非酒精性脂肪肝肝纤维化评分与脂肪肝及胰岛素抵抗的相关性研究

Relationship of nonalcoholic fatty liver disease fibrosis score with fatty liver disease and insulin resistance

目的分析非酒精性脂肪肝肝纤维化评分(NAFLDFS)与非酒精性脂肪肝(NAFLD)及胰岛素抵抗(IR)的相关性。方法以来自江苏徐州地区的2622例健康体检人群为研究对象,检测受试者的血清谷丙转氨酶(ALT),谷草转氨酶(AST),血小板计数(PLT),血清白蛋白(ALB),空腹血糖(FBG),餐后2 h血糖(PBG),空腹胰岛素(Fins)等相关生化指标,计算出NAFLDFS及胰岛素抵抗指数(HOMA2-IR),将研究对象按非酒精性脂肪肝纤维化评分的低诊断阈值(-1.455)及高诊断阈值(0.676)分成三组,A1组:NAFLDFS<-1.455;A2组:0.676≥NAFLDFS≥-1.455和A3组NAFLDFS>0.676。Pearson分析肝纤维化评分与各指标相关性;运用二元Logistic回归计算NAFLDFS与NAFLD、IR的风险性。结果随着NAFLDFS值增高,年龄(Age)、体重(Weight)、体重指数(BMI)、腰围(WC)、臀围(Hip)、糖化血红蛋白(HbA1c)、颈围(NC)、FBG、PBG、Fins、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)水平逐渐增高,且三组间的差异有统计学意义;而ALT、AST、PLT、ALB、高密度脂蛋白(HDL-C)随着NAFLDFS值的增高而减小。Pearson分析显示Age、NC、WC、Hip、Weight、BMI、HbA1c、FBG、PBG、PLT与NAFLDFS正相关。随着NAFLDFS值的增加,NAFLD与IR的患病风险(OR)也增加。NAFLD的患病风险由1.22(OR=1.22)增加到1.79(OR=1.79);IR的患病风险由1.13(OR=1.13)增加到1.91(OR=1.91);进一步校正性别及年龄后,NAFLD的患病风险由1.15(OR=1.15)增加到1.53(OR=1.53);IR的患病风险由1.15(OR=1.15)增加到2.02(OR=2.02)。结论 NAFLDFS与NAFLDF及IR密切相关,在临床上可将其作为简易评价NAFLD及IR的指标。

Objective To investigate the relationship of nonalcoholic fatty liver disease fibrosis score （NAFLDFS） with the risk of fatty liver disease and insulin resistance. Methods A total of 2622 subjects from Medical Examination Center of Central hospital of Xuzhou were included in the study. Blood samples were gained to measure relative indexes, alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, platelet cotmt（PLT）, serum albumin（ALB）, fasting blood glucose（FBG）, 2 hour postprandial blood glucose （PBG）, fasting insulin （Fins） and other related biochemical index. All the blood test results were collected to calculate nonalcoholic fatty liver disease fibrosis score and insulin resistance index（HOMA2-IR）. Subjects were divided into three groups according to low diagnostic threshold（- 1.455） and high diagnostic threshold（0.676） of nonalcoholic fatty liver fibrosis score. Group AI： NAFLDFS〈- 1.455, group A2： 0.676≥NAFLDFS≥- 1.455 and group A3 NAFLDFS 〉 0.676. The correlation between liver fibrosis score and each index was analyzed by Pearson analysis. We also analyzed the risk of the fatty liver and insulin resistance with NAFLDFS. Results With the increase of the NAFLDFS, Age, Weight, BMI, WC, Hip, HbAlc, NC, FBG; PBC~ Fins, SBP, DBP, TG; TC, LDL-C level were gradually increased significantly. While ALT, AST, PLT, ALB, HDL-C were decreased with the increasing the NAFLDFS. Age, NC, WC, Hip, Weight, BMI, HbAlc, FBG~ PBG and PLT were positively related to NAFLDFS according to Pearsonanalysis. Along with the increasing of NAFLDFS, the risk of NAFLD and insulin resistance also increased. Unadjusted variables non-alcoholic fatty liver risk increased from 1.22（OR= 1.22） to 1.79（OR= 1.79）, risk of insulin resistance（OR=-1.13）increased froml.13 to 1.91（OR=1.91）. After corrected gender and age, the risk of non-alcoholic fatty liver increased from 1.15（OR= 1.15） to 1.53（OR= 1.53）; insulin resistance risk increased by 1.15（OR=l.15）to 2.02（OR=2.02）. Coadusion The NAFLDFS level were closely related with non-alcoholic fatty liver and insulin resistance index, which can be used as a simple evaluation of nonalcoholic fatty liver disease and insulin resistance index in clinical.