代谢相关脂肪性肝病伴2型糖尿病患者幽门螺杆菌感染与炎症因子及肝纤维化进展的关系

doi:10.3969/j.issn.1006-5725.2025.13.015

Abstract

Abstract:

Objective To explore the correlation between helicobacter pylori （Hp） infection and inflammatory factors， as well as its association with the progression of liver fibrosis in patients with metabolically associated fatty liver disease （MAFLD） and type 2 diabetes mellitus （T2DM）. Methods A total of 300 patients diagnosed with MAFLD and T2DM who were admitted to the Hepatology Department of Hebei Hospital of Traditional Chinese Medicine between April 2023 and March 2024 were recruited. Based on Hp infection status， these patients were classified into an Hp-positive group and an Hp-negative group. Subsequently， the clinical data， inflammatory factors， and liver fibrosis indices of the two groups were comprehensively compared. Furthermore， the patients in the Hp-positive group were randomly assigned to an intervention group and a control group. The intervention group received standard Hp eradication therapy， whereas the control group was administered placebo therapy. Pearson correlation analysis was employed to investigate the associations among Hp infection， inflammatory factors， and liver fibrosis indices. Binary logistic regression analysis was utilized to identify the independent risk factors influencing the progression of liver fibrosis. Results In both the Hp-positive and Hp-negative groups， parameters including age， fasting blood glucose （FPG）， glycosylated hemoglobin （HbA1c）， total bilirubin （TBIL）， direct bilirubin （DBIL）， indirect bilirubin （IBIL）， tumor necrosis factor-α （TNF-α）， and interleukin-6 （IL-6）， along with C-reactive protein （CRP） and liver stiffness measurement （LSM）， were meticulously measured. Statistical analysis revealed that the differences in these parameters between the two groups were significant （P < 0.05）. Specifically， within the experimental setup， the levels of TNF-α， IL-6， CRP， and LSM in the intervention group were notably lower than those in the control group （P < 0.05）. Pearson correlation analysis was employed to explore the relationships among variables， and the results indicated a positive correlation between the Hp detection value （DPM） and the levels of TNF-α， IL-6， CRP， and LSM （P < 0.05）. Furthermore， binary logistic regression analysis was conducted to identify independent risk factors. The findings demonstrated that positive Hp infection， elevated TNF-α， elevated IL-6， and elevated CRP were independent risk factors for the progression of liver fibrosis （P < 0.05）. To evaluate the diagnostic performance， the receiver operating characteristic （ROC） curve analysis was carried out. The areas under the curve （AUC） for HP infection， TNF-α， IL-6， and CRP were 0.800， 0.786， 0.769， and 0.783， respectively. These values were significantly lower than the AUC of 0.896 obtained from the combined detection （P < 0.05）. Conclusions In MAFLD patients with T2DM， DPM is closely associated with inflammatory factors （such as TNF-α， IL-6， and CRP） and the advancement of liver fibrosis. The combined detection of these factors holds significant value in predicting the progression of liver fibrosis. It can offer a reliable foundation for the clinical assessment of the risk of liver fibrosis progression.

Key words: metabolically related fatty liver disease, type 2 diabetes, Helicobacter pylori, inflammatory factors, hepatic fibrosis

CLC Number:

R587.1

Jingyao LI,Xiaodi ZHU,Fei SU,Yunfeng ZHANG,Nilin ZHANG,Qiquan LIU. Association of Hp infection with inflammatory factors and hepatic fibrosis progression in metabolically associated fatty liver disease with type 2 diabetes mellitus[J]. The Journal of Practical Medicine, 2025, 41(13): 2045-2051.

Figures/Tables 7

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References 22

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指标	Hp阳性组（n = 121）	Hp阴性组（n = 179）	χ²/t值	P值
性别/［例（%）］			0.192	0.661
男	68（56.20）	96（53.63）
女	53（43.80）	83（46.37）
年龄（x ± s）/岁	55.34 ± 10.59	46.25 ± 10.18	7.465	< 0.001
BMI（x ± s）/（kg/m²）	23.34 ± 1.59	23.25 ± 1.48	0.501	0.616
高血压病史/［例（%）］			0.143	0.706
有	30（24.79）	41（22.91）
无	91（75.21）	138（77.09）
FPG（x ± s）/（mmol/L）	9.32 ± 2.51	7.73 ± 1.54	6.795	< 0.001
HbA1c（x ± s）/%	8.34 ± 2.11	5.67 ± 1.73	11.989	< 0.001
ALB（x ± s）/（g/L）	45.91 ± 2.57	45.32 ± 2.64	1.919	0.056
ALP（x ± s）/（U/L）	73.64 ± 11.23	72.26 ± 9.68	1.135	0.257
TBIL（x ± s）/（μmol/L）	11.32 ± 3.41	12.79 ± 3.37	3.689	< 0.001
DBIL（x ± s）/（μmol/L）	3.65 ± 1.18	4.59 ± 1.34	6.250	< 0.001
IBIL（x ± s）/（μmol/L）	7.86 ± 2.11	8.94 ± 2.17	4.276	< 0.001
ALT（x ± s）/（U/L）	23.22 ± 3.67	24.01 ± 3.74	1.808	0.072
AST（x ± s）/（U/L）	23.45 ± 4.12	23.76 ± 3.87	0.663	0.508
UA（x ± s）/（μmol/L）	407.39 ± 33.64	411.59 ± 31.83	1.096	0.274
TG（x ± s）/（mmol/L）	2.26 ± 0.42	2.35 ± 0.49	1.651	0.100
TC（x ± s）/（mmol/L）	5.03 ± 1.18	5.16 ± 1.21	0.922	0.357
HDL-C（x ± s）/（mmol/L）	1.67 ± 0.32	1.61 ± 0.30	1.654	0.099
LDL-C（x ± s）/（mmol/L）	3.16 ± 0.74	3.09 ± 0.78	0.778	0.437
TNF-α（x ± s）/（pg/mL）	326.95 ± 30.66	287.64 ± 29.35	11.177	< 0.001
IL-6（x ± s）/（ng/L）	1.34 ± 0.12	1.06 ± 0.11	20.845	< 0.001
CRP（x ± s）/（mg/L）	9.25 ± 2.21	7.81 ± 2.15	5.627	< 0.001
LSM（x ± s）/（kPa）	13.15 ± 3.67	7.39 ± 2.54	16.068	< 0.001

指标	干预组（n = 61）	对照组（n = 60）	t值	P值
干预前TNF-α/（pg/mL）	329.57 ± 25.41	324.33 ± 26.19	1.117	0.266
干预后TNF-α/（pg/mL）	267.63 ± 28.24	327.73 ± 26.15	12.142	< 0.001
干预前IL-6/（ng/L）	1.36 ± 0.13	1.32 ± 0.11	1.826	0.070
干预后IL-6/（ng/L）	1.04 ± 0.09	1.35 ± 0.12	16.093	< 0.001
干预前CRP/（mg/L）	9.43 ± 1.93	9.07 ± 1.89	1.036	0.302
干预后CRP/（mg/L）	7.51 ± 1.74	9.40 ± 2.04	5.486	< 0.001
干预前LSM/kPa	13.44 ± 2.37	12.86 ± 2.42	1.332	0.185
干预后LSM/kPa	7.16 ± 2.09	13.19 ± 2.45	14.574	< 0.001

指标	DPM
指标	r值	P值
TNF-α	0.578	< 0.001
IL-6	0.627	< 0.001
CRP	0.535	< 0.001
LSM	0.668	< 0.001

变量	赋值
肝纤维化进展	无肝纤维化=1，轻微肝纤维化=2，显著肝纤维化=3
Hp感染	阴性=0，阳性=1
TNF-α	连续变量
IL-6	连续变量
CRP	连续变量

指标	β	标准误	Wald χ²	OR	95%CI	P值
Hp感染	1.672	0.479	21.333	5.323	2.618 ~ 10.821	< 0.001
TNF-α	0.983	0.431	7.374	2.672	1.315 ~ 5.433	0.007
IL-6	1.022	0.440	7.970	2.779	1.367 ~ 5.649	0.005
CRP	0.884	0.415	5.963	2.421	1.191 ~ 4.921	0.015

Association of Hp infection with inflammatory factors and hepatic fibrosis progression in metabolically associated fatty liver disease with type 2 diabetes mellitus

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变量	曲线下面积	标准误	P值	95%CI	截断值	灵敏度	特异度
Hp感染	0.800	0.050	< 0.001	0.702 ~ 0.898	阳性	0.792	0.873
TNF-α	0.786	0.046	< 0.001	0.697 ~ 0.875	346.72 pg/mL	0.816	0.714
IL-6	0.769	0.049	< 0.001	0.673 ~ 0.865	1.4 1ng/L	0.731	0.829
CRP	0.783	0.048	< 0.001	0.690 ~ 0.876	11.18 mg/L	0.763	0.691
联合检测	0.896	0.029	< 0.001	0.839 ~ 0.954		0.883	0.781

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