2型糖尿病合并非酒精性脂肪性肝病患者危险因素的Meta分析

目的 通过STATA/SE 12.0软件系统评价2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者的危险因素。方法 计算机检索EBSCO、PubMed、Web of Science、CNKI、Wanfang数据库文献,检索时间为建库至2021年08月17日,由两名研究员依据预先制定的纳入标准及排除标准独立筛选病例对照研究文献、提取数据和质量评价后,进行Meta分析。结果 最终纳入可用研究文献67篇,研究对象20 688例。暴露因素中身体质量指数WMD=2.91,95%CI(2.65～3.16)]、甘油三酯WMD=1.02,95%CI(0.92～1.11)]、总胆固醇WMD=0.73,95%CI(0.55～0.91)]、低密度脂蛋白WMD=0.67,95%CI(0.51～0.82)]、同型半胱氨酸WMD=3.01,95%CI(1.69～4.34)]等是与脂代谢相关的危险因素; 糖化血红蛋白WMD=1.23,95%CI(0.91～1.54)]、空腹胰岛素SMD=0.57,95%CI(0.43～0.71)]、空腹C肽SMD=0.96,95%CI(0.76～1.16)]、胰岛素抵抗指数SMD=0.89,95%CI(0.69～1.08)等是与糖代谢相关的危险因素; 天门冬氨酸氨基转移酶WMD=5.74,95%CI(4.85～6.64)]、丙氨酸氨基转移酶WMD=11.29,95%CI(9.60～12.99)]等是与肝功能相关的危险因素; 铁蛋白WMD=56.26,95%CI(38.11～74.42)]、中性粒/淋巴细胞WMD=0.27,95%CI(0.09～0.45)]等是与炎性反应相关的危险因素; 高密度脂蛋白WMD=-0.18,95%CI(-0.22～-0.15)]、年龄WMD=-7.66,95%CI(-9.24～-6.09)]、脂联素WMD=-4.45,95%CI(-5.38～-3.52)]是2型糖尿病合并非酒精性脂肪性肝病的保护因素。结论 2型糖尿病合并非酒精性脂肪性肝病的危险因素包括肥胖、糖尿病、高脂血症、肝功能损伤、高尿酸,年龄、高密度脂蛋白、脂联素为2型糖尿病合并非酒精性脂肪性肝病的保护因素。

Meta-analysis of risk factors in patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease

Objective To evaluate the risk factors of patients with type 2 diabetes mellitus(T2DM)combined with non-alcoholic fatty liver disease(NAFLD)through the STATA/SE12.0 software system. Methods Computer search of EBSCO, PubMed, Web of Science, CNKI, Wanfang database documents was conducted, and the search time was from the establishment of the database to August 17, 2021. Two researchers independently screened case-control research documents based on pre-established inclusion and exclusion criteria. After data extraction and quality evaluation, meta-analysis was performed. Results With 67 available research literatures included and 20 688 subjects studied, exposure factors in BMI WMD=2.91, 95%CI (2.65-3.16)], TG WMD=1.02, 95%CI (0.92-1.11)], TC WMD=0.73, 95%CI (0.55-0.91)], LDL WMD=0.67, 95%CI (0.51-0.82)] and HCY WMD=3.01, 95%CI (1.69-4.34)] were risk factors related to lipid metabolism. HbA1c WMD=1.23, 95%CI (0.91-1.54)], FINS(SMD=0.57, 95%CI (0.43-0.71)], FCP SMD=0.96, 95%CI (0.76-1.16)], insulin resistance index SMD=0.89, 95%CI (0.69-1.08)] were risk factors related to glucose metabolism. AST WMD=5.74, 95%CI (4.85-6.64)] and ALT WMD=11.29, 95%CI (9.60-12.99)] were risk factors related to liver function. SF WMD=56.26, 95%CI (38.11-74.42)] and NLR WMD=0.27, 95%CI (0.09-0.45)] were risk factors associated with inflammatory response. HDL WMD=0.18, 95%CI (0.22-0.15)], age WMD=7.66, 95%CI (9.24-6.09)], and APN WMD=4.45, 95%CI (5.38-3.52)] were protective factors for type 2 diabetes with non-alcoholic fatty liver. Conclusion The risk factors for type 2 diabetes with non-alcoholic fatty liver disease include obesity, diabetes, hyperlipidemia, liver damage, high uric acid. Age, high-density lipoprotein, and adiponectin are protective factors of type 2 diabetes with non-alcoholic fatty liver disease.