标题：2型糖尿病患者EGR1、UACR及CMI指数与非酒精性脂肪性肝病的关系

      作者：金婷 1，曹含弘 2，张斌 1，朱薇珊 1    复旦大学附属中山医院青浦分院感染科 1、内分泌科 2，上海 201700

      卷次： 2021年32卷23期

      【摘要】 目的 探究2型糖尿病(T2DM)患者早期生长反应因子1 (EGR1)、微量白蛋白与尿肌酐比值(UACR)及心脏代谢指数(CMI)与非酒精性脂肪性肝病(NAFLD)的关系。方法 回顾性分析2019年1月至2021年1月复旦大学附属中山医院青浦分院收治的106例T2DM患者的临床资料，根据是否发生NAFLD分为NAFLD组72例和无NAFLD组 34例。NAFLD组患者根据病情严重程度分为轻度组(28例)、中度组(23例)和重度组(21例)。比较NAFLD组和无NAFLD组、NAFLD组各亚组患者的EGR1、UACR、CMI水平，采用 Spearman相关性分析EGR1、UACR及CMI与NAFLD程度的关系，采用受试者工作特征(ROC)曲线分析EGR1、UACR及CMI对NAFLD的预测价值。结果 无NAFLD组和NAFLD组患者的性别、年龄比较差异均无统计学意义(P>0.05)，但病程、体质量指数(BMI)、空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、胰岛素抵抗指数(HOMA-IR)比较差异均有统计学意义(P<0.05)；NAFLD组患者的 EGR1、UACR及 CMI水平分别为 (3.15±1.04) ng/mL、[41.30 (20.75，77.84)] mg/g、3.526(0.737，5.868)，明显高于无NAFLD组的(1.65±0.17) ng/mL、[14.18 (9.54，21.47)] mg/g、0.464 (0.123，1.285)，差异均有统计学意义(P<0.05)；重度组患者的EGR1、UACR及CMI水平高于中度组，中度组高于轻度亚组，差异均有统计学意义(P<0.05)；经Spearman相关性分析结果显示，EGR1、UACR及CMI与NAFLD程度呈正相关(P<0.05)；ROC曲线分析结果显示，EGR1、UACR、CMI早期预测NAFLD的AUC分别为 0.972、0.831、0.815，EGR1的AUC显著高于UACR、CMI (Z=3.482、3.705 8，P<0.05)；且以EGR1>1.83 ng/mL为临界值，预测NAFLD的敏感度为95.8%，特异度为91.2%；以UACR>32.02 mg/g为临界值，预测NAFLD的敏感度为62.5%，特异度为97.1%；以CMI>1.58为临界值，预测NAFLD的敏感度为63.9%，特异度为97.1%。结论 EGR1、UACR、CMI与NAFLD程度呈正相关，且对T2DM患者发生NAFLD的预测价值较高，EGR1相对而言预测价值最高。
      【关键词】 2型糖尿病；早期生长反应因子1；微量白蛋白与尿肌酐比值；心脏代谢指数；非酒精性脂肪性肝病
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2021）23—3003—05

Association of EGR1, UACR and CMI with non-alcoholic fatty liver disease in type 2 diabetic patients.
JIN Ting 1,CAO Han-hong 2, ZHANG Bin 1, ZHU Wei-shan 1. Department of Infectious Disease 1, Department of Endocrinology 2,Qingpu Branch, Zhongshan Hospital Affiliated to Fudan University, Shanghai 201700, CHINA
【Abstract】 Objective To investigate the relationship between early growth response factor 1 (EGR1), urine al-bumin-to-creatinine ratio (UACR) and cardiometabolic index (CMI) and nonalcoholic fatty liver disease (NAFLD) in pa-tients with type 2 diabetes mellitus (T2DM). Methods The clinical data of 106 patients with T2DM admitted to Qing-pu Branch, Zhongshan Hospital Affiliated to Fudan University from January 2019 to January 2021 were retrospectivelyanalyzed. The patients were divided into 72 cases in the NAFLD group and 34 cases in the no-NAFLD group accordingto whether NAFLD occurred. The patients in the NAFLD group were divided into mild (28 cases), moderate (23 cases)and severe (21 cases) subgroups according to the severity of their disease. The levels of EGR1, UACR and CMI werecompared between the NAFLD group and the no-NAFLD group, and each subgroup of patients in the NAFLD group.The relationship between EGR1, UACR and CMI and the degree of NAFLD was analyzed by spearman correlation, andthe predictive value of EGR1, UACR and CMI for NAFLD was analyzed by receiver operating characteristic (ROC)curves. Results No statistically significant differences were found in the comparison of gender and age between pa-tients in the no-NAFLD group and NAFLD group (P>0.05), but the differences were statistically significant in the com-parison of disease duration, BMI, FPG, TG, TC, and HOMA-IR (all P<0.05); the levels of EGR1, UACR, and CMI inthe NAFLD group were (3.15 ± 1.04) ng/mL, [41.30 (20.75, 77.84)] mg/g, 3.526 (0.737, 5.868), respectively, in theNAFLD group, which were significantly higher than corresponding (1.65 ± 0.17) ng/mL, [14.18 (9.54, 21.47)] mg/g,0.464 (0.123, 1.285) in the no-NAFLD group (P<0.05); the levels of EGR1, UACR and CMI were higher in the severesubgroup than in the moderate subgroup and also in the moderate subgroup than in the mild subgroup, and the differenc-es were statistically significant (all P<0.05). The results of correlation analysis showed that EGR1, UACR and CMI werepositively correlated with the degree of NAFLD (P<0.05); the results of ROC curve analysis showed that the AUCs ofEGR1, UACR and CMI for early prediction of NAFLD were 0.972, 0.831 and 0.815, respectively, and the AUCs ofEGR1 were significantly higher than those of UACR and CMI (Z=3.482, 3.705 8, P<0.05); and the sensitivity of predict-