非酒精性脂肪性肝病患者的代谢紊乱特征比较及鉴别方法分析

Study on metabolic disorders and identification methods of non-alcoholic fatty liver disease

目的:本研究旨在发现非酒精性脂肪性肝病(NAFLD)的患病类型及相关的人体代谢紊乱指标,以及常见人体测量指标和脂肪肝指数(FLI)对于鉴别非肥胖型NAFLD的价值。方法:以2 320例南京市某社区职业体检人群为调查对象,收集该人群人口学特征及体格测量信息,结合实验室血液生化指标。采用非参数检验比较不同NAFLD患病结局(非NAFLD患者、非肥胖型NAFLD患者和肥胖型NAFLD患者)人群之间的基本特征和代谢情况,采用受试者工作特征(ROC)曲线评估人体测量指标和FLI鉴别非肥胖人群中NAFLD患病情况的价值。结果:本研究人群的NAFLD的患病率为42.0%,其中非肥胖型的NAFLD患病率高达35.4%。不同NAFLD患病结局人群的腰围、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转移酶(GGT)、空腹血糖(FPG)、尿酸(UA)、肌酐(CRE)、高密度脂蛋白(HDL)、甘油三酯(TG)、总胆固醇(TC)水平均有显著性差异(均P<0.05)。FLI和其他人体测量指标相比,可以更好地鉴别非肥胖人群中NAFLD患病情况,其ROC曲线下面积可达0.843,当截断值为22.4时,灵敏度可达82.3%,特异度为72.8%。结论:本研究人群的NAFLD患病率较高,非肥胖型NAFLD是所有NAFLD中的主要类型,NAFLD患病后存在着多种代谢指标的紊乱,FLI可以较好地鉴别非肥胖型NAFLD。

Objective:To find out the types of non-alcoholic fatty liver disease(NAFLD),the related factors of metabolic disorders,as well as the value of common anthropometric indicators fatty liver index(FLI)in identifying non-obese NAFLD among a community population.Methods:A total of 2320 occupational subjects were enrolled in this study.Relevant information,demographic characteristics and laboratory data were collected.Non parametric tests were used to compare basic characteristics and metabolic status among populations with different NAFLD outcomes.FLI in differentiating NAFLD among non-obese population was by receiver operating characteristic curve(ROC).Results:The prevalence of NAFLD in this community population was 42.0%.and non-obese NAFLD was prevalent in 35.4%of the study participants.Waist circumference,alanine transaminase(ALT),aspartate transaminase(AST),gamma glutamyl transferase(GGT),fasting blood sugar(FPG),uric acid(UA),creatinine(CRE),high-density lipoprotein(HDL),triglycerides(TG)and total cholesterol(TC)levels were ignorantly different among non-NAFLD subjects,non-obese NAFLD patients,and obese NAFLD patients.Compared with other anthropometric indicators,FLI could better distinguish the NAFLD in non-obese populations.The area under ROC curve of FLI reached 0.843,the cut-off value was 22.4 and the sensitivity and specificity could reach 82.3%and 72.8%.Conclusion:The prevalence of NAFLD in this community was at a high level and non-obese NAFLD was the majority.After the onset of NAFLD,many metabolic disorders may accompany.FLI can better differentiate non-obese NAFLD.