不同中医证型2型糖尿病合并非酒精性脂肪性肝病患者空腹C肽与FIB-4指数的相关性研究OA

Objective:This study investigates the relationship between fasting C-peptide and FIB-4 index in T2DM pa-tients with NAFLD,classified by traditional Chinese medicine(TCM)syndromes,aiming to provide objective evidence for syndrome differentiation and integrative treatment strategies.Methods:A retrospective cohort study included 150 T2DM patients with NAFLD,classified into four TCM syndromes:phlegm-blood stagnation,liver-spleen deficiency,damp-heat retention,and liver-kidney deficiency.The indicators such as age,disease duration,BMI,glycated hemoglobin(HbA1c),fasting C-peptide and FIB-4 index of each group were recorded.Statistical processing was performed using analysis of variance,non-parametric tests and Pearson correlation analysis.Results:(1)There was no statistically sig-nificant difference in HbA1c among patients with T2DM combined with NAFLD of different TCM syndrome types(P>0.05).Patients in the liver-kidney deficiency group were significantly older compared to those in the phlegm-blood stasis group(P<0.05),and they also had the longest disease duration(P<0.05).BMI levels demonstrated a signifi-cant gradient:lowest in the liver-kidney deficiency group,followed by the liver-spleen deficiency group,then the phlegm-blood stasis group,and highest in the damp-heat retention group(P<0.05).(2)Fasting C-peptide levels var-ied significantly across the groups(P<0.05),with the lowest values observed in the liver-kidney deficiency group,fol-lowed by the liver-spleen deficiency group,the damp-heat retention group,and the highest levels found in the phlegm-blood stasis group.(3)Regarding the FIB-4 index,there were significant differences in the FIB-4 index among patients with T2DM combined with non-NAFLD of different TCM syndrome types(P<0.05).FIB-4 index levels were signifi-cantly elevated in the liver-kidney deficiency group compared to other TCM syndrome groups(P<0.05),whereas the lowest levels were observed in the damp-heat retention group,suggesting a potential correlation between syndrome dif-ferentiation and fibrosis severity.(4)Pearson correlation analysis showed that the fasting C-peptide level and FIB-4 in-dex in patients with T2DM combined with NAFLD were significantly positively correlated(P<0.05).Conclusion:The dynamic reflection of TCM syndrome types reflects the pathological characteristics and fibrosis process of NAFLD:Patients with phlegm and blood stasis interstitial syndrome have the highest levels of IR and fasting C-peptide,and require expectorant and blood stasis removal combined with insulin sensitizers.The FIB-4 index is the highest in the syndrome of liver and kidney deficiency,indicating advanced fibrosis.Combined anti-fibrotic treatment with nourishing the liver and kidneys is required.The FIB-4 index is the lowest in the syndrome of internal accumula-tion of damp-heat,which mostly belongs to the early stage of steatosis.Combined metabolic regulation of clearing heat and promoting diuresis is advisable.Fasting C-peptide and FIB-4 index can provide an objective basis for syndrome dif-ferentiation in TCM and guide stratified intervention.