关键词: 糖尿病, 2型；非酒精性脂肪性肝病；心脏代谢指数；影响因素分析；预测

Abstract: Background　The increasing prevalence of type 2 diabetes mellitus （T2DM） and nonalcoholic fatty liver disease（NAFLD） has emerged as a critical public health problem.Recent guidelines recommend that more attention should be paid to the screening of NAFLD in T2DM patients，but it is difficult to perform the screening in clinical practice，especially in primary care.Objective　To investigate the relationship between cardiometabolic index （CMI） and risk of NAFLD in patients with T2DM.Methods　A total of 501 individuals with T2DM were recruited between May 2018 and March 2020 at the Affiliated Hospital of Jiangsu University and divided into NAFLD group（n=336） and non-NAFLD group（n=165） according to the result of ultrasound.The clinical data of the two groups were collected and analysed.NAFLD prevalence was compared across the tertile groups of CMI（CMI <0.765，0.765-1.375 and >1.375，167 cases in each tertile）.The correlation of CMI with other clinical indicators was analyzed to explore the influencing factors of NAFLD and the predictive value of CMI for NAFLD in patients with T2DM.Results　Compared with T2DM patients without NAFLD，those with NAFLD showed lower average age，shorter average T2DM duration，higher prevalence of hypertension，higher average levels of diastolic blood pressure，body mass index （BMI），visceral fat area（VFA），subcutaneous fat area（SFA），visceral-to-subcutaneous fat area ratio（VSR），alanine aminotransferase（ALT），aspartate transaminase（AST），triglyceride，total cholesterol（TC），gamma-glutamyl transpeptidase（GGT），uric acid，fasting C-peptide（FC-P），fasting insulin（FINS），homeostasis model assessment of insulin resistance（HOMA-IR） and CMI ，as well as lower average high-density lipoprotein cholesterol （P<0.05）.The low CMI tertile group had lower NAFLD prevalence than other two groups（P<0.05）.The medium CMI tertile group had lower NAFLD prevalence than top CMI tertile group（P<0.05）.CMI was positively correlated with diastolic blood pressure，BMI，VFA，SFA，VSR，ALT，AST，GGT，uric acid，TC，fasting plasma glucose，FINS，FC-P，and HOMA-IR （P<0.05），but negatively correlated with age and T2DM duration in correlation analysis（P<0.05）.The binary Logistic regression analysis showed that T2DM duration〔OR=0.996，95%CI（0.994，0.999）〕，BMI〔OR=1.400，95%CI（1.264，1.551）〕，FC-P〔OR=1.959，95%CI（1.442，2.661）〕and CMI〔OR=2.053，95%CI（1.422，2.964）〕were influencing factors for NAFLD in patients with T2DM （P<0.05）.The area under the ROC curve predicted by CMI for NAFLD was 0.738〔95%CI（0.691，0.784），P<0.01〕，and the optimal cut-off value was 0.692，with sensitivity and specificity of 83.6% and 51.5%，respectively.The binary Logistic regression analysis was used to fit the equation of CMI and BMI，where the fitting equation was Log（P）=-9.103+0.938×CMI+0.358×BMI，and the AUC of CMI with BMI was 0.816〔95%CI（0.776，0.856），P<0.01〕，with sensitivity and specificity of 84.2% and 64.8%，respectively.Conclusion　CMI was associated with NAFLD in patients with T2DM，and it with BMI may have good predictive value for NAFLD.CMI is expected to become a predictor for NAFLD in patients with T2DM.

Key words: Diabetes mellitus, type 2；Nonalcoholic fatty liver disease；Cardiometabolic index；Root cause analysis；Forecasting