2种新型人体测量指标对成人代谢相关脂肪性肝病的筛查能力

The Ability of Two New Anthropometric Indices to Screen Metabolic Associated Fatty Liver Disease among Adults

【目的】评估身体形态指数(ABSI)和身体圆度指数(BRI)2种新型人体测量指标对成人代谢相关脂肪性肝病(MAFLD)的筛查能力,并确定最佳截断值。【方法】利用2018年3月至2019年10月“华南区域自然人群慢性病前瞻性队列研究”(SCC)在广东省东莞市调查点采集的有效基线调查数据,共纳入9214名完成体格检查、腹部超声检查和实验室检测的成年人。MAFLD的诊断标准参考最新国际专家共识声明。以体质指数(BMI)、腰围(WC)和腰围身高比(WHtR)为参考,评价ABSI和BRI的筛查能力。使用Spearman秩相关分析和logistic回归模型,比较各指标与MAFLD的相关性。绘制受试者工作特征曲线(ROC),比较曲线下面积(AUC)。【结果】MAFLD患病率为31.41%,除ABSI以外,患病率在各指标四分位数组中呈线性增加的趋势(P-trend<0.001)。各指标与MAFLD患病均呈正相关,但ABSI关联性最弱(男性r_(s)=0.069;女性r_(s)=0.045),BRI较强(男性r_(s)=0.409;女性r_(s)=0.413)。在多因素logistic回归分析中,以最低四分位数组为参考,比较各指标最高四分位数组与MAFLD的OR值,发现ABSI最低,男性OR及95%CI为1.09(0.85,1.41),女性OR及95%CI为0.90(0.74,1.08);BRI与WHtR相近;BMI最高,男性为61.15(35.12,106.47),女性为20.07(15.24,26.43)。ABSI筛查MAFLD的AUC值最低(男性0.55;女性0.53),截断值为男性0.0805、女性0.0782。BRI具有较高的筛查价值(男性0.77;女性0.75),与WHtR相等、WC相近(男性0.79;女性0.77),略低于BMI(男性0.81;女性0.79),其最佳截断值为男性4.10、女性4.51。BRI在体质量消瘦或正常(男性0.73;女性0.69)、糖尿病患者(男性0.73;女性0.71)、体质量消瘦或正常但代谢功能失调人群(男性0.60;女性0.55)中对MAFLD均具有一定的筛查能力。【结论】BRI能较好筛查MAFLD(AUC>0.7),其截断值分别为男性4.10、女性4.51,而ABSI表现较差。考虑到其在不同人群中对MAFLD均具有一定区分价值,BRI有希望作为MAFLD早期筛查指标。

【Objective】To assess the screening ability of two new anthropometric indices:a body shape index(ABSI)and body roundness index(BRI)for metabolic associated fatty liver disease(MAFLD)in adults,and to determine the optimal cut-off value.【Methods】Based on the valid baseline data collected from March 2018 to October 2019 in Dongguan City,Guangdong Province by South China Cohort(SCC)project,a total of 9214 adults were included,with physical examination,ultrasound and laboratory tests.MAFLD was diagnosed according to the consensus statement of international experts.Body mass index(BMI),waist circumference(WC)and waist-height-ratio(WHtR)were used as reference to evaluate the screening ability of ABSI and BRI.Spearman rank test and logistic regression model were used to compare the correlation between each index and MAFLD.The receiver operating characteristic curve(ROC)was used to compare the area under the curve(AUC).【Results】The prevalence of MAFLD was 31.41%,which increased linearly across the quartile of each index except ABSI.There was a positive correlation between each index and MAFLD but ABSI was the weakest(r_(s)=0.069 in males and r_(s)=0.045 in females)while BRI was stronger(r_(s)=0.409 in males and r_(s)=0.413 in females).A multivariate logistic regression analysis of the presence of MAFLD for the highest quartile vs.the lowest quartile of each anthropometric measure,showed that ABSI had the lowest OR without statistical significance.The OR and 95%CI was 1.09(0.85,1.41)in males and 0.90(0.74,1.08)in females,respectively.BRI was similar to WHtR,and BMI had the strongest association whose OR and 95%CI was 61.15(35.12,106.47)in males and 20.07(15.24,26.43)in females,respectively.ABSI had the lowest AUC for MAFLD(0.55 in males and 0.53 in females)and the cut-off value was respectively 0.0805 in males and 0.0782 in females.BRI had a higher AUC(0.77 in males and 0.75 in females),equal to WHtR and similar to WC(0.79 in males and 0.77 in females)but lower than BMI(0.81 in males and 0.79 in females).The optimal cut-off value for BRI was 4.10 in males and 4.51 in females.BRI also showed a certain screening ability on MAFLD in lean/normal weight population(0.73 in males and 0.69 in females),patients with diabetes(0.73 in males and 0.71 in females)and subjects with lean/normal weight and metabolic dysfunction(0.60 in males and 0.55 in females).【Conclusions】BRI can effectively identify MAFLD(AUC>0.7)and the optimal cut-off value is 4.10 for males and 4.51 for females,while ABSI performs poorly.Considering the screening on MAFLD in population with different characteristics,BRI shows a potential for use in early screening of MAFLD.