摘要目的:分析早发2型糖尿病患者非高密度脂蛋白胆固醇（non-HDL-C）水平与非酒精性脂肪性肝病（NAFLD）的关系。方法:回顾性分析2008年6月至2012年6月于北京朝阳糖尿病医院住院治疗的早发T2DM患者100例的临床资料，根据是否合并NAFLD将患者分为NAFLD组50例与非NAFLD组50例。收集患者临床资料、生化指标［血脂、血糖、肝功能、血尿酸、高敏C反应蛋白（hs-CPR）］和糖化血红蛋白（HbA1c），并计算体质量指数（BMI）和non-HDL-C。采用logistic回归分析早发T2DM患者non-HDL-C水平与NAFLD的关系，应用受试者工作特征（ROC）曲线评估non-HDL-C对早发T2DM合并NAFLD的预测价值和最佳切点。结果:NAFLD组BMI、腰臀比、收缩压、舒张压分别为（28.55±3.47）kg/m 2、（0.94±0.05）、（121.00±10.25）mmHg（1 mmHg=0.133 kPa）、（80.00±8.51）mmHg，均高于非NAFLD组［（23.95±2.87）kg/m 2、（0.90±0.07）、（115.20±13.36）mmHg、（73.70±7.75）mmHg］（ t=-7.23、-3.11、-2.44、-3.87，均 P < 0.05）。NAFLD组non-HDL-C［（4.88±3.01）mmol/L］、总胆固醇［（6.33±3.23）mmol/L］、三酰甘油［（4.50±6.03）mmol/L］、低密度脂蛋白胆固醇［（3.27±1.26）mmol/L］、丙氨酸氨基转移酶［（39.80±23.58）U/L］、天冬氨酸氨基转移酶［（27.72±13.83）U/L］、γ-谷氨酰转肽酶［（52.96±46.16）U/L］、血尿酸［（350.32±102.12）μmol/L］、hs-CPR［（1.26±0.88）mg/L］、HbA1c［（9.3±2.5）%］均高于非NAFLD组［（3.35±1.03）mmol/L、（4.81±1.24）mmol/L、（1.87±2.29）mmol/L、（2.70±0.71）mmol/L、（23.76±13.45）U/L、（21.98±10.13）U/L、（35.24±35.41）U/L、（296.04±88.26）μmol/L、（0.22±1.54）mg/L、（8.2±2.7）%］，差异均有统计学意义（ t=-3.40、-3.11、-2.88、-2.81，-4.18、-2.36、-2.14、-2.85、-4.12、-2.08，均 P < 0.05）。logistic回归分析显示，non-HDL-C升高是T2DM合并NAFLD的独立危险因素（ OR=3.064，95% CI：1.604~5.852， P=0.001）。ROC曲线分析结果提示non-HDL-C预测NAFLD的最佳切点是3.60 mmol/L，敏感性为0.700，特异性为0.620。 结论:non-HDL-C水平升高是早发T2DM合并NAFLD的独立危险因素，当non-HDL-C > 3.60 mmol/L，可预测出现NAFLD。

abstractsObjective:To investigate the association of non-high-density lipoprotein cholesterol (non-HDL-C) level with non-alcoholic fatty liver disease (NAFLD) in patients with early-onset type 2 diabetes.Methods:The clinical data of 100 patients with early-onset type 2 diabetes who were admitted to Beijing Chaoyang Diabetes Hospital from June 2008 to June 2012 were retrospectively analyzed. These patients were divided into a NAFLD group and a non-NAFLD group, with 50 patients in each group, according to the presence or absence of NAFLD. Clinical data, biochemical indices [blood lipids, blood glucose, liver function, uric acid, high-sensitivity C-reactive protein], and glycosylated hemoglobin were collected. Body mass index and non-HDL-C levels were recorded. The association of non-HDL-C level with NAFLD in patients with early-onset type 2 diabetes was analyzed using logistic regression analysis. The predictive value and optimal cut-off point of non-HDL-C for early-onset T2 diabetes complicated by NAFLD were evaluated using the receiver operating characteristic curve.Results:Body mass index, waist-to-hip ratio, systolic blood pressure, and diastolic blood pressure in the NAFLD group were (28.55 ± 3.47) kg/m 2, (0.94 ± 0.05), (121.00 ± 10.25) mmHg (1 mmHg = 0.133 kPa), and (80.00 ± 8.51) mmHg respectively, which were significantly higher than (23.95 ± 2.87) kg/m 2, (0.90 ± 0.07), (115.20 ± 13.36) mmHg, and (73.70 ± 7.75) mmHg in the non-NAFLD group ( t = -7.23, -3.11, -2.44, -3.87, all P < 0.05). Non-HDL-C, total cholesterol, triglyceride, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase, uric acid, high-density lipoprotein cholesterol, and glycosylated hemoglobin levels in the NAFLD group were (4.88 ± 3.01) mmol/L, (6.33 ± 3.23) mmol/L, (4.50 ± 6.03) mmol/L, (3.27 ± 1.26) mmol/L, (39.80 ± 23.58) U/L, (27.72 ± 13.83) U/L, (52.96 ± 46.16) U/L, (350.32 ± 102.12) μmol/L, (1.26 ± 0.88) mg/L, and (9.3 ± 2.5)%, respectively, which were significantly higher than (3.35 ± 1.03) mmol/L, (4.81±1.24) mmol/L, (1.87 ± 2.29) mmol/L, (2.70 ± 0.71) mmol/L, (23.76 ± 13.45) U/L, (21.98 ± 10.13) U/L, (35.24 ± 35.41) U/L, (296.04 ± 88.26) μmol/L, (0.22 ± 1.54) mg/L, (8.2 ± 2.7)% in the non-NAFLD group ( t = -3.40, -3.11, -2.88, -2.81, -4.18, -2.36, -2.14, -2.85, -4.12, -2.08, all P < 0.05). Logistic regression analysis showed that the increase in non-HDL-C level was an independent risk factor for T2 diabetes mellitus complicated by NAFLD ( OR = 3.064, 95% CI: 1.604-5.852, P = 0.001). The receiver operating characteristic curve analysis results showed that the optimal cut-off point, sensitivity, and specificity of non-HDL-C level to predict NAFLD were 3.60 mmol/L, 0.700, and 0.620 respectively. Conclusion:An increase in non-HDL-C level is an independent risk factor for NAFLD complicated by early-onset type 2 diabetes When non-HDL-C is > 3.60 mmol/L, NAFLD can be predicted.