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)预测非酒精性脂肪肝(NAFLD)的价值

The Value of Triglyceride Versus High-density Lipoprotein Cholesterol(TG/HDL-C) and Glutamyl Transferase(GGT) in Predicting Non-alcoholic Fatty Liver(NAFLD)

目的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)预测非酒精性脂肪肝(NAFLD)的价值。方法方便选取该院2015年11月—2017年11月收治的400例NAFLD患者作为观察组,选取同期健康体检者500名作为对照组,观察两组研究对象年龄、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)、空腹血糖(FPG)、甘油三酯与高密度脂蛋白胆固醇比值(TG/HDL-C)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ-谷氨酰基转移酶(GGT)情况、观察NAFLD危险因素回归分析和ROC曲线分析,观察TG/HDL-C、GGT诊断NAFLD的敏感度和特异度情况。结果观察组TG/HDL-C(1.7±0.6)、GGT(36.9±12.3)U/L均高于对照组(1.2±0.5)、(22.1±10.0)U/L,以NAFLD作为因变量,患者的TG/HDL-C、GGT作为自变量,通过Logistic回归分析,TG/HDL-C、GGT是NAFLD危险因素,差异有统计学意义(P<0.05)。以2017年作为状态变量,2015年对照组SBP、DBP、TC、TG、HDL-C、LDL-C、UA、FPG、TG/HDL-C、AST、ALT、GGT作为检验变量,通过ROC曲线分析,结果表明,TG/HDL-C的曲线下面积0.734,面积95%可信区间范围是(0.647~0.868),>SBP、DBP、TC、TG、HDL-C、LDL-C、UA、FPG、AST、ALT曲线下方面积,GGT曲线下方面积达到0.761,面积95%可信区间范围是(0.678~0.879)>TG/HDL-C。以2017年发生NAFLD作为状态变量,2015年无NAFLD的TG/HDL-C、GGT为检验变量,随着TG/HDL-C、GGT数值降低,其敏感度逐步升高,然而特异度降低。通过统计学软件中ROCcurve进行灵敏度和特异度计算,获得Youden指数,其最大的诊断界点作为临界点,TG/HDL-C诊断NAFLD的临界值1.402 3,GGT诊断NAFLD的临界值28.1 U/L。结论 TG/HDL-C、GGT可以作为诊断NAFLD的参考指标,值得临床推广应用。

Objective To investigate the value of triglyceride and high density lipoprotein cholesterol（TG/HDL-C） and glutamyl transferase（GGT） in predicting non-alcoholic fatty liver（NAFLD）. Methods A total of 400 patients with NAFLD from November 2015 to November 2017 in the hospital were convenient selected as the observation group. 500 healthy patients were selected as the control group. The age, body mass index（BMI）, and systolic blood pressure（SBP） of the two groups were observed. Diastolic blood pressure（DBP）, total cholesterol（TC）, triglyceride（TG）, high-density lipoprotein cholesterol（HDL-C）, low-density lipoprotein cholesterol（LDL-C）, uric acid（UA）, fasting blood glucose（ FPG）,triglyceride-to-high-density lipoprotein-cholesterol ratio（TG/HDL-C）, aspartate aminotransferase（AST）, alanine aminotransferase（ALT）, and gamma-glutamyl transferase（GGT） status, observed NAFLD risk factors. Regression analysis and ROC curve analysis were performed to observe the sensitivity and specificity of TG/HDL-C and GGT in the diagnosis of NAFLD. Results The TG/HDL-C（1.7 ±0.6） and GGT（36.9±12.3） U/L were higher in the observation group than in the control group（1.2±0.5） and（22.1±10.0） U/L. The patients were treated with NAFLD as the dependent variable. TG/HDL-C and GGT were used as independent variables. Logistic regression analysis showed that TG/HDL-C and GGT were risk factors for NAFLD, and the differences were statistically significant（P 0.05）. Using 2017 as a state variable, the control group SBP, DBP, TC, TG, HDL-C, LDL-C, UA, FPG, TG/HDL-C, AST, ALT, GGT in 2015 were used as test variables and analyzed by ROC curve. The results showed that the area under the curve of TG/HDL-C was 0.734, 95% confidence interval range was（0.647-0.868）, SBP, DBP, TC, TG, HDL-C, LDL-C, UA, FPG, The area under the AST and ALT curves, the area under the GGT curve reached 0.761, and the 95% confidence interval range was（0.678-0.879）TG/HDLC. Taking NAFLD as a state variable in 2017, the TG/HDL-C and GGT without NAFLD were used as test variables in2015. With the decrease of TG/HDL-C and GGT values, the sensitivity gradually increased, whereas the specificity decreased. The sensitivity and specificity of ROCcurve in the statistical software were used to calculate the Youden index.The largest diagnostic cut-off point was used as the critical point. The critical value of TG/HDL-C for diagnosis of NAFLD was 1.402 3, and the critical value of GGT for diagnosis of NAFLD was 28.1 U/L. Conclusion TG/HDL-C and GGT can be used as reference indexes for diagnosis of NAFLD, which is worthy of clinical application.