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total skeletal muscle mass（kg）/total fat mass（kg）. We measured controlled attenuation parameter（CAP）and liver stiffness
measurement（LSM）via FibroScan. Patients were divided into the non⁃MAFLD and MAFLD groups a ccording to whether they had
MAFLD. MFR was stratified into gender⁃specific tertiles. Its association with MAFLD was analyzed using logistic regression and trend
tests，with diagnostic performance evaluated via receiver operating characteristic（ROC）curve analysis. Results：A total of 2 056
T2DM patients were screened，of whom 448 met the inclusion criteria and were enrolled. The mean age was 55.33 ± 12.00 years，and
2
the mean body mass index（BMI）was 25.13 ± 3.51 kg/m . The overall prevalence of MAFLD was 62.5%（280/448）. The prevalence
was lower in males（59.9%，187/312）than in females（68.4%，93/136）. The MFR was significantly lower in the MAFLD group（n=280）
than in the non⁃MAFLD group（n=168）［1.01（0.77，1.24）vs. 1.29（0.96，1.74），P < 0.001］. MFR tertile analysis showed a decreasing
prevalence of MAFLD with increasing MFR（P < 0.001）. Multivariable logistic regression revealed gender ⁃ specific associations.
Compared to the highest MFR tertile，males in the lowest and middle tertiles had a significantly higher risk of MAFLD［OR（95% CI）：
3.36（1.49-7.57）and 2.03（1.02-4.03），respectively］，with a significant linear trend（P for trend = 0.001）. In contrast，among females，

only the middle tertile showed a significantly increased risk［OR（95% CI）：3.53（1.05-11.88）］，with no linear trend（P for trend =
0.699）. Additionally，mediation analysis demonstrated a statistically significant indirect effect of BMI in females（effect=- 3.59，
Bootstrap 95% CI：-7.23--1.09）. The area under the ROC curve of MFR for diagnosing MAFLD was 0.766（cut⁃off value：1.22）in
males and 0.711（cut⁃off value：0.78）in females. Correlation analysis indicated that MFR was negatively correlated with obesity indices，

homeostatic model assessment of insulin resistance，CAP，and LSM in both genders. However，age was negatively correlated with MFR
only in females，whereas blood lipids，uric acid，and liver enzymes showed inverse correlations only in males. Conclusion：MFR is
independently associated with MAFLD risk in patients with T2DM，and this association exhibits distinct gender⁃specific patterns，
highlighting the importance of considering gender in clinical management.
［Key words］ muscle⁃to⁃fat ratio；metabolic dysfunction⁃associated fatty liver disease；type 2 diabetes mellitus；bioelectrical imped⁃
ance analysis；gender differences
［J Nanjing Med Univ，2026，46（08）：1187⁃1196］

代谢相关脂肪性肝病（metabolic dysfunction⁃ 了肌肉与脂肪的平衡状态，多项研究表明，低 MFR
associated fatty liver disease，MAFLD）由非酒精性脂 或高脂肪肌肉比（fat⁃to⁃muscle ratio，FMR）与T2DM、
肪肝（non⁃alcoholic fatty liver disease，NAFLD）变更而 MAFLD或NAFLD以及代谢综合征和心血管疾病风
来，其本质是一种由代谢失调驱动的慢性肝病，内在 险增加独立相关 ［8- 10］ 。然而，现有关于 MFR 与
遗传易感性与营养过剩等环境因素的相互作用共同 MAFLD 的研究多基于社区或体检人群，针对住院
构成了其发病基础，胰岛素抵抗贯穿全程，为核心驱 T2DM 患者这一高风险人群的研究较少。此外，性
［1］ ［11］
动机制 。而 MAFLD 与 2 型糖尿病（type 2 diabetes 激素影响体成分分布与代谢调节 ，这提示MFR与
mellitus，T2DM）常相伴发生，并相互影响 ［2-3］ 。MAFLD MAFLD的关联可能存在性别差异，但这一假设在住
通过加剧胰岛素抵抗等机制，加速 T2DM 及其并发 院 T2DM 患者中尚未得到充分验证。基于上述背
症的进展。反之，T2DM则会促进MAFLD向脂肪性 景，本研究拟通过回顾性分析，探讨 MFR 与住院
肝炎、肝纤维化演变，从而显著提升肝病相关死亡 T2DM患者MAFLD风险之间的关系，并分析其性别
风险。这种双向的病理生理互动，协同增加了患者 差异，为MAFLD的筛查和临床干预提供科学依据。
心血管事件与全因死亡风险 ［2-3］ 。因此，国内外多个
1 对象和方法
指南均强调在 T2DM 患者中开展 MAFLD 的筛查与
管理 。研究表明，低肌肉量与高脂肪量，尤其“肌 1.1 对象
［4］
少性肥胖”，可通过胰岛素抵抗、慢性炎症、脂毒性 回顾性收集2023年9月—2024年8月于南京医
等途径促进 T2DM 和 MAFLD 的进展 ［5-7］ 。人体肌肉 科大学第一附属医院内分泌科住院的T2DM患者的
量与脂肪量常同时发生变化，肌肉量下降伴随脂肪 临床资料，共筛查患者 2 056 例，根据纳入排除标
量增加可能造成双重代谢负担，引发更严重的代谢 准，最终448例患者被纳入本研究。纳入标准：年龄≥
紊乱。而肌肉脂肪比（muscle⁃to⁃fat ratio，MFR）反映 18岁；参照《中国2型糖尿病防治指南（2020年版）》