摘要： 目的 探讨血小板/白细胞比值(PWR)在2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者肝纤维化进展中的作用。方法 选取2018年7月至2020年11月就诊于中国医科大学附属第四医院内分泌代谢内科的T2DM患者440例,并将其分为单纯T2DM组(120例)和T2DM合并NAFLD组(320例);将T2DM合并NAFLD组根据NAFLD纤维化评分(NFS)分为T2DM+F0(除外肝纤维化亚组NFS<-1.455,120例),T2DM+F1(可疑肝纤维化亚组-1.455≤NFS<0.676,120例),T2DM+F2(肝纤维化亚组NFS≥0.676,80例)3个亚组,其中,F0表示无肝纤维化,F1表示可疑肝纤维化,F2表示肝纤维化。收集患者一般临床资料并根据外周血化验结果计算PWR、单核细胞与高密度脂蛋白比值(MHR)等数值,采用SPSS 25.0软件统计分析PWR与T2DM患者NAFLD肝纤维化进展的相关性,采用受试者工作特征(ROC)曲线分析PWR在预测肝纤维化进展过程中的临床价值。结果 MHR(OR=0.757,95% CI:1.272~3.571; P=0.004)是T2DM患者发生NAFLD的危险因素。PWR与T2DM合并NAFLD肝纤维化进展呈负相关(OR=-0.893,95% CI:0.266~0.632; P < 0.001)。PWR可较好地预测T2DM合并NAFLD患者肝纤维化的发生风险,ROC曲线下面积为0.874,最佳截断值为28.61,灵敏度为78.8%,特异度为83.3%。结论 PWR可作为T2DM合并NAFLD患者肝纤维化进展的预测指标。

血小板/白细胞比值与2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化进展的相关性

韩孟冉, 张晨钰, 杜岑, 都健, 敖娜

中国医科大学附属第四医院内分泌代谢内科, 沈阳 110032

收稿日期:2021-12-09出版日期:2022-06-30发布日期:2022-06-09
通讯作者:敖娜E-mail:bingxue3058@126.com
作者简介:韩孟冉(1993-),女,医师,硕士.
基金资助:中国博士后科学基金(2020M670096ZX)


关键词: 非酒精性脂肪性肝病, 2型糖尿病, 血小板/白细胞比值
Abstract: Objective To explore the correlation between platelet-to-white blood cell ratio(PWR)and the progression of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM). Methods Overall,440 T2DM patients were enrolled in this study. The subjects were divided into the simple T2DM group(n=120)and the T2DM combined with NAFLD group(n=320). The T2DM combined with NAFLD group was divided into three subgroups according to the NAFLD fibrosis score(NFS). T2DM+F0(excluding liver fibrosis subgroup NFS<-1.455)120 cases; T2DM+F1(suspected liver fibrosis subgroup -1.455 ≤ NFS<0.676)120 cases,and T2DM+F2(liver fibrosis subgroup NFS ≥ 0.676)80 cases. The patients' general clinical data were collected,and the PWR,monocyte/high-density lipoprotein ratio(MHR),and other values were based on the results of peripheral blood tests. SPSS 25.0 software was used to statistically analyze the correlation between PWR and the progression of NAFLD liver fibrosis in T2DM patients. Receiver operating characteristic (ROC) curve analyses were used to assess the clinical value of PWR in predicting the progression of liver fibrosis. Results MHR(OR=0.757,95%CI:1.272-3.571; P=0.004)is a risk factor of NAFLD in patients with T2DM. PWR was negatively correlated with T2DM combined with NAFLD liver fibrosis progression(OR=-0.893,95%CI:0.266-0.632; P < 0.001). The PWR can thus better predict the risk of liver fibrosis in patients with T2DM and NAFLD. The area under the ROC curve was 0.874,the best cutoff value was 28.61,the sensitivity was 78.8%,and the specificity was 83.3%. Conclusion PWR can be used as a predictor of liver fibrosis progression in patients with concurrent T2DM and NAFLD.
Key words: non-alcoholic fatty liver disease, type 2 diabetes, platelet to white blood cell ratio
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