Abstract: Background　In recent years，the incidence and prevalence of metabolic-associated fatty liver disease （MAFLD）have increased annually，and more than 25% of the global population suffers from MAFLD. Type 2 diabetes mellitus （T2DM）is closely related to MAFLD，but simple and accurate predictors of MAFLD in T2DM patients are scant. Objective　To investigate the correlation between albumin/γ-glutamyl transferase ratio（AGTR）with T2DM combined with MAFLD，and to construct a nomogram to predict the risk of T2DM combined with MAFLD. Methods　A total of 1 050 adult patients with T2DM who were hospitalized in the Department of Endocrinology，Hebei General Hospital from 2018 to 2023 were enrolled. After several rounds of rigorous screening，a total of 723 eligible patients were included in the study，involving 430 cases in the T2DM combined with MAFLD group and 293 cases of T2DM without MAFLD.The basic information of patients were collect and analyze，MAFLD was diagnosed by ultrasound. Spearman correlation analysis was used to analyze the correlation between AGTR and MAFLD risk factors. Multivariate logistic regression analysis was used to explore the risk factors for T2DM complicated with MAFLD. An individualized nomogram for predicting the risk of T2DM complicated with MAFLD was constructed and validated. Results　Compared with the T2DM without MAFLD group，the levels of body mass index（BMI），alanine aminotransferase （ALT），aspartate aminotransferase（AST），gamma glutamyl transferase（GGT），bile acids（BA），fasting blood glucose（FBG），triglycerides（TG），total cholesterol（TC），low-density lipoprotein cholesterol（LDL-C），very low-density lipoprotein cholesterol（VLDL-C），apolipoprotein B（ApoB），uric acid（UA）in the T2DM combined with MAFLD group were significantly higher，while age，duration of T2DM， albumin（ALB），and high-density lipoprotein cholesterol （HDL-C）were significantly lower（P <0.05）. Patients were divided into T1-T3 groups according to the AGTR tertiles. The general data of the three groups were compared. BMI，ALT，GGT，FBG，TC，TG，LDL-C，VLDL-C，ApoB，and UA were significantly lower than those of T1 and T2 groups，while HDL-C and AST were significantly lower than T1 groups（P<0.05）. Age and course of T2DM in T3 group were significantly higher than those of T1 and T2 groups（P<0.05）. BMI，ALT，AST，GGT，TG，VLDL-C，and UA in T2 group were significantly lower than those of T1 groups（P<0.05）. Spearman correlation analysis showed that AGTR was positively correlated with age，course of T2DM，ALB，and HDL-C（P<0.05），and negatively correlated with VLDL-C，BMI，ALT，AST，GGT，BA，FBG，TC，TG，LDL-C，ApoB，and UA（P<0.05）. Multivariate logistic regression analysis showed that the increased BMI（OR=1.256，95%CI=1.187-1.330），increased TG（OR=1.272，95%CI=1.043-1.551），and the decreased AGTR（OR=0.707，95%CI=0.562-0.890）were the influencing factors for the risk of T2DM combined with MAFLD. Receiver operating characteristic（ROC）curve analysis showed that the nomogram involving BMI，TG and AGTR effectively predict the risk of MAFLD in T2DM patients，with the area under the curve（AUC）of 0.827 （95%CI=0.790-0.864）. The calibration curve showed that the predicted value was close to the ideal curve，indicating a good consistency. The clinical decision curve showed that the nomogram had good clinical prediction effect on T2DM combined with MAFLD. Conclusion　AGTR reduction is a protective factor for T2DM combined with MAFLD. The individualized nomogram constructed based on BMI，TG，and AGTR can effectively predict the risk of T2DM combined with MAFLD.

Key words: Metabolic-associated fatty liver disease；Diabetes mellitus, type 2；Albumin；Gamma-glutamyl transferase；Albumin/gamma-glutamyl transferase；Root cause analysis

摘要： 背景　近年来代谢相关脂肪性肝病（MAFLD）的发病率和患病率逐年上升，全球有超过四分之一的人口患有MAFLD。2型糖尿病（T2DM）与MAFLD密切相关，但目前T2DM患者合并MAFLD的简单且准确预测指标很少。目的　研究白蛋白/γ-谷氨酰转移酶（AGTR）与T2DM合并MAFLD的相关性，构建发生T2DM合并MAFLD风险的列线图预测模型。方法　选择2018—2023年在河北省人民医院内分泌科住院的1 050例成年T2DM患者为研究对象。经过多轮严格筛选，最终共有723例患者符合研究标准并被纳入研究，其中T2DM合并MAFLD组430例，单纯T2DM组293例。收集并分析患者的基本资料，MAFLD均经超声确诊。采用Spearman相关分析方法，分析AGTR合并MAFLD危险因素之间的相关性。采用多因素Logistic回归分析探讨T2DM合并MAFLD的危险因素，并据此构建和验证个体化预测T2DM合并MAFLD风险的列线图模型。结果　与单纯T2DM组相比，T2DM合并MAFLD组的BMI、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）、胆汁酸（BA）、空腹血糖（FBG）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、极低密度脂蛋白胆固醇（VLDL-C）、载脂蛋白B（ApoB）、尿酸（UA）水平增高，而年龄、糖尿病病程、ALB、HDL-C较单纯T2DM组患者水平降低，差异有统计学意义（P<0.05）；依据AGTR三分位数将患者分为T1~T3组，比较3组一般资料，T3组BMI、ALT、GGT、FBG、TC、TG、LDL-C、VLDL-C、ApoB、UA低于T2、T1组，HDL-C、AST低于T1组，年龄、糖尿病病程高于T2、T1组（P<0.05），T2组BMI、ALT、AST、GGT、TG、VLDL-C、UA低于T1组（P<0.05）。Spearman相关性分析显示，AGTR与年龄、糖尿病病程、ALB、HDL-C呈正相关（P<0.05），与VLDL-C、BMI、ALT、AST、GGT、BA、FBG、TC、TG、LDL-C、ApoB、UA呈负相关（P<0.05）。多因素Logistic回归分析结果显示BMI、TG升高［OR（95%CI）=1.256（1.187~1.330），1.272（1.043~1.551）］、AGTR降低［OR（95%CI）=0.707（0.562~0.890）］是T2DM合并MAFLD的影响因素。ROC曲线分析显示三者联合模型预测T2DM发生MAFLD的AUC值为0.827（95%CI=0.790~0.864）。校正曲线显示预测值靠近理想曲线，有较好的一致性，临床决策曲线分析显示该模型对T2DM合并MAFLD临床预测效果良好。结论　AGTR降低是T2DM合并MAFLD保护因素，基于BMI、TG、AGTR构建的个体化列线图模型可以有效预测T2DM合并MAFLD的风险。

关键词: 代谢相关脂肪性肝病；糖尿病, 2 型；白蛋白；γ- 谷氨酰转移酶；白蛋白 /γ- 谷氨酰转移酶；影响因素分析