胰岛素抵抗代谢评分在中老年人群非酒精性脂肪性肝病筛查中的价值研究

Value of metabolic score for insulin resistance in screening non-alcoholic fatty liver disease in middle-aged and elderly people

目的:探讨胰岛素抵抗代谢评分(METS-IR)在中老年人群非酒精性脂肪性肝病(NAFLD)筛查中的价值。方法:收集40岁及以上人群1281例为研究对象,根据是否患有NAFLD分为非NAFLD组(946例)和NAFLD组(335例)。采集受试者的既往病史,进行体格检查、实验室检查及腹部超声检查。采用Logistic回归模型评价METS-IR与中老年人群NAFLD患病风险的相关性。采用受试者工作特征(ROC)曲线分析METS-IR对中老年人群NAFLD的筛查价值。结果:NAFLD组收缩压、舒张压、腰围、转氨酶、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、体重指数(BMI)、METS-IR、稳态模型评估的胰岛素抵抗指数(HOMA-IR)高于非NAFLD组,高密度脂蛋白胆固醇(HDL-C)低于非NAFLD组(均P<0.05)。单因素Logistic回归分析结果发现,随着BMI、腰围、血压、转氨酶、TG、TC、LDL-C、HbA1c、FBG、FINS、HOMA-IR、METS-IR水平的升高,NAFLD患病风险增加;HDL-C越高,年龄越大,NAFLD患病风险越小(均P<0.05)。根据METS-IR四分位数将中老年人群分位四组,进行多因素Logistic回归分析,结果显示在校正了混杂因素后,以Q1组作为参照,Q2、Q3和Q4组NAFLD患病风险增加(均P<0.05)。ROC曲线分析显示,METS-IR对NAFLD的筛查价值高于HOMA-IR (P<0.05)。结论:在中老年人群中,METS-IR升高与NAFLD患病风险增加独立相关。METS-IR对NAFLD的筛查优于HOMA-IR,比HOMA-IR更有助于中老年人群NAFLD的早期筛查。

Objective:To investigate the value of metabolic score for insulin resistance(METS-IR)in screening non-alcoholic fatty liver disease(NAFLD)in middle-aged and elderly people.Methods:A total of 1281 people aged 40 years and over were enrolled in the study.According to whether they had NAFLD,they were divided into non-NAFLD group(946 cases)and NAFLD group(335 cases).The past medical history of the subjects was collected,and physical examination,laboratory tests and abdominal ultrasound were performed.Logistic regression model was used to evaluate the correlation between METS-IR and the risk of NAFLD in middle-aged and elderly people.ROC curve was used to analyze the screening value of METS-IR for NAFLD in middle-aged and elderly people.Results:The NAFLD group had higher systolic blood pressure,diastolic blood pressure,waist circumference,transaminase,triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG),fasting insulin(FINS),glycosylated hemoglobin(HbA1c),body mass index(BMI),METS-IR,and homeostasis model assessment of insulin resistance(HOMA-IR)than the non-NAFLD group,and the high density lipoprotein cholesterol(HDL-C)in NAFLD group was lower than that in non-NAFLD group(all P<0.05).Univariate Logistic regression analysis showed that the risk of NAFLD increased with the increase of BMI,waist circumference,blood pressure,transaminase,TG,TC,LDL-C,HbA1c,FBG,FINS,HOMA-IR and METS-IR;the higher the HDL-C level,the older the age,the lower the risk of NAFLD(all P<0.05).The middle-aged and elderly people were divided into four groups according to the quartile of METS-IR,and multivariate Logistic regression analysis showed that after adjusting for confounding factors,with Q1 group as a reference,the risk of NAFLD in Q2,Q3,and Q4 groups increased(all P<0.05).ROC curve analysis showed that METS-IR had a higher screening value for NAFLD than HOMA-IR(P<0.05).Conclusion:Elevated METS-IR is independently associated with increased risk of NAFLD in middle-aged and elderly people.METS-IR is better than HOMA-IR in the screening of NAFLD,and is more helpful for the early screening of NAFLD in middle-aged and elderly people than HOMA-IR.