人体肥胖测量指标对非酒精性脂肪性肝病的预测价值

Predictive value of different body obesity measures for nonalcoholic fatty liver disease

目的探讨不同人体肥胖测量指标对非酒精性脂肪性肝病(NAFLD)的预测价值。方法本研究为横断面研究,选取2022年1至4月接受健康检查的553例体检者为研究对象,根据腹部B超影像学参数,分为NAFLD组(321例)与非NAFLD组(232例)。所有研究对象完成一般资料问卷调查、肝脏超声检查、血清生化指标检测以及体格测量。应用logistic回归模型以分析人体肥胖测量指标[颈围、肱三头肌皮褶厚度(TSF)、体重指数(BMI)、腰臀比、脂质蓄积指数(LAP)、内脏脂肪指数(VAI)、身体圆度指数(BRI)以及身体形态指数(ABSI)]与NAFLD的相关性;运用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估单一人体肥胖测量指标及联合指标对NAFLD的预测价值。结果将研究对象以性别进行分层,在男性和女性人群中,BMI、颈围、TSF、腰臀比、LAP、VAI、BRI四分位水平与NAFLD均具有相关性(均P<0.05);进一步校正混杂因素后,相较于Q1组,上述指标的Q4组仍具有更高的OR值(均P<0.05)。对于男性和女性,LAP预测NAFLD的AUC值均最大,为0.836(0.788~0.876)、0.885(0.839~0.921),最佳临界值分别为41.93、33.27,其与BRI、BMI的AUC比较差异无统计学意义;而ABSI的AUC<0.7,即0.584(0.525~0.641)和0.679(0.618~0.735),其对NAFLD预测效能不佳。在两两联合指标中,男性以TSF+LAP的AUC最大,为0.864(0.819~0.901),与BRI[AUC=0.818(0.769~0.860)]、BMI[AUC=0.816(0.767~0.858)]比较,均P<0.05,但与LAP[AUC=0.836(0.788~0.876)]比较,P>0.05;女性以VAI+LAP的AUC最大,即0.894(0.849~0.928),与BMI[AUC=0.849(0.799~0.890)]比较,P<0.05,但与LAP[AUC=0.885(0.839~0.921)]和BRI[AUC=0.870(0.822~0.908)]比较,均P>0.05。结论BMI、颈围、TSF、腰臀比、LAP、VAI和BRI对NAFLD均具有良好的预测价值。

Objective To investigate the predictive value of different body obesity measures for non-alcoholic fatty liver disease(NAFLD).Methods It was a cross-sectional study.The present study was a case-control study involving 553 subjects who underwent physical examination from January to April 2022.The subjects were divided into NAFLD group(n=321 cases)and control group(n=232 cases)according to abdominal ultrasound imaging parameters.All subjects completed a general information questionnaire,liver ultrasound examination,serum biochemical indices and physical measurements.Logistic regression model was used to analyze the correlation between human obesity measures(neck circumference,triceps skinfold thickness(TSF),body mass index(BMI),waist-to-hip ratio,lipid accumulation index(LAP),visceral fat index(VAI),body roundness index(BRI)and a body shape index(ABSI))and NAFLD.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of single and combined measures of obesity for NAFLD.Results The subjects were stratified by gender,and the quartile levels of BMI,neck circumference,TSF,waist-to-hip ratio,LAP,VAI and BRI were all correlated with NAFLD in both male and female(all P<0.05).After further adjustment for confounding factors,compared with those in group Q1,group Q4 of the above-mentioned indexes still had higher odds ratios(P<0.05).The AUC value of LAP in predicting NAFLD was the largest in both men and women,which was 0.836(0.788-0.876)and 0.885(0.839-0.921),and the cut-off value was 41.93 and 33.27,respectively.There was no significant difference in AUC of ROC predicting NAFLD among LAP,BRI and BMI(P>0.05).The AUC of ABSI in predicting NAFLD was less than 0.7(namely 0.584(0.525-0.641)and 0.679(0.618-0.735)in men and women,respectively),which indicated poor predictive performance for NAFLD.In the pairwise combination index,the AUC of ROC predicting NAFLD with TSF+LAP in male was the largest,which was 0.864(0.819-0.901),and there was statistical significance when compared with BRI(AUC=0.818(0.769-0.860))and BMI(AUC=0.816(0.767-0.858))(P<0.05),but there was no statistical significance when compared with LAP(AUC=0.836(0.788-0.876))(P>0.05).The AUC of ROC predicting NAFLD with VAI+LAP in women was the largest,it was 0.894(0.849-0.928),there was statistical significance when compared with BMI(AUC=0.849(0.799-0.890))(P<0.05),but there was no statistical significance when compared with LAP(AUC=0.885(0.839-0.921))and BRI(AUC=0.870(0.822-0.908))(P>0.05).Conclusion BMI,neck circumference,TSF,waist-to-hip ratio,LAP,VAI and BRI all have good predictive value for NAFLD.