| ObjectiveThe purpose of this study was to investigate the correlation between nonalcoholic fatty liver fibrosis score(NFS)and coronary Gensini score in patients with type 2 diabetes mellitus(T2DM)and nonalcoholic fatty liver disease(NAFLD),and to explore the predictive value of NFS for the severity of coronary artery disease.Methods242 patients who underwent coronary angiography(CAG)and were diagnosed as NAFLD in the Department of Endocrinology and Cardiovascular Medicine of the First Affiliated Hospital of Xi'an Medical University from January 2018 to December 2018 were collected.According to the results of CAG,170 patients were divided into coronary heart disease(CHD)group and 72 patients without CHD group.168 patients with T2 DM and NAFLD were further divided into two groups according to the results of CAG.There were 129 cases in CHD group and 39 cases in non-CHD group.74 patients with NAFLD were divided into CHD group(33 cases)and non-CHD group(41 cases)according to the results of coronary angiography.Sex,age,height,weight,smoking history,hypertension history,T2 DM history and drinking history were collected.Blood analysis,blood lipids,glycosylated hemoglobin A1c(HbA1c)and other test data were recorded.Gensini integral and NFS were calculated,and the data were analyzed by SPSS20.0 software.The difference was statistically significant(P < 0.05).Results1 Study on the correlation between the score of nonalcoholic fatty liver fibrosis and the Gensini score of coronary artery in patients with NAFLD.1.1 Compared with non-CHD group,age,white blood cell(WBC),neutrophile granulocyte(NEUT),direct bilirubin(DBIL),uric acid(UA),HbA1 c,insulin resistance(IR)levels in CHD group were significantly higher than those in non-CHD group(P <0.05),plasma albumin(A)in CHD group.ALB level was lower than that of CHD-free group(P < 0.05).The percentage of CHD in male,T2 DM,AST and high NFS group was significantly higher than that in CHD-free group(P < 0.05).1.2 Compared with clinical data of different lesion branches,age,WBC,NEUT,HbA1 c and IR levels and percentage of patients in T2 DM group and high NFS group increased gradually with the increase of lesion branches(P < 0.05).ALB level gradually decreased with the increase of the number of lesion branches(P < 0.05).1.3 Compared with the clinical data of different Gensini scores,the levels of WBC,NEUT and HbA1 c and the percentage of T2 DM group and high NFS group increased gradually with the increase of Gensini scores(P < 0.05).1.4 The correlation analysis between NFS and clinical indicators showed that NFS was positively correlated with age(r=0.432),AST(r=0.453),HbA1c(r=0.215),IR(r=0.274),number of coronary artery lesions(r=0.381)and Gensini score(r=0.427),with significant difference(P<0.05).1.5 The binary progressive logistic regression analysis of risk factors for coronary heart disease showed that there were significant differences in gender,albumin,uric acid,insulin resistance and non-alcoholic fatty liver fibrosis(P < 0.05).1.6 Multivariate logistic regression analysis showed that there were significant differences in gender,white blood cells,albumin,insulin resistance and non-alcoholic fatty liver fibrosis(P < 0.05).1.7 Multivariate ordered logistic regression analysis showed that there were significant differences in gender,white blood cells,albumin,glycosylated hemoglobin,insulin resistance,aspartate Aminotransferase stratification and non-alcoholic fatty liver fibrosis stratification(P < 0.05).1.8 The area under ROC curve(AUC)was used to indicate the diagnostic value of non-alcoholic fatty liver fibrosis score for coronary heart disease.The AUC was 0.717.By calculating,the cut-off point was-0.0181,which was the best critical value.That is,when the score of non-alcoholic fatty liver fibrosis was(-0.0181),it was positive,and predicted coronary heart disease,Yoden index was 0.717.0.359,sensitivity 55.3%,specificity80.6%,positive predictive value 87.1%,negative predictive value 43.3%.2 Study on the correlation between NFS and Gensini score of coronary artery lesions in patients with T2 DM and NAFLD.2.1 The difference of age,WBC,NEUT,DBIL and IR between CHD group and high non-NFS group and high NEUT/lymphocyte(LY)group was significantly higher than that of non-CHD group(P < 0.05).2.2 Analysis of clinical data among different lesion branches showed that age,WBC,NEUT and IR levels and the percentage of high NFS score group increased gradually with the increase of lesion branches(P < 0.05).2.3 Clinical data analysis among different Gensini scores showed that with the increase of Gensini scores,WBC and NEUT levels and the percentage of high AST and high NFS groups increased gradually(P < 0.05).2.4 The correlation analysis between NFS and clinical indicators showed that NFSwas positively correlated with age(r = 0.410),indirect bilirubin(IBIL)(r = 0.182),lesion branch(r = 0.376)and Gensini score(r = 0.430)(P < 0.05).2.5 The binary progressive logistic regression analysis showed that there were significant differences in white blood cells,direct bilirubin,albumin,insulin resistance and high non-alcoholic fatty liver fibrosis score(P < 0.05).2.6 There were significant differences in albumin,insulin resistance and high non-alcoholic fatty liver fibrosis score groups(P < 0.05).2.7 Multivariate ordered logistic regression analysis showed that there were significant differences in white blood cells,insulin resistance,high non-alcoholic fatty liver fibrosis score and glutamic oxaloacetic aminotransferase group(P < 0.05).2.8 Non-alcoholic fatty liver fibrosis score was used to predict coronary heart disease.The area under ROC curve(AUC)was used to express the diagnostic value of non-alcoholic fatty liver fibrosis score for coronary heart disease.AUC was 0.721.By calculating,the cut-off point was 0.2863,which was the best critical value,i.e.when the non-alcoholic fatty liver fibrosis score was more than 0.2863,it was positive and predicted that type 2 diabetes complicated with NAFLD.The Yoden index was 0.381,the sensitivity was 53.5%,the specificity was 84.6%,the positive predictive value was 91.9%,and the negative predictive value was 35.4%.3 Study on the correlation between NFS and Gensini score of coronary artery lesions in patients with NAFLD alone3.1 The levels of HBG,SCr,UA and IR in CHD group were significantly higher than those in non-CHD group(P < 0.05).The percentage of male patients in CHD group was higher than that in non-CHD group(P < 0.05).There was no significant difference in the percentage of high NFS between CHD group and non-CHD group(P > 0.05).3.2 SCr,UA and IR levels increased with the increase of coronary artery lesions(P <0.05).The percentage of male patients increased with the increase of lesion branches(P <0.05),but there was no significant difference in the percentage of high NFS group(P >0.05)..3.3 With the gradual increase of Gensini score,the level of serum uric acid showed a gradual increase trend(P < 0.05).With the gradual increase of Gensini score,IR level,SCr level,HGB level and the percentage of male group showed an increasing trend(P < 0.05),while the percentage of high NFS group showed no significant difference(P > 0.05).Conclusions1 In NAFLD patients,NFS can well reflect the severity of coronary artery diseaseand can be used as a predictor of the severity of CHD and coronary artery disease.NFS is helpful in clinical diagnosis of CHD and assessment of the severity of coronary artery disease in NAFLD patients.2 In patients with T2 DM and NAFLD,NFS can well reflect the severity of coronary artery disease and can be used as a predictor of the severity of CHD and coronary artery disease.NFS is helpful to the diagnosis of CHD and the assessment of the severity of coronary artery disease in patients with T2 DM and NAFLD.3 In patients with NAFLD alone,this study does not prove a good correlation between NFS and the severity of CHD and coronary artery disease. |
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