甘油三酯与高密度脂蛋白胆固醇比值和谷氨酰转移酶对非酒精性脂肪肝的预测价值

Value of ratio of triglyceride/high-density lipoprotein and γ-glutamyl transferase in prognosis of non-alcoholic fatty liver disease

目的分析非酒精性脂肪肝(NAFLD)发病的危险因素,探讨甘油三酯与高密度脂蛋白胆固醇比值(TG/HDL-C)和谷氨酰转移酶(GGT)对非酒精性脂肪肝(NAFLD)的预测价值。方法于2012年3—9月选取宁波市第一医院的24岁及以上健康体检者335例作为研究对象,纳入后每年随访一次,连续3年,检测其基线水平及随访时谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转移酶(GGT)、甘油三酯(TG)、尿酸(UA)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及空腹血糖(FPG),计算TG/HDL-C。结果 3年后发生NAFLD的人群,其基础体重指数(BMI)、收缩压(SBP)、舒张压(HBP)、TC、TG、UA、FPG、TG/HDL-C、ALT、AST、GGT较无NAFLD组高,HDL-C较无NAFLD组低(P<0.05)。(2)TG/HDL-C、GGT对NAFLD的发生有一定作用,具有更高的诊断敏感性和特异性,TG/HDL-C的曲线下面积为0.723,95%可信区间是(0.632~0.813),GGT的曲线下面积为0.753,95%可信区间是(0.661~0.846),当TG/HDL-C比值为1.396,而GGT在28.0 U/L时对NAFLD的诊断具有一定意义。结论 TG/HDL-C和GGT对NAFLD的诊断具有较高的敏感性和特异性。

Objective To analyze the risk factors of the non-alcoholic fatty liver diseases （NAFLD） and explore the value of triglyceride/high-density lipoprotein（TG/HDL-C） ratio and -y-glutamyl transferase level in the diagnosis of NAFLD. Methods Total 335 individuals receiving physical examination were enrolled into this study and were followed up for 3 years. Their alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, uric acid, lipid profile, fasting glucose were examined in baseline and during following up. The triglyceride （TG）/high-density lipoprotein （HDL-C） ratio was calculated by TG/HDL-C. Results ①The level of basic body index, triglyceride, TG/HDL-C, γ-glutamyl transferase were higher and the body mass index （ BMI ） , blood pressure, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein, uric acid, alanine aminotransferase, alkaline phosphatase had no difference in NAFLD group as compared with the normal group at 3 years after the physical examination （P 〈 0. 01 ）. ②TG/HDL-C and γ-glutamyl transferase enzyme had higher sensitivity and specificity than triglyceride, blood pressure, total cholesterol, high density fipoprotein,low density lipoproteinalanine aminotransferase, aspartate aminotransferase, fasting plasma glucose in the diagnosis of NAFLD. Area under curve of TG/HDL-C was 0. 723 and 95% confidence limits was 0.632 -0. 813. Area under curve of GGT was 0. 753 and 95% confidence limits was 0.661 -0. 846. There were significance in the diagnosis of NAFLD when TG/HDL-C were 1. 396 or γ-glutamyl transferase were 28 U/L. Conclusion TG/HDL-C and γ-glutamyl transferase has comparably higher sensitivity and specificity in the diagnosis of NAFLD.