基于甘油三酯相关指标的非酒精性脂肪性肝病预测价值研究

doi:10.3969/j.issn.1006-3110.2023.06.012

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摘要目的探讨不同甘油三酯相关指标,即甘油三酯高密度脂蛋白胆固醇比值(triglyceride to high density lipoprotein cholesterol ratio,TG/HDL-C)、甘油三酯葡萄糖乘积指数(triglyceride glucose index,TyG指数)及相关参数与非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)的相关性及在NAFLD疾病预测中的应用价值。方法选取2022年1—4月在新疆医科大学第一附属医院参与健康检查的608例体检者为研究对象;根据B型超声影像学参数结果,分为NAFLD组(328例)和非NAFLD组(280例),比较两组间各临床相关指标差异;采用logistic回归分析五种甘油三酯相关指标与NAFLD之间的相关性,并运用受试者工作特征曲线(receiver operating characteristic curve,ROC)进一步分析其在NAFLD疾病筛查中的预测价值。结果 logistic回归分析结果显示,在五种甘油三酯相关指标中,无论调整混杂因素前或后,均以TyG指数-腰高比(triglyceride glucose index-waist height ratio,TyG-WHtR)的比值比最为显著,分别为13.485(95%CI:8.919～20.389)和12.559(95%CI:7.729～20.405)。ROC曲线结果分析显示,五种甘油三酯相关指标预测NAFLD的ROC曲线下面积(area under the curve,AUC)均大于0.7(P<0.05);其中,TyG指数-体质指数(triglyceride glucose index-body mass index,TyG-BMI)在18～40岁男性受试者中预测NAFLD的AUC最大,为0.871(95%CI:0.797～0.926);TyG指数-腰围(triglyceride glucose index-waist circumference,TyG-WC)预测总体男性、女性、体质指数(body mass index,BMI)<24人群以及40岁以上女性受试者的AUC最大,分别为0.850(95%CI:0.805～0.888)、0.908(95%CI:0.869～0.938)、0.840(95%CI:0.783～0.888)和0.913(95%CI:0.864～0.949);TyG-WHtR预测BMI≥24人群、18～40岁女性受试者以及40岁以上男性受试者的AUC最大,分别为0.803(95%CI:0.761～0.841)、0.904(95%CI:0.835～0.952)和0.851(95%CI:0.791～0.899)。结论 TG/HDL-C、TyG指数及相关参数与NAFLD密切相关,其中与TyG指数相关的参数对NAFLD具有更高的预测价值。

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关键词 ：非酒精性脂肪性肝病, 甘油三酯高密度脂蛋白胆固醇比值, 甘油三酯葡萄糖乘积指数, 甘油三酯葡萄糖乘积指数相关参数

Abstract：Objective To explore the correlation of different triglyceride related indicators, namely triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) and triglyceride glucose index (TyG) and their related parameters, with non-alcoholic fatty liver disease (NAFLD) and their application values in the prediction of NAFLD. Methods Six hundred and eight physical examinees in the First Affiliated Hospital of Xinjiang Medical University from January to April 2022 were selected as the subjects, and then they were divided into the NAFLD group (n=328) and the non-NAFLD group (n=280) according to the results of B-type ultrasound imaging parameters. The differences in the clinical related indexes were compared between the two groups. Logistic regression was used to analyze the correlation of five triglyceride related indicators with NAFLD, and receiver operating characteristic curve (ROC curve) was used to further analyze their predictive values in the screening of NAFLD. Results The results of logistic regression analysis showed that both before and after adjusting for potential confounding factors, the odds ratio of triglyceride glucose index-waist height ratio (TyG-WHtR) was the most significant among the five triglyceride related indicators, which was 13.485 (95%CI:8.919-20.389) and 12.559 (95%CI:7.729-20.405) respectively. ROC curve analysis displayed that the areas under receiver operating characteristic curves (AUCs) of the five triglyceride related indexes for predicting NAFLD were all greater than 0.7 (all P<0.05). Among them, the AUC of triglyceride glucose index-body mass index (TyG-BMI) in predicting NAFLD among male subjects aged 18-40 years was the largest, which was 0.871 (95%CI:0.797-0.926). The AUCs of triglyceride glucose index-waist circumference (TyG-WC) in predicting NAFLD among overall males, females, population with body mass index (BMI) <24 and females over 40 years old were the largest, which were 0.850 (95%CI:0.805-0.888), 0.908 (95%CI:0.869-0.938), 0.840 (95%CI:0.783-0.888) and 0.913 (95%CI:0.864-0.949) respectively. The AUCs of TyG-WHtR in predicting NAFLD among population with BMI ≥24, female subjects aged 18-40 years and male subjects aged over 40 years were the largest, which were 0.803 (95%CI:0.761-0.841), 0.904 (95%CI:0.835-0.952) and 0.851 (95%CI:0.791-0.899) respectively. Conclusion TG/HDL-C, TyG index and their related parameters are closely correlated with NAFLD, and the parameters related to TyG index have higher predictive values for NAFLD.

Key words： non-alcoholic fatty liver disease triglyceride to high density lipoprotein cholesterol ratio triglyceride glucose index triglyceride glucose index related parameter

收稿日期: 2022-07-06

R575.5

基金资助:新疆维吾尔自治区自然科学基金资助项目(2021D01C270)

通讯作者: 林素兰,E-mail:linsulan@163.com。

作者简介: 王仁媛(1997-),女,在读硕士研究生,护师,研究方向:慢性病预防与健康管理。

引用本文:

王仁媛, 咸亚静, 林栋羚, 何丽, 林素兰. 基于甘油三酯相关指标的非酒精性脂肪性肝病预测价值研究[J]. 实用预防医学, 2023, 30(6): 693-699. WANG Ren-yuan, XIAN Ya-jing, LIN Dong-ling, HE Li, LIN Su-lan. Predictive values of triglyceride-related indicators on non-alcoholic fatty liver disease. , 2023, 30(6): 693-699.

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[1] 吴挺丰,廖献花,钟碧慧.中国部分地区非酒精性脂肪肝病的流行情况[J].临床肝胆病杂志,2020,36(6):1370-1373.
[2] Wang FS,Fan JG,Zhang Z,et al.The global burden of liver disease: the major impact of China[J].Hepatology,2014,60(6):2099-2108.
[3] 范建高,曾静.非酒精性脂肪性肝病的流行现状与危害[J].中华消化杂志,2020,40(9):577-580.
[4] Estes C,Anstee QM,Arias-Loste MT,et al.Modeling NAFLD disease burden in China,France,Germany,Italy,Japan,Spain,United Kingdom,and United States for the period 2016-2030[J].J Hepatol,2018,69(4):896-904.
[5] Li N,Tan HW,Xie AX,et al.Value of the triglyceride glucose index combined with body mass index in identifying non-alcoholic fatty liver disease in patients with type 2 diabetes[J].BMC Endocr Disord,2022,22(1):101-109.
[6] 李小林,何伟,刘盛扶.老年2型糖尿病患者中非酒精性脂肪性肝病与代谢性指标的相关性[J].实用预防医学,2022,29(2):145-148.
[7] Lim J,Kim J,Koo SH,et al.Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: an analysis of the 2007-2010 Korean National Health and Nutrition Examination Survey[J].PLoS One,2019,14(3):e0212963.
[8] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南(2018年更新版)[J].临床肝胆病杂志,2018,34(5):177-186.
[9] 刘奕婷,王巍.健康体检人群白细胞计数与非酒精性脂肪肝的关联性研究[J].实用预防医学,2020,27(1):57-60.
[10] 高小莲,肖明中,陶军秀,等.非酒精性脂肪性肝病预测模型的特征分析[J].中国全科医学,2021,24(30):3888-3892,3899.
[11] Xue M,Yang X,Zou Y,et al.A non-invasive prediction model for non-alcoholic fatty liver disease in adults with type 2 diabetes based on the population of northern Urumqi, China[J].Diabetes Metab Syndr Obes,2021,14:443-454.
[12] 桑潮,梁丹丹,谢国祥,等.非酒精性脂肪性肝病血清学无创诊断的研究进展[J].上海交通大学学报(医学版),2021,41(1):112-117.
[13] Zhang YN,Fowler KJ,Hamilton G,et al.Liver fat imaging-a clinical overview of ultrasound, CT, and MR imaging[J].Br J Radiol,2018,91(1089):20170959.
[14] Xu MY,Ma JH,Du J,et al.Nonalcoholic fatty liver disease is associated with Helicobacter pylori infection in north urban Chinese: a retrospective study[J].Gastroenterol Res Pract,2020,2020:9797841.
[15] Sheng GT, Xie QY, Wang RS, et al. Waist-to-height ratio and non-alcoholic fatty liver disease in adults[J].BMC Gastroenterol,2021,21(1):239-246.
[16] Sheng GT, Lu S, Xie QY, et al. The usefulness of obesity and lipid-related indices to predict the presence of non-alcoholic fatty liver disease[J].Lipids Health Dis,2021,20(1):134-147.
[17] Khamseh ME,Malek M,Abbasi R,et al.Triglyceride glucose index and related parameters (triglyceride glucose-body mass index and triglyceride glucose-waist circumference) identify nonalcoholic fatty liver and liver fibrosis in individuals with overweight/obesity[J].Metab Syndr Relat Disord,2021,19(3):167-173.
[18] Wells JC.Sexual dimorphism of body composition[J].Best Pract Res Clin Endocrinol Metab,2007,21(3):415-430.
[19] 张荣欣,薛长勇,郑子新,等.成人BMI与体脂含量和脂肪分布的关系[J].营养学报,2002,24(2):144-148.
[20] 白静雅,何烨,海向军,等.兰州市汉族成人皮褶厚度与体成分分析[J].解剖学杂志,2014,37(4):527-532.
[21] Santosa S,Jensen MD.Sex and sex steroids: impact on the kinetics of fatty acids underlying body shape[J].Horm Mol Biol Clin Invest,2014,20(1):15-23.
[22] Zhang SJ,Du TT,Li MN,et al.Triglyceride glucose-body mass index is effective in identifying nonalcoholic fatty liver disease in nonobese subjects[J].Medicine (Baltimore),2017,96(22):e7041.
[23] 章萌,张姗,金笑寒,等.体重指数与非酒精性脂肪肝关联的国内外研究现状[J].中国健康教育,2022,38(1):76-80.
[24] 王珊,张健,张卫欢,等.体质量指数联合腰围对2型糖尿病患者新发非酒精性脂肪肝的预测价值[J].南方医科大学学报,2019,39(11):1293-1297.
[25] Tutunchi H,Naeini F,Mobasseri M,et al.Triglyceride glucose (TyG) index and the progression of liver fibrosis: a cross-sectional study[J].Clin Nutr ESPEN,2021,44:483-487.