睡眠呼吸暂停患者内脏脂肪指数与转氨酶水平及非酒精性脂肪肝发生的相关性

Relationship of visceral adiposity index with serum aminotransferase and nonalcoholic fatty liver disease in patients with sleep apnea

目的 探讨睡眠呼吸暂停（SA）患者内脏脂肪指数与转氨酶水平及非酒精性脂肪肝发生的关系.方法 纳入2011年1月至2014年12月因反复打鼾或睡眠呼吸障碍至福建省睡眠疾病诊治中心就诊的患者.患者均行多导睡眠图（PSG）监测及腹部超声检查,根据呼吸暂停低通气指数（AHI）分为非SA组及轻、中、重度SA组（AHI分别为：＜5、5～＜15、15～＜30、≥30次/h）.比较组间PSG相关参数、转氨酶、内脏脂肪指数等差异.运用Spearman相关分析探讨内脏脂肪指数与PSG相关参数及转氨酶的相关性.以受试者工作特征（ROC）曲线及logistic回归分析内脏脂肪指数预测非酒精性脂肪肝发生的最佳切点及风险.结果 共分析152例患者资料,其中男110例,女42例,年龄（51.1±11.3）岁.其中,非SA组20例,轻、中、重度SA组分别有31、39、62例.152例患者中非酒精性脂肪肝患者92例.不同SA组间性别、年龄、碱性磷酸酶差异均无统计学意义（均P＞0.05）,而体质指数、腰围、AHI、最低血氧饱和度、氧减指数（ODI）、内脏脂肪指数、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、谷氨酰转肽酶（GGT）、非酒精性脂肪肝患病率差异均有统计学意义（均P＜0.05）.内脏脂肪指数与AHI（β=0.222,P=0.006）、ODI（β =0.216,P=0.008）、ALT（β=0.237,P=0.003）、GGT（β=0.238,P=0.003）呈正相关.ROC曲线提示,在总人群中,内脏脂肪指数预测非酒精性脂肪肝发生的最佳切点为1.59.高内脏脂肪指数组发生非酒精性脂肪肝风险增加至4.550倍（OR=4.550,P＜0.001）.结论 内脏脂肪指数与SA患者转氨酶水平及非酒精性脂肪肝的发生密切相关.

Objective To evaluate the relationship of visceral adiposity index （VAI） with serum aminotransferase levels and incidence of nonalcoholic fatty liver disease （NAFLD） in patients with sleep apnea （SA）.Methods Between January 2011 and December 2014,participants who were referred from Fujian Provincial Sleep-disordered Breathing （SDB） Clinic Center with repeated snoring or a clinical suspicion of SDB were recruited.All individuals underwent polysomnography （PSG） testing and an abdominal ultrasonography scan during this period.They were classified into four groups by apnea-hypopnea index （AHI）,non-SA group,mild,moderate and severe group （AHI 〈5/h,5-〈 15/h,15-〈30/h,≥ 30/h,respectively）.The differences in SA-related parameters,serum aminotransferase and VAI were tested,and the correlations of VAI with indices of PSG and serum aminotransferase were analyzed using Spearman coefficient.Receiver operating characteristic （ROC） curve was conducted to obtain a cut-off value of VAI for predicting NAFLD.Afterwards,logistic regression was performed to analyze VAI＆#39;s predictive ability regarding incidence of NAFLD in SDB patients.Results A total of 152 participants including 110 males and 42 females were analyzed,with mean age （51.1 ±11.3） years.There were 20 subjects in non-SA group,31 in mild,39 in moderate and 62 in severe group,with 92 NAFLD patients and 60 controls.No differences in sex,age,alkaline phosphatase were observed among groups according to AHI.However,body mass index,waist circumference,AHI,lowest oxygen saturation,oxygen desaturation index （ODI）,VAI,alanine aminotransferase （ALT）,aspartate aminotransferase,gamma glutamyltransferase （GGT） and incidence of NAFLD were significantly different among groups.Significant positive relations were observed between VAI and AHI （3 =0.222,P =0.006）,ODI （β =0.216,P =0.008）,ALT （β =0.237,P =0.003）,GGT （β =0.238,P =0.003）.As shown in ROC curve,the cut-off point of VAI for predicting NAFLD was 1.59 in all individuals.SDB patients with VAI ≥ 1.59 tended to have significantly greater risk in incidence of NAFLD （OR =4.550,P 〈 0.001）.Conclusion VAI was closely associated with increased serum aminotransferase levels and incidence of NAFLD.