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已发表论文
中国 2 型糖尿病患者空腹 C 肽与高密度脂蛋白胆固醇比值与非酒精性脂肪肝疾病的相关性：一项横断面研究
Authors Liang Q , Hu H , Chen X, Yang S, Zhang Y, Wu Y, Wang X, Chen H
Received 16 August 2025
Accepted for publication 24 November 2025
Published 11 December 2025 Volume 2025:18 Pages 4507—4522
DOI https://doi.org/10.2147/DMSO.S556539
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Jae Woong Sull
Qian Liang,1– 4 Haofei Hu,5 Xuan Chen,2– 4 Shufen Yang,2– 4 Ying Zhang,2– 4 Yan Wu,2– 4 Xinyu Wang,6 Hong Chen1
1Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Endocrinology, Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 3Department of Endocrinology, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China; 4Department of Endocrinology, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong, People’s Republic of China; 5Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 6Department of Endocrinology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, People’s Republic of China
Correspondence: Hong Chen, Email chenhong123@smu.edu.cn Xinyu Wang, Email wxyhorse@126.com
Objective: To investigate fasting C-peptide to high-density lipoprotein cholesterol ratio (FHR) as a predictor for non-alcoholic fatty liver disease (NAFLD) in Chinese adults with type 2 diabetes mellitus (T2DM).
Methods: This study enrolled 718 participants with T2DM from Shenzhen People’s Hospital, China. Participants were stratified by FCP/HDL-C ratio (FHR) quartiles. Multiple linear regression assessed the association between FHR and NAFLD. A generalized additive model (GAM) tested for nonlinearity. Subgroup analyses evaluated result robustness. The area under the curve (AUC) evaluated the performance of the FHR model for NAFLD occurrence.
Results: After adjusting for relevant variables, FHR was positively correlated with NAFLD (OR = 1.30, 95% CI (1.15, 1.48)). FHR demonstrated a nonlinear association with NAFLD, characterized by a threshold value of 1.23. The effect sizes and confidence intervals on the left and right sides of the inflection point were 3.07 (1.51, 6.24) and 1.20 (1.05, 1.37), respectively. Subgroup analysis showed a stronger correlation could be detected in patients with systolic blood pressure (SBP) < 140 mmHg, alanine transaminase (ALT) > 40U/L, fasting blood glucose (FBG) ⩽7 mmol/L, urinary albumin to creatinine ratio (UACR) ⩽30mg/g, triglyceride (TG) ⩽1.7 mmol/L and the patients with drinking history. The FHR ratio model exhibited better discriminative ability in NAFLD (AUC = 0.697) compared to individual FCP (AUC = 0.649) or HDL-C (AUC = 0.635) alone.
Conclusion: The association between FHR and NAFLD was nonlinear, with a positive relationship observed when FHR exceeded the threshold of 1.23.
Keywords: fasting C-peptide to high-density lipoprotein cholesterol ratio, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, insulin resistance, overweight, obesity, diabetes mellitus
1Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Endocrinology, Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 3Department of Endocrinology, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China; 4Department of Endocrinology, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong, People’s Republic of China; 5Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 6Department of Endocrinology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, People’s Republic of China
Correspondence: Hong Chen, Email chenhong123@smu.edu.cn Xinyu Wang, Email wxyhorse@126.com
Objective: To investigate fasting C-peptide to high-density lipoprotein cholesterol ratio (FHR) as a predictor for non-alcoholic fatty liver disease (NAFLD) in Chinese adults with type 2 diabetes mellitus (T2DM).
Methods: This study enrolled 718 participants with T2DM from Shenzhen People’s Hospital, China. Participants were stratified by FCP/HDL-C ratio (FHR) quartiles. Multiple linear regression assessed the association between FHR and NAFLD. A generalized additive model (GAM) tested for nonlinearity. Subgroup analyses evaluated result robustness. The area under the curve (AUC) evaluated the performance of the FHR model for NAFLD occurrence.
Results: After adjusting for relevant variables, FHR was positively correlated with NAFLD (OR = 1.30, 95% CI (1.15, 1.48)). FHR demonstrated a nonlinear association with NAFLD, characterized by a threshold value of 1.23. The effect sizes and confidence intervals on the left and right sides of the inflection point were 3.07 (1.51, 6.24) and 1.20 (1.05, 1.37), respectively. Subgroup analysis showed a stronger correlation could be detected in patients with systolic blood pressure (SBP) < 140 mmHg, alanine transaminase (ALT) > 40U/L, fasting blood glucose (FBG) ⩽7 mmol/L, urinary albumin to creatinine ratio (UACR) ⩽30mg/g, triglyceride (TG) ⩽1.7 mmol/L and the patients with drinking history. The FHR ratio model exhibited better discriminative ability in NAFLD (AUC = 0.697) compared to individual FCP (AUC = 0.649) or HDL-C (AUC = 0.635) alone.
Conclusion: The association between FHR and NAFLD was nonlinear, with a positive relationship observed when FHR exceeded the threshold of 1.23.
Keywords: fasting C-peptide to high-density lipoprotein cholesterol ratio, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, insulin resistance, overweight, obesity, diabetes mellitus