适合中国人群的非酒精性脂肪肝简易筛检工具研究

A Simple Screening Tool for Nonalcoholic Fatty Liver Disease Among Chinese Population

目的设计一个适合中国人群的、能够快速筛检非酒精性脂肪肝(NAFLD)的简易筛检工具,进而为其有效管理及防治提供科学依据。方法采用横断面病例对照研究设计方法,以2013年1月1日—8月31日在西京医院体检中心接受健康体检的15 000名成年人为研究对象。每名研究对象均接受肝脏超声检查、人体学测量、实验室检查及问卷调查4种评估。采用SAS 9.2和SPSS 13.0统计软件进行统计学分析,基于多因素Logistic回归分析的结果,构建NAFLD筛检指数。结果 15 000名研究对象中有4 573人被排除,最终纳入10 427人,经超声诊断,其中有2 215人被诊断为NAFLD,为病例组;其余8 212人为对照组。将10 427名研究对象随机分成两组,其中一组为训练样本(n=5 213),另一组为验证样本(n=5 214)。逐步多因素Logistic回归分析显示,体质指数(BMI)、三酰甘油(TG)、空腹血糖(FPG)、天冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)对NAFLD的影响有统计学意义(P<0.05)。这些变量被用于构建NAFLD筛检指数:NAFLD指数=2×BMI+TG+FPG-6×(AST/ALT)。该指数在训练样本中的受试者工作特征(ROC)曲线下面积为0.843〔95%CI(0.831,0.855)〕,在验证样本中的ROC曲线下面积为0.848〔95%CI(0.837,0.860)〕。结论 NAFLD指数是一个针对中国人群的简单的、有效的NAFLD筛检工具,其可为进一步的评价和/或详尽的生活方式治疗筛选对象提供依据,并有可能增加筛检的成本效益值。

Objective To design a simple screening tool that can be used for the fast screening of nonalcoholic fatty liver disease（ NAFLD） among Chinese people,in order to provide scientific references for the effective management,prevention and treatment of NAFLD. Methods In this cross- sectional case control study,we enrolled 15 000 adults who received physical examination in Xijing Hospital from January 1 to August 31,2013. The subjects received liver ultrasonography,anthropometric measurement,laboratory examination and questionnaire survey. SAS 9. 2 and SPSS 13. 0 were used to conduct statistic analysis,and NAFLD screening index was constructed based on the results of multivariate logistic regression analysis. Results After the exclusion of 4 573 subjects,we at last enrolled 10 427 subjects. Through ultrasonic diagnosis,2 215 subjects were diagnosed with NAFLD and were assigned into case group; the rest 8 212 subjects were enrolled as control group. The 10 427 subjects were randomly divided into two samples： training sample（ n = 5 213） and verification sample（ n = 5 214）. Stepwise multivariate logistic regression analysis showed that BMI,TG,FPG and AST / ALT had significant influence on NAFLD（ P〈0. 05）. These variables were used to construct NAFLD screening index： NAFLD index = 2 × BMI ＋ TG ＋ FPG- 6 ×（ AST / ALT）. The AUC of the index was 0. 843 〔95% CI（ 0. 831,0. 855） 〕in the training sample and was 0. 848 〔95% CI（ 0. 837,0. 860） 〕in the verification sample. Conclusion NAFLD index is a simple and effective NAFLD screening tool for Chinese people. It can screen patients who need further evaluation and / or specific living style management and may increase the cost- effectiveness of screening.