界值為1.236，麯線下麵積為0.677，敏感度為86.7%，特異度為45.3%。結論肝腎迴聲比值可作為預測肝髒脂肪含量的可靠指標；T2DM患者肝髒脂肪含量與TG、ALT、AST、γ-GT濃度具有相關性；TG濃度的升高可反映T2MD患者肝髒內脂肪含量的增加，且肝腎迴聲比值達到1.236時T2MD患者TG濃度易齣現異常。
목적：이간신회성비치예측간장지방함량，탐토2형당뇨병（T2DM）환자간장지방함량여혈청학지표적상관성。방법수집2011년1월지2012년9월청도대학부속의원취진적T2DM환자120례。소유환자균행상규초성검사，획취간우신시상절면도，이용NIHimage도상분석연건계산간신회성비치；우초성검사후24 h내검측수시자상관혈청학지표。채용Spearman질상관분석법분석T2DM환자간신회성비치여혈청학지표적상관성；이간신회성비치위인변량，삼선감유（TG，X1）、총담고순（TC，X2）、고밀도지단백담고순（HDL-C，X3）、저밀도지단백담고순（LDL-C，X4）、병안산안기전이매（ALT，X5）、천동안산안기전이매（AST，X6）、γ-곡안선전이매（γ-GT，X7）、감성린산매（ALP，X8）농도위자변량작다원선성회귀분석，분석T2DM환자간신회성비치적영향인소；회제간신회성비치진단T2DM환자TG농도증고（＞1.92 mmol/L）적조작자공작특성（ROC）곡선。결과 T2DM환자간신회성비치여TG、AST、ALT、γ-GT농도균정정상관（r=0.420，P=0.000；r=0.383，P=0.000；r=0.309，P=0.001；r=0.253，P=0.005），여당화혈홍단백、TC、HDL-C、LDL-C、ALP、혈뇨산농도균무상관성（r=0.0.067，P=0.368；r=0.145，P=0.115；r=-0.148，P=0.106；r=0.002，P=0.986；r=0.160，P=0.081；r=0.064，P=0.489）；부TG농도（X1）여T2MD환자간신회성비치유선성회귀관계，회귀방정위：Y=1.245+0.062X1；ROC곡선현시，간신회성비치진단T2DM환자TG농도증고（＞1.92 mmol/L）적최가계치위1.236，곡선하면적위0.677，민감도위86.7%，특이도위45.3%。결론간신회성비치가작위예측간장지방함량적가고지표；T2DM환자간장지방함량여TG、ALT、AST、γ-GT농도구유상관성；TG농도적승고가반영T2MD환자간장내지방함량적증가，차간신회성비치체도1.236시T2MD환자TG농도역출현이상。
ObjectiveTo explore the relationship between serum markers and liver fat content predicted by hepatorenal ratio in type 2 diabetic mellitus (T2DM) patients.Methods A total of 120 T2DM patients were recruited from January 2011 to September 2012 in the Affi liated Hospital of Qingdao University. The sagittal liver-right kidney diagrams of the patients were obtained by two-dimensional ultrasonic examination, and the hepatorenal ratio were analyzed by NIHimage. Then, the related serum markers were tested 24 hours later. The relationship between hepatorenal ratio and serum markers was analyzed by Spearman rank correlation on the patients of T2DM. Then, the affective factors on the hepatorenal ratio were analysed by multivariate linear regression analysis, with hepatorenal ratio as dependent variable, and the concentration of triglyceride (TG,X1) , total cholesterol (TC,X2), high density lipoprotein cholesterol (HDL-C,X3), low density lipoprotein cholesterol (LDL-C,X4), alanine aminotransferase (ALT,X5), aspartateaminotransferase (AST,X6), glutamyltransferase (γ-GT,X7) , and alkaline phosphatase (ALP,X8) as independent variables. The receiver operating characteristic curve (ROC) was drawn to diagnose the point of the hepatorenal ratio when the TG began to increase (>1.92 mmol/L).Results There was positive correlation between hepatorenal ratio and TG, AST, ALT,γ-GT (r=0.420,P=0.000;r=0.383,P=0.000;r=0.309,P=0.001;r=0.253,P=0.005), while no correlation between hepatorenal ratio and glycosylated hemoglobin, TC, HDL-C, LDL-C, ALP or blood uric acid (BUA) (r=0.0.067,P=0.368;r=0.145,P=0.115;r=?-0.148,P=0.106;r=0.002,P=0.986;r=0.160,P=0.081;r=0.064,P=0.489) were found; the linear regression analysis showed that TG level (X1) was the only markers which had correlation with hepatorenal ratio in the T2MD patients with the regression equation ofY=1.245+0.062X. The ROC curve analysis showed that the optimal cutoff value for hepatorenal ratio to in diagnosinge increased TG (>1.92 mmol/L) was 1.236 in T2DM patients, and the area under the curve was 0.677. The sensitivity and specifi city were 86.7% and 45.3% respectively. Conclusions Hepatorenal ratio can be a reliable indicator to predict liver fat content, which has correlation with TG, ALT, AST andγ-GT. The increased TG level can refl ect the increasing fat content in the liver, and TG begin to increase when the hepatorenal ratio reach 1.236.