四项体脂测量指标与非酒精性脂肪肝的关联性研究

A study on association of four physical measurements indexes with non-alcoholic fatty liver disease

目的探讨天津市体检人群腰围、体质指数（BMI）、内脏脂肪面积、皮下脂肪体积与非酒精性脂肪肝（NAFLD）的关联性和诊断价值。方法选取364例体检者为研究对象，根据2010年中华医学会非酒精性脂肪肝诊断标准及B超结果，分为NAFLD组182例和对照组182例。对所有研究对象均进行一般检查、腹部B超检查、人体成分分析和生化指标测定，内科医生询问饮酒史、既往病史、用药史等情况，采用4项体脂测量指标（腰围、BMI、内脏脂肪面积和皮下脂肪体积）反映肥胖者脂肪堆积情况，并比较各指标与NAFLD间的关联。结果无论男女，NAFLD组腰围、BMI、内脏脂肪面积和皮下脂肪体积平均水平均高于对照组，差异均有统计学意义（P〈0．05）。受试者工作特征（ROC）曲线分析发现，男性BMI、女性腰围对NAFLD具有最高诊断效能，且男性内脏脂肪面积诊断效能高于女性，而皮下脂肪体积低于女性。ROC曲线确定各体脂测量指标诊断发生NAFLD的最佳切点值，男女性腰围分别为91．50和86．50cm；男女性BMI分别为26．07和25．68kg／m^2；男性内脏脂肪面积为112．40cm^2，女性为95．60cm^2；男性皮下脂肪体积为193．70cm^3，女性为226．37cm^3。非条件logistic回归分析发现，内脏脂肪面积更易增加NAFLD发生风险唠性OR=7．240（95％CI：3．099～16．913），女性OR=9．360（95％C1：3．563～24．487），增加1标准差1。结论4项体脂测量指标（腰围、BMI、内脏脂肪面积和皮下脂肪体积）与NAFLD之间存在关联，其中女性腰围、男性BMI对NAFLD具有最高诊断效能，同时确定了各体质指标诊断NAFLD发生的最佳切点值，内脏脂肪面积比其他指标更易增加NAFLD的发病风险。

Objective To investigate the relationship between waist circumstance （WC）, body mass index （BMI）, visceral fat area or subcutaneous fat volume and nonalcoholic fatty liver disease （NAFLD） in the health examination residents of Tianjin. Methods The subjects （364 residents） were divided into NAFLD group （182 cases） and control group （182 controls） according to the diagnosis and treatment guidelines of the Chinese Liver Disease Association in 2010 and the diagnosis result of B-ultrasound test. The physical examination, B-ultrasonic test, body composition analysis and biochemistry examination were conducted for all subjects. Alcohol consumption, disease history and medication history were inquired by physicians. Four indexes （WC, BMI, visceral fat area and subcutaneous fat volume） were compared between two groups to analyze the association of 4 indexes with NAFLD. Results Four indexes in NAFLD group were significantly higher than those in control group for males and females （P〈 0.05 ）. The analysis of the ROC curve indicated the male BMI and female WC had the highest diagnostic efficiencies on NAFLD. The diagnostic efficiency of male visceral fat area was higher than that of female visceral fat area, but the diagnostic efficiency of male subcutaneous fat volume was lower than that of female subcutaneous fat volume. Analysis of ROC curves revealed the best cut-off points of WC （91.50 cm for males and 86.50 cm for females）, BMI （26.07 kg/m2 for males and 25.68 kg/m2 for females）, visceral fat area （ 112.40 cm2 for males and 95.60 cm2 for females） and subcutaneous fat volumes （ 193.7 cm3 for males and 226.37 cm3 for females）. Unconditioned logistic regression analysis showed that the visceral fat area was a risk factor of NAFLD （OR= 7.240, 95%CI： 3.099-16.913 for males and OR=9.360, 95%CI： 3.563-24.487 for females, if 1 SD increased）. Conclusion There is the association of 4 indexes with NAFLD. Among 4 indexes, female WC and male BIM are the most useful for diagnosis of NAFLD. The visceral fat area is a high risk factor for NAFLD.