评估肥胖相关指标对非酒精性脂肪肝的筛查价值

李婧; 李小凤; 闫妮; 刘玲娇

doi:10.16766/j.cnki.issn.1674-4152.002843

评估肥胖相关指标对非酒精性脂肪肝的筛查价值

doi: 10.16766/j.cnki.issn.1674-4152.002843

李婧¹,
李小凤¹,
闫妮²,
刘玲娇^1, ,

1.
陕西省人民医院内分泌科，陕西西安 710068
2.
陕西省人民医院风湿免疫科

基金项目:

国家自然科学基金项目 81700735

详细信息

通讯作者:
刘玲娇，E-mail：jorlin2008@163.com

中图分类号: R575.5
计量
- 文章访问数: 212
- HTML全文浏览量: 64
- PDF下载量: 21
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-13
- 网络出版日期: 2023-04-20

Evaluation the screening value of obesity-related indices for non-alcoholic fatty liver disease

1.
Department of Endocrinology, Shaanxi Provincial People' s Hospital, Xi' an, Shaanxi 710068, China

摘要

摘要: 目的探讨筛查中老年人非酒精性脂肪肝(NAFLD)的最佳肥胖相关指标。方法本项横断面研究筛选了2019年1—3月在陕西省人民医院健康管理中心参加体检的40岁及以上受试者1 281人，进行病史采集、体格检查及实验室检查，所有受试者均接受腹部B超检查。应用logistic回归分析研究各肥胖指标与NAFLD患病风险的相关性，采用ROC曲线评估肥胖指标对NAFLD患病风险的筛查价值。结果在1 281例受试者中，335例诊断为NAFLD，NAFLD的患病率为26.15%。NAFLD组的血压、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、转氨酶、空腹血糖、空腹胰岛素、稳态模型估计的胰岛素抵抗指数、糖化血红蛋白、腰围、腰臀比、BMI、脂质蓄积指数(LAP)均明显升高，高密度脂蛋白胆固醇降低。Logistic回归分析显示，在校正了相关混杂因素后，腰围、腰臀比、BMI、LAP均与NAFLD的患病风险相关。其中LAP与NAFLD的相关性最强，与处于LAP第一分位的受试者相比，处于LAP第四分位的受试者NAFLD的患病风险显著增加(OR=18.055，95% CI: 7.683~42.427，P < 0.001)。4个肥胖相关指标的AUC均>0.7，表明4个肥胖相关指标均对NAFLD有较高的筛查价值。不论男性还是女性，LAP对NAFLD的筛查价值均最高，男性AUC为85.34(95% CI: 81.78~88.90)，女性AUC为80.22(95% CI: 76.95~83.48)。结论 LAP与NAFLD的患病风险密切相关，可能是筛查中老年人NAFLD的有效工具。
- 肥胖相关指标 /
- 脂质蓄积指数 /
- 非酒精性脂肪肝 /
- 中老年人
Abstract: Objective To explore obesity-related indices suitable for screening non-alcoholic fatty liver disease (NAFLD) in middle-aged and elderly population. Methods This cross-sectional study screened 1 281 people aged 40 and above who attended physical examinations at the Health Management Center of Shaanxi Provincial People' s Hospital from January to March 2019. Their medical history was recorded, and they underwent physical examination and laboratory tests. All subjects underwent abdominal ultrasonography. Logistic regression was used to analyse the association between obesity index and the risk of NAFLD. ROC curve was used to evaluate the screening value of obesity indices for the risk of NAFLD. Results Among 1 281 subjects, 335 were diagnosed with NAFLD, with a prevalence rate of 26.15%. The blood pressure, triglyceride, total cholesterol, low density lipoprotein cholesterol, transaminase levels, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance, haemoglobin A1c, waist circumference (WC), waist-to-hip ratio (WHR), BMI and lipid accumulation product (LAP) values significantly increased in the NAFLD group, and the high-density lipoprotein cholesterol decreased. Logistic regression analysis showed that WC, WHR, BMI and LAP were significantly correlated with NAFLD after adjusting for confounding factors. Among them, LAP had the strongest correlation with NAFLD. Compared with subjects in the first quartile of LAP, subjects in the fourth quartile had a significantly increased risk of NAFLD (OR=18.055, 95% CI: 7.683-42.427, P < 0.001). The AUC of the four obesity indices were all greater than 0.7, indicating that they had high screening value for NAFLD. LAP had the highest screening value for NAFLD in males and females, with AUC 85.34 (95% CI: 81.78-88.90) in males and AUC 80.22 (95% CI: 76.95-83.48) in females. Conclusion LAP is closely associated with the risk of NAFLD and may be an effective tool for screening the disease in middle-aged and elderly people.
- Obesity-related index /
- Lipid accumulation product /
- Non-alcoholic fatty liver disease /
- Middle-aged and elderly people

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表 1 NAFLD组和非NAFLD组体检人群基线指标比较

Table 1. Comparison of baseline indexes between the NAFLD group and the non-NAFLD group

项目	非NAFLD组 (n=946)	NAFLD组 (n=335)	统计量	P值
年龄(x±s, 岁)	58.6±10.5	57.2±8.9	2.244^a	0.025
性别(男/女, 例)	330/616	128/207	1.191^b	0.275
吸烟[例(%)]	187(19.8)	81(24.2)	2.910^b	0.088
饮酒[例(%)]	23(2.4)	15(4.5)	3.599^b	0.058
SBP(x±s, mm Hg)	139.4±19.6	146.5±18.4	5.724^a	< 0.001
DBP(x±s, mm Hg)	80.5±10.1	85.2±10.8	7.157^a	< 0.001
ALT[M(P₂₅, P₇₅), U/L]	17.8(14.2, 24.3)	25.7(19.2, 35.5)	11.343^c	< 0.001
AST[M(P₂₅, P₇₅), U/L]	23.0(19.7, 26.9)	23.9(20.1, 30.1)	2.883^c	0.004
GGT[M(P₂₅, P₇₅), U/L]	17.0(13.0, 26.0)	30.0(21.0, 44.0)	13.186^c	< 0.001
TG[M(P₂₅, P₇₅), mmol/L]	1.1(0.9, 1.6)	1.8(1.2, 2.6)	12.325^c	< 0.001
TC(x±s, mmol/L)	5.3±1.0	5.6±1.3	4.737^a	< 0.001
HDL-C(x±s, mmol/L)	1.4±0.3	1.2±0.3	8.876^a	< 0.001
LDL-C(x±s, mmol/L)	3.1±0.8	3.2±0.9	3.564^a	< 0.001
糖化血红蛋白(x±s, %)	5.7±0.8	6.1±1.1	7.542^a	< 0.001
FBG(x±s, mmol/L)	5.4±1.6	6.1±2.1	6.221^a	< 0.001
FINS[M(P₂₅, P₇₅), mIU/L]	3.0(1.4, 5.2)	6.5(4.0, 9.9)	14.687^c	< 0.001
HOMA-IR[M(P₂₅, P₇₅)]	0.7(0.3, 1.2)	1.7(1.0, 2.7)	15.368^c	< 0.001
WC(x±s, cm)	78.3±7.9	87.5±7.4	18.480^a	< 0.001
WHR(x±s)	0.86±0.06	0.91±0.05	15.213^a	< 0.001
BMI(x±s)	24.4±2.8	27.7±2.8	18.153^a	< 0.001
LAP[M(P₂₅, P₇₅)]	20.4(12.3, 32.1)	47.7(32.0, 71.1)	16.089^c	< 0.001
注：^a为t值，^b为χ²值，^c为Z值。1 mm Hg=0.133 kPa。

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表 2 受试者各肥胖指标与NAFLD患病风险的logistic回归分析

Table 2. Logistic regression analysis of obesity index and risk of NAFLD

变量	NAFLD [例(%)]	B	SE	Wald χ²	P值	OR(95% CI)
WHR
Q2	49(15.3)	1.083	0.383	7.998	0.005	2.953(1.394~6.255)
Q3	83(27.9)	1.796	0.371	23.479	< 0.001	6.026(2.914~12.460)
Q4	193(56.4)	2.702	0.366	54.399	< 0.001	14.904(7.269~30.555)
腰臀比
Q2	51(15.7)	0.754	0.331	5.178	0.023	2.125(1.110~4.068)
Q3	101(31.8)	1.735	0.313	30.780	< 0.001	5.668(3.071~10.463)
Q4	168(53.0)	2.293	0.320	51.503	< 0.001	9.904(5.295~18.526)
BMI
Q2	43(13.3)	0.735	0.340	4.663	0.031	2.085(1.070~4.061)
Q3	95(29.7)	1.609	0.319	25.403	< 0.001	4.999(2.674~9.347)
Q4	179(56.3)	2.287	0.319	51.239	< 0.001	9.843(5.263~18.410)
LAP
Q2	43(13.4)	1.319	0.396	11.099	0.001	3.741(1.721~8.130)
Q3	98(30.7)	2.013	0.395	25.991	< 0.001	7.488(3.453~16.237)
Q4	185(57.8)	2.893	0.436	44.058	< 0.001	18.055(7.683~42.427)
注：均以Q1为对照。

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表 3 不同性别受试者各个肥胖指标筛查NAFLD患病风险的ROC曲线的结果分析

Table 3. Analysis of ROC curves for the risk of NAFLD in subjects of different genders for each obesity index

变量	AUC(95% CI)	截点值	灵敏度	特异度	约登指数
总人群
WC	80.32(77.68~82.96)	81.75	0.805	0.679	0.483
WHR	76.65(73.79~79.51)	0.87	0.796	0.603	0.399
BMI	79.17(76.43~81.90)	26.01	0.718	0.721	0.439
LAP	82.13(79.70~84.56)	33.90	0.730	0.775	0.505
男性
WC	82.24(78.34~86.13)	82.75	0.913	0.581	0.494
WHR	79.56(75.37~83.74)	0.91	0.803	0.663	0.466
BMI	80.53(76.21~84.85)	25.86	0.780	0.696	0.476
LAP	85.34(81.78~88.90)	32.99	0.780	0.827	0.607
女性
WC	79.96(76.55~83.37)	80.75	0.757	0.711	0.468
WHR	77.06(73.48~80.65)	0.86	0.777	0.646	0.423
BMI	78.32(74.78~81.86)	26.03	0.694	0.731	0.425
LAP	80.22(76.95~83.48)	35.46	0.704	0.766	0.470

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