Correlation of 25(OH)D and SUA/SCr with type 2 diabetes mellitus combined with non-alcoholic fatty liver disease

doi:10.3969/j.issn.1004-583X.2024.08.005

Abstract

Abstract:

Objective To explore the correlation of 25 hydroxyvitamin D [25(OH)D] level and serum uric acid and serum creatinine ratio (SUA/SCR) with type 2 diabetes mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD). Methods A cross-sectional study involving 404 T2DM patients admitted to the Department of Endocrinology and Metabolism, Three Gorges Hospital Affiliated to Chongqing University from January 1, 2022 to March 31, 2023. They were assigned into the combined group (T2DM combined with NAFLD, n=219) and simple group (T2DM, n=185) based on the comorbidity of NAFLD. Clinical data were collected to analyze the correlation of 25(OH)D and SUA/SCr with other clinical data. Logistic regression was performed to evaluate the risk factors of NAFLD. The receiver operating characteristic (ROC) curves were plooted to evaluate the predictive value of 25(OH)D and SUA/SCr in T2DM combined with NAFLD.Results Compared with those of the simple group, patients in the combined group showed significantly higher body weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), total cholesterol (TC), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), SUA, insulin resistance index, and SUA/SCr, but significantly lower age, disease duration, high-density lipoprotein cholesterol (HDL-C), and 25(OH)D (P<0.05). Spearman correlation analysis showed that 25(OH)D was negatively correlated with BMI and glycated hemoglobin (HbA₁c), and positively correlated with SCr. SUA/SCr was negatively correlated with age, disease duration, SBP and HDL-C, and positively correlated with low-density lipoprotein cholesterol (LDL-C), TG, TC, aspartate aminotransferase (AST), ALT, GGT, and insulin resistance index. Logistic regression analysis showed that SUA/SCr>4.64 and GGT were risk factors for NAFLD in T2DM patients, while disease duration and 25(OH)D were protective factors. ROC curves further suggested that 25(OH)D combined with SUA/SCr had a high value in predicting NALFD in T2DM patients. Conclusion Serum 25(OH)D level decreases in T2DM patients combined with NAFLD, while SUA/SCr increases. 25(OH)D combined with SUA/SCr has a predictive value in diagnosing NAFLD in T2DM patients.

Key words: diabetes mellitus, type 2, non-alcoholic fatty liver disease, 25-hydroxyvitamin D, the ratio of serum uric acid to serum creatinine (SUA/SCr)

CLC Number:

R587.1

Xiong Lu, Guo Lian. Correlation of 25(OH)D and SUA/SCr with type 2 diabetes mellitus combined with non-alcoholic fatty liver disease[J]. Clinical Focus, 2024, 39(8): 706-711.

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URL: http://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2024.08.005

http://www.lchc.cn/EN/Y2024/V39/I8/706

Figures/Tables 6

Tab.1 General and laboratory data between groups

项目	单纯组( $n$ =185)	合并组( $n$ =219)	$t$ /χ²值	$P$ 值
男性[例(%)]	94(50.8)	125(57.1)	1.59	0.21
年龄(岁)	61.16±11.78	57.06±14.11	3.89	<0.05
体重(kg)	60.00(52.00, 67.00)	68.00(60.00, 75.00)	7.24	<0.01
BMI(kg/m²)	23.15(21.48, 25.10)	25.69(23.53, 27.76)	7.41	<0.01
病程(年)	8.00(1.00, 12.00)	4.00(0.25, 10.00)	3.91	<0.01
收缩压(mmHg)	126.00(113.50, 138.00)	130.00(118.00, 142.00)	2.41	<0.05
舒张压(mmHg)	77.00(70.00, 88.00)	83.00(74.00, 90.00)	3.49	<0.01
HbA₁c(%)	9.52±2.47	9.74±2.23	4.79	0.35
LDL-C(mmol/L)	2.78(1.99, 3.41)	2.85(2.12, 3.54)	0.77	0.44
HDL-C(mmol/L)	1.26(1.06, 1.47)	1.05(0.82, 1.25)	6.26	<0.01
TC(mmol/L)	4.69(3.88, 5.40)	4.78(4.04, 5.83)	2.05	<0.05
TG(mmol/L)	1.55(1.12, 2.62)	2.34(1.57, 4.46)	6.50	<0.01
25(OH)D(ng/ml)	16.32(11.75, 23.34)	14.41(8.65, 19.60)	3.33	<0.01
AST(U/L)	17.00(13.35, 22.65)	17.50(13.80, 22.60)	0.62	0.53
ALT(U/L)	16.10(12.05, 24.25)	19.20(14.80, 24.60)	2.71	<0.01
GGT(U/L)	19.00(13.00, 31.50)	27.00(19.00, 45.00)	5.64	<0.01
FPG(mmol/L)	8.55(6.70, 11.11)	8.67(7.14, 11.73)	1.00	0.32
HOMA-IR	1.15(0.86, 1.56)	4.87(2.83, 9.84)	1.26	<0.01
SCr(μmol/L)	65.00(56.00, 82.00)	69.00(58.00, 83.00)	1.66	0.10
SUA(μmol/L)	242.00(203.00, 313.00)	338.00(279.00, 402.00)	9.28	<0.01
SUA/SCr	3.72(3.06, 4.58)	4.65(3.75, 5.73)	6.83	<0.01

Tab.1 General and laboratory data between groups

项目	单纯组( $n$ =185)	合并组( $n$ =219)	$t$ /χ²值	$P$ 值
男性[例(%)]	94(50.8)	125(57.1)	1.59	0.21
年龄(岁)	61.16±11.78	57.06±14.11	3.89	<0.05
体重(kg)	60.00(52.00, 67.00)	68.00(60.00, 75.00)	7.24	<0.01
BMI(kg/m²)	23.15(21.48, 25.10)	25.69(23.53, 27.76)	7.41	<0.01
病程(年)	8.00(1.00, 12.00)	4.00(0.25, 10.00)	3.91	<0.01
收缩压(mmHg)	126.00(113.50, 138.00)	130.00(118.00, 142.00)	2.41	<0.05
舒张压(mmHg)	77.00(70.00, 88.00)	83.00(74.00, 90.00)	3.49	<0.01
HbA₁c(%)	9.52±2.47	9.74±2.23	4.79	0.35
LDL-C(mmol/L)	2.78(1.99, 3.41)	2.85(2.12, 3.54)	0.77	0.44
HDL-C(mmol/L)	1.26(1.06, 1.47)	1.05(0.82, 1.25)	6.26	<0.01
TC(mmol/L)	4.69(3.88, 5.40)	4.78(4.04, 5.83)	2.05	<0.05
TG(mmol/L)	1.55(1.12, 2.62)	2.34(1.57, 4.46)	6.50	<0.01
25(OH)D(ng/ml)	16.32(11.75, 23.34)	14.41(8.65, 19.60)	3.33	<0.01
AST(U/L)	17.00(13.35, 22.65)	17.50(13.80, 22.60)	0.62	0.53
ALT(U/L)	16.10(12.05, 24.25)	19.20(14.80, 24.60)	2.71	<0.01
GGT(U/L)	19.00(13.00, 31.50)	27.00(19.00, 45.00)	5.64	<0.01
FPG(mmol/L)	8.55(6.70, 11.11)	8.67(7.14, 11.73)	1.00	0.32
HOMA-IR	1.15(0.86, 1.56)	4.87(2.83, 9.84)	1.26	<0.01
SCr(μmol/L)	65.00(56.00, 82.00)	69.00(58.00, 83.00)	1.66	0.10
SUA(μmol/L)	242.00(203.00, 313.00)	338.00(279.00, 402.00)	9.28	<0.01
SUA/SCr	3.72(3.06, 4.58)	4.65(3.75, 5.73)	6.83	<0.01

Tab.2 Correlation analysis of 25(OH)D with other clinical indicators

	性别	年龄 (岁)	体重 (kg)	BMI (kg/m²)	病程 (年)	收缩压 (mmHg)	舒张压 (mmHg)	HbA₁c (%)	LDL-C (mmol/L)	HDL-C (mmol/L)
$r$ 值	-0.08	0.04	-0.03	-0.10	0.06	-0.02	0.05	-0.10	-0.01	0.05
$P$ 值	0.11	0.41	0.51	0.04	0.20	0.70	0.33	0.04	0.83	0.33
	TC (mmol/L)	TG (mmol/L)	AST (U/L)	ALT (U/L)	GGT (U/L)	FPG (mmol/L)	HOMA-IR	SCr (μmol/L)	SUA (μmol/L)	SUA/SCr
$r$ 值	-0.03	-0.06	0.06	0.03	-0.01	-0.08	-0.03	0.11	0.02	-0.03
$P$ 值	0.59	0.21	0.25	0.50	0.78	0.11	0.55	0.03	0.64	0.56

Tab.2 Correlation analysis of 25(OH)D with other clinical indicators

	性别	年龄 (岁)	体重 (kg)	BMI (kg/m²)	病程 (年)	收缩压 (mmHg)	舒张压 (mmHg)	HbA₁c (%)	LDL-C (mmol/L)	HDL-C (mmol/L)
$r$ 值	-0.08	0.04	-0.03	-0.10	0.06	-0.02	0.05	-0.10	-0.01	0.05
$P$ 值	0.11	0.41	0.51	0.04	0.20	0.70	0.33	0.04	0.83	0.33
	TC (mmol/L)	TG (mmol/L)	AST (U/L)	ALT (U/L)	GGT (U/L)	FPG (mmol/L)	HOMA-IR	SCr (μmol/L)	SUA (μmol/L)	SUA/SCr
$r$ 值	-0.03	-0.06	0.06	0.03	-0.01	-0.08	-0.03	0.11	0.02	-0.03
$P$ 值	0.59	0.21	0.25	0.50	0.78	0.11	0.55	0.03	0.64	0.56

Tab.3 Correlation analysis between SUA/SCr and other clinical indicators

	性别		年龄 (岁)		体重 (kg)		BMI (kg/m²)		病程 (年)		收缩压 (mmHg)		舒张压 (mmHg)		HbA₁c (%)		LDL-C (mmol/L)
$r$ 值	0.07		-0.34		0.06		0.05		-0.18		-0.10		0.10		0.04		0.10
$P$ 值	0.16		<0.01		0.30		0.29		<0.01		<0.05		<0.05		0.44		0.04
		HDL-C (mmol/L)		TC (mmol/L)		TG (mmol/L)		AST (U/L)		ALT (U/L)		GGT (U/L)		FPG (mmol/L)		HOMA-IR
$r$ 值		-0.14		0.10		0.74		0.10		0.10		0.13		0.02		0.16
$P$ 值		0.01		0.04		<0.01		0.05		0.04		0.01		0.71		<0.01

Tab.3 Correlation analysis between SUA/SCr and other clinical indicators

	性别		年龄 (岁)		体重 (kg)		BMI (kg/m²)		病程 (年)		收缩压 (mmHg)		舒张压 (mmHg)		HbA₁c (%)		LDL-C (mmol/L)
$r$ 值	0.07		-0.34		0.06		0.05		-0.18		-0.10		0.10		0.04		0.10
$P$ 值	0.16		<0.01		0.30		0.29		<0.01		<0.05		<0.05		0.44		0.04
		HDL-C (mmol/L)		TC (mmol/L)		TG (mmol/L)		AST (U/L)		ALT (U/L)		GGT (U/L)		FPG (mmol/L)		HOMA-IR
$r$ 值		-0.14		0.10		0.74		0.10		0.10		0.13		0.02		0.16
$P$ 值		0.01		0.04		<0.01		0.05		0.04		0.01		0.71		<0.01

Tab.4 Multivariate logistic regression analysis for NAFLD in T2DM patients

指标	β	标准误	$O R$ 值	$P$ 值	95% $C I$
指标	β	标准误	$O R$ 值	$P$ 值	下限	上限
SUA/SCr>4.46	1.424	0.513	4.16	<0.01	1.52	11.35
病程	-0.097	0.040	0.91	0.014	0.84	0.98
25(OH)D	-0.15	0.000	0.86	<0.01	0.80	0.92
GGT	0.014	0.044	1.02	0.044	1.00	1.03

Tab.4 Multivariate logistic regression analysis for NAFLD in T2DM patients

指标	β	标准误	$O R$ 值	$P$ 值	95% $C I$
指标	β	标准误	$O R$ 值	$P$ 值	下限	上限
SUA/SCr>4.46	1.424	0.513	4.16	<0.01	1.52	11.35
病程	-0.097	0.040	0.91	0.014	0.84	0.98
25(OH)D	-0.15	0.000	0.86	<0.01	0.80	0.92
GGT	0.014	0.044	1.02	0.044	1.00	1.03

Fig.1 ROC curve of 25(OH)D, SUA/SCr, and their combination in predicting T2DM patients complicated with NAFLD

Tab.5 Predictive value of 25 (OH) D, SCr/SUA, and their combination for T2DM patients complicated with NAFLD

变量	曲线下面积	敏感度	特异度	截断值	$P$ 值	95% $C I$
变量	曲线下面积	敏感度	特异度	截断值	$P$ 值	下限	上限
25(OH)D	0.596	28.3%	88.6%	9.00	<0.01	0.547	0.645
SUA/SCr	0.697	51.1%	78.9%	4.46	<0.01	0.650	0.742
25(OH)D联合SUA/SCr	0.714	67.1%	65.9%	0.13	<0.01	0.667	0.757

Tab.5 Predictive value of 25 (OH) D, SCr/SUA, and their combination for T2DM patients complicated with NAFLD

变量	曲线下面积	敏感度	特异度	截断值	$P$ 值	95% $C I$
变量	曲线下面积	敏感度	特异度	截断值	$P$ 值	下限	上限
25(OH)D	0.596	28.3%	88.6%	9.00	<0.01	0.547	0.645
SUA/SCr	0.697	51.1%	78.9%	4.46	<0.01	0.650	0.742
25(OH)D联合SUA/SCr	0.714	67.1%	65.9%	0.13	<0.01	0.667	0.757

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