Type 2 diabetes mellitus (T2DM) is often associated with metabolic fatty liver disease (MAFLD) , which significantly increases the risk of microanglopathy through the interaction of insulin resistance, abnormal lipid metabolism, chronic inflammation and other mechanisms. However, the quantitative analysis of related risk factors and the construction of predictive models are insufficient in existing studies. Identification of key biomarkers to guide early intervention‌ is urgently needed.

To investigate the correlation factors and predictive value of microangiopathy in T2DM patients with MAFLD.

A retrospective analysis was conducted on the clinical data of patients with T2DM combined with MAFLD admitted to the Lu'an Hospital Affiliated to Anhui Medical University from January 2021 to August 2023. According to the medical record system, 110 patients with microvascular complications and 110 patients without microvascular complications were selected as the modeling group at a 1∶1 ratio. Another 106 patients with T2DM combined with MAFLD during the same period were selected as the validation group. Patients with microvascular complications were assigned to the occurrence group (n=110) , and those without microvascular complications were assigned to the non-occurrence group (n=110) . General information and laboratory test results of the patients were collected through the medical record system. The non-alcoholic fatty liver fibrosis score (NFS) , liver fibrosis 4-factor index (FIB-4) , and triglyceride-glucose index (TyG) were calculated. Multivariate logistic regression analysis was performed on indicators with a variance inflation factor (VIF) <10 selected by collinearity analysis. The receiver operating characteristic (ROC) curve was constructed to evaluate the predictive effect of each indicator on the occurrence of microvascular complications in patients with T2DM combined with MAFLD.

There were no significant differences in baseline data between the modeling cohort and the validation cohort (P>0.05) . Among the patients with T2DM combined with MAFLD who developed microvascular complications, 44 (40.0%) had diabetic nephropathy, 29 (26.4%) had diabetic retinopathy, and 37 (33.6%) had both diabetic nephropathy and diabetic retinopathy. Significant differences were observed in smoking history, duration of diabetes, C-reactive protein (CRP) , TyG, triglycerides (TG) , FIB-4, and NFS between the non-occurrence and occurrence groups (P<0.05) . Multivariate logistic regression analysis showed that smoking history (OR=8.298, 95%CI=1.957-35.175) , long duration of diabetes (OR=2.638, 95%CI=1.515-4.596) , elevated CRP (OR=7.918, 95%CI=4.013-15.624) , elevated TyG (OR=1.533, 95%CI=1.171-2.006) , elevated TG (OR=2.055, 95%CI=1.475-2.862) , elevated FIB-4 (OR=29.598, 95%CI=9.179-95.437) , and elevated NFS (OR=3.433, 95%CI=2.113-5.576) were risk factors for microvascular complications in patients with T2DM combined with MAFLD (P<0.05) . The areas under the ROC curve (AUC) for predicting microvascular complications in patients with T2DM combined with MAFLD based on CRP, TyG, duration of diabetes, smoking history, TG, NFS, and FIB-4 were 0.964 (95%CI=0.944-0.984, P<0.001) , 0.620 (95%CI=0.546-0.693, P=0.002) , 0.795 (95%CI=0.737-0.853, P=0.001) , 0.605 (95%CI=0.530-0.679, P=0.004) , 0.663 (95%CI=0.592-0.735, P<0.001) , 0.730 (95%CI=0.664-0.796, P<0.001) , and 0.743 (95%CI=0.678-0.808, P<0.001) , respectively. The AUC (95%CI) of the predictive model based on the above indicators in the modeling cohort was 0.990 (0.990-1.000) , indicating good predictive value.

Clinically, the occurrence of microvascular complications in patients with T2DM combined with MAFLD can be effectively predicted by observing CRP, TyG, duration of diabetes, smoking history, TG, NFS, and FIB-4. This approach is conducive to identifying high-risk patients with microvascular complications among patients with T2DM combined with MAFLD.

2型糖尿病（T2DM）与代谢相关脂肪性肝病（MAFLD）常合并存在，二者通过胰岛素抵抗、脂代谢异常及慢性炎症等机制相互作用，显著增加了微血管病变风险，但现有研究对相关危险因素的定量分析及预测模型构建不足，亟需明确关键生物标志物以指导早期干预‌。

研究T2DM合并MAFLD患者微血管病变发生的相关因素及预测价值。

回顾性分析2021年1月—2023年8月安徽医科大学附属六安医院接收的T2DM合并MAFLD患者的临床资料，通过病历系统记录按照1∶1的比例，选取110例发生微血管病变的患者及110例未发生微血管病变的患者为建模组，选取同期106例T2DM合并MAFLD患者为验证组，另外将出现微血管病变者划分到发生组（n=110），未出现微血管病变者划分到未发生组（n=110）。通过病历系统记录内容收集患者一般资料及实验室检查结果，计算非酒精性脂肪肝纤维化评分（NFS）、肝纤维化4因子指数（FIB-4）、甘油三酯-葡萄糖指数（TyG）。采用共线性分析筛选方差膨胀系数（VIF）<10的指标进行多因素Logistic回归分析，构建受试者工作特征（ROC）曲线，判断各指标对T2DM合并MAFLD患者发生微血管病变的预测效果。

建模队列和验证队列基线资料比较，差异无统计学意义（P>0.05）。发生微血管病变的T2DM合并MAFLD患者中，44例（40.0%）发生糖尿病肾病，29例（26.4%）发生糖尿病视网膜病变，37例（33.6%）发生糖尿病肾病合并糖尿病视网膜病变。未发生组与发生组患者吸烟史、糖尿病病程、C反应蛋白（CRP）、TyG、三酰甘油（TG）、FIB-4、NFS比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，有吸烟史（OR=8.298，95%CI=1.957~35.175）、糖尿病病程长（OR=2.638，95%CI=1.515~4.596）、CRP升高（OR=7.918，95%CI=4.013~15.624）、TyG升高（OR=1.533，95%CI=1.171~2.006）、TG升高（OR=2.055，95%CI=1.475~2.862）、FIB-4升高（OR=29.598，95%CI=9.179~95.437）、NFS升高（OR=3.433，95%CI=2.113~5.576）为T2DM合并MAFLD患者发生微血管病变的危险因素（P<0.05）。CRP、TyG、糖尿病病程、吸烟史、TG、NFS、FIB-4预测T2DM合并MAFLD患者发生微血管病变的ROC曲线下面积（AUC）分别为0.964（95%CI=0.944~0.984，P<0.001）、0.620（95%CI=0.546~0.693，P=0.002）、0.795（95%CI=0.737~0.853，P=0.001）、0.605（95%CI=0.530~0.679，P=0.004）、0.663（95%CI=0.592~0.735，P<0.001）、0.730（95%CI=0.664~0.796，P<0.001）、0.743（95%CI=0.678~0.808，P<0.001）。基于上述指标构建预测模型，建模队列AUC（95%CI）为0.990（0.990~1.000），预测价值较好。

临床可通过对T2DM合并MAFLD患者的CRP、TyG、糖尿病病程、吸烟史、TG、NFS、FIB-4的观察和检测对微血管病变发生进行有效预测，有利于T2DM合并MAFLD患者中筛选发生微血管病变的高危患者。