Abstract: Background　The prevalence of nonalcoholic fatty liver disease （NAFLD） is significantly higher in patients with type 2 diabetes mellitus （T2DM）. However，there are few studies on the relationship between serum remnant cholesterol （RC） and NAFLD and liver fibrosis in T2DM patients. Objective　To investigate the relationship between serum RC level and NAFLD and progressive liver fibrosis in patients with T2DM. Methods　316 patients with T2DM hospitalized in the Second People's Hospital of Lianyungang from 2022 to 2024 were selected and divided into NAFLD group （195 cases） and Non-NAFLD group （121 cases） according to whether they were complicated with NAFLD. According to NAFLD fibrosis score（NFS）, NAFLD group was divided into progressive liver fibrosis subgroup （92 cases） and non-progressive liver fibrosis subgroup （103 cases）. General information and laboratory findings of patients were collected and RC levels were calculated. ROC curves were drawn to explore the diagnostic efficacy of RC for NAFLD and progressive liver fibrosis, and the area under ROC curve （AUC） was calculated. Results　Fasting insulin （FINS）, homeostasis model assessment of insulin resistance （HOMA-IR）, aspartate aminotransferase （AST）, uric acid, triglyceride （TG）, and serum RC levels were significantly higher in patients with NAFLD than those in Non-NAFLD group（P<0.05）, while high density lipoprotein cholesterol （HDL-C） was significantly lower in patients with NAFLD than those in Non-NAFLD group（P<0.05）. Compared with the non-progressive liver fibrosis group, the patients in the progressive liver fibrosis group were older, had longer diabetes duration, higher levels of FINS, HOMA-IR, AST, uric acid, TG, RC, and lower levels of alanine aminotransferase （ALT） and gamma-glutamyl transpeptidase （GGT）（P<0.05）. Spearman correlation analysis showed that the serum RC level was positively correlated with body mass index, FINS, HOMA-IR, glycosylated hemoglobin(HbA1c), total cholesterol, TG, low density lipoprotein cholesterol, AST, GGT and uric acid （P<0.05）, and negatively correlated with age and HDL-C （P<0.05）. Logistic regression analysis showed that elevated RC was a risk factor for NAFLD（OR=1.879，95%CI=1.026-3.443，P=0.041） and progressive liver fibrosis（OR=4.365，95%CI=1.952-9.760， P<0.001） in patients with T2DM after adjusting for age, gender, duration of diabetes, body mass index, systolic blood pressure, diastolic blood pressure, HOMA-IR and HbA1c. The AUC for RC diagnosis of NAFLD was 0.604，with a sensitivity of 67.69% and a specificity of 49.59%. The AUC for RC diagnosis of progressive liver fibrosis in NAFLD patients was 0.629，with a sensitivity of 39.13% and a specificity of 91.26%. Conclusion　Elevated serum RC is an independent risk factor for NAFLD and progressive liver fibrosis in patients with T2DM. It has certain diagnostic value for NAFLD and progressive liver fibrosis.

Key words: Diabetes mellitus, type 2, Remnant cholesterol, Non-alcoholic fatty liver disease, Progressive liver fibrosis

摘要： 背景　非酒精性脂肪肝（NAFLD）在2型糖尿病（T2DM）患者中的患病率明显升高，目前关于血清残余胆固醇（RC）与T2DM患者NAFLD及肝纤维化相关研究较少。目的　探讨T2DM患者血清RC水平与NAFLD及进展性肝纤维化的关系。方法　选取2022—2024年于连云港市第二人民医院住院的T2DM患者316例，根据是否合并NAFLD分为NAFLD组（195例）和Non-NAFLD组（121例），按NAFLD纤维化评分（NFS）将NAFLD组患者分为进展性肝纤维化亚组（92例）和非进展性肝纤维化亚组（103例），收集患者的一般资料和实验室检查指标，计算RC水平。绘制受试者工作（ROC）曲线探讨RC对NAFLD及进展性肝纤维化的诊断效能，并计算ROC曲线下面积（AUC）。结果　NAFLD组患者空腹胰岛素（FINS）、稳态模型评估胰岛素抵抗指数（HOMA-IR）、天冬氨酸氨基转移酶（AST）、尿酸、三酰甘油（TG）、RC水平均高于Non-NAFLD组，高密度脂蛋白胆固醇（HDL-C）低于Non-NAFLD组（P<0.05）。与非进展性肝纤维化亚组相比，进展性肝纤维化亚组患者年龄更高，糖尿病病程更长，FINS、HOMA-IR、AST、尿酸、TG、RC水平更高，丙氨酸氨基转移酶（ALT）、γ-谷氨酰转肽酶（GGT）水平更低（P<0.05）。Spearman秩相关分析结果显示，血清RC水平与BMI、FINS、HOMA-IR、糖化血红蛋白（HbA1c）、总胆固醇、TG、低密度脂蛋白胆固醇、AST、GGT、尿酸呈正相关（P<0.05），与年龄、HDL-C呈负相关（P<0.05）。Logistic回归分析结果显示，在校正年龄、性别、糖尿病病程、BMI、收缩压、舒张压、HOMA-IR、HbA1c后，RC水平升高是T2DM患者发生NAFLD及进展性肝纤维化的危险因素（OR=1.879，95%CI=1.026~3.443，P=0.041；OR=4.365，95%CI=1.952~9.760，P<0.001）。ROC曲线结果显示，RC诊断T2DM患者发生NAFLD的AUC为0.604，灵敏度为67.69%，特异度为49.59%；RC诊断NAFLD患者发生进展性肝纤维化的AUC为0.629，灵敏度为39.13%，特异度为91.26%。结论　血清RC水平升高是T2DM患者NAFLD及进展性肝纤维化的独立危险因素，对NAFLD及进展性肝纤维化有一定的诊断价值。

关键词: 糖尿病, 2 型；残余胆固醇；非酒精性脂肪肝；进展性肝纤维化