甘油三酯/葡萄糖指数预测非酒精性脂肪性肝病严重程度效能研究

Efficacy of triglyceride glucose index in predicting severity of patients with non-alcoholic fatty liver diseases

目的探讨应用甘油三酯-葡萄糖指数(TyG指数)预测非酒精性脂肪性肝病(NAFLD)的效能,为NAFLD的防治提供简便的筛选方法。方法2020年1月~2022月12月湖南省人民医院健康管理中心参加体检且符合纳入和排除标准的体检者44913例,使用腹部超声检查诊断NAFLD。根据文献报道的公式计算TyG指数,采用单因素和多因素Logistic回归分析影响NAFLD发生的因素,绘制TyG指数、TyG指数联合BMI和ALT预测NAFLD的受试者工作特征曲线(ROC),计算ROC曲线下面积(AUC),评估指标的预测效能。结果在纳入的44913例体检人群中,检出NAFLD患者15901例(35.4%);NAFLD组年龄、BMI、收缩压、舒张压、血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、空腹血糖(FPG)、ALT和TyG指数分别为(45.9±13.6)岁、(26.5±3.0)kg/m^(2)、(129.9±15.9)mm Hg、(78.7±11.2)mm Hg、(2.5±2.4)mmol/L、(3.2±0.9)mmol/L、(5.2±1.0)mmol/L、(5.7±1.6)mmol/L、(38.6±36.1)U/L和(9.1±0.7),均显著高于非NAFLD组【分别为(40.9±13.8)岁、(22.3±2.7)kg/m^(2)、(119.0±15.9)mm Hg、(70.7±10.4)mm Hg、(1.3±1.0)mmol/L、(3.0±0.8)mmol/L、(4.9±0.9)mmol/L、(5.2±0.9)mmol/L、(21.0±19.4)U/L和(8.4±0.5),P<0.001】,而NAFLD组血清高密度脂蛋白胆固醇(HDL-C)水平为(1.1±0.2)mmol/L,显著低于非NAFLD组【(1.3±1.0)mmol/L,P<0.001】;在NAFLD患者中,肥胖组收缩压、舒张压、TG、ALT和TyG指数分别为(133.3±15.3)mm Hg、(82.0±11.3)mm Hg、(2.7±2.5)mmol/L、(46.2±31.5)U/L和(9.2±0.7),均显著高于超重组【分别为(129.5±15.7)mm Hg、(78.2±10.9)mm Hg、(2.5±2.4)mmol/L、(37.7±41.0)U/L和(9.1±0.6),P<0.05】或正常组【分别为(125.9±16.4)mm Hg、(74.9±10.7)mm Hg、(2.2±2.3)mmol/L、(30.0±22.2)U/L和(9.0±0.6),P<0.05】,肥胖组年龄和血清HDL-C水平分别为(42.9±12.8)岁和(1.0±0.2)mmol/L,均显著低于超重组【分别为(46.6±13.6)岁和(1.1±0.2)mmol/L,P<0.05】或正常组【分别为(48.3±13.9)岁和(1.2±0.3)mmol/L,P<0.05】,而超重组收缩压、舒张压、血清TG、ALT和TyG指数均显著高于正常组(P<0.05),超重组年龄和血清HDL-C均显著低于正常组(P<0.05);肥胖组FPG为(5.8±1.6)mmol/L,显著高于超重组【为(5.7±1.5)mmol/L,P<0.05】;经Logistic回归分析显示,年龄、BMI、舒张压、TG、FPG、TyG指数、ALT水平升高和HDL-C降低是NAFLD发病的独立危险因素(P<0.05),其OR值分别为1.023、1.521、1.014、0.873、0.972、3.992、1.019和0.404,其中TyG指数的OR值最大;TyG指数预测NAFLD的AUC为0.814【95%CI(0.810,0.817),P<0.001】,最佳截断点为8.67,敏感性和特异性分别为76.1%和71.4%,TyG指数联合BMI和ALT预测NAFLD的AUC为0.899【95%CI(0.896,0.901),P<0.001】。结论TyG指数是NAFLD的独立危险因素,对于NAFLD具有较好的预测价值,与BMI和ALT联合检测预测价值更高。TyG指数由于其经济实用、计算简易的特点,有助于门诊及基层医院对NAFLD的早期识别。

Objective The aim of this study was to investigate the efficacy of triglyceride glucose index(TyG)in predicting severity of patients with non-alcoholic fatty liver diseases(NAFLD).Methods 44913 individuals who participated in health examinations at the Health Management Center,Hunan Provincial People's Hospital between January 2020 and December 2022 were enrolled.The diagnosis of NAFLD was made by ultrasonography,and the TyG index was calculated according to literature report.The univariate and multivariate Logistic regression analysis were applied to reveal the risk factors,and the area under receiver operating characteristic curve(AUC)was used to predict the diagnostic efficacy.Results Out of our 44913 participants,there were 15901 patients(35.4%)with NAFLD confirmed;the age,BMI,systolic blood pressure,diastolic blood pressure,serum triglyceride(TG),low density cholesterol(LDL-C),total cholesterol(TC),fasting plasma glucose(FPG),ALT levels and TyG index in patients with NAFLD were(45.9±13.6)years old,(26.5±3.0)kg/m^(2),(129.9±15.9)mm Hg,(78.7±11.2)mm Hg,(2.5±2.4)mmol/L,(3.2±0.9)mmol/L,(5.2±1.0)mmol/L,(5.7±1.6)mmol/L,(38.6±36.1)U/L and(9.1±0.7),all significantly higher than[(40.9±13.8)years old,(22.3±2.7)kg/m^(2),(119.0±15.9)mm Hg,(70.7±10.4)mm Hg,(1.3±1.0)mmol/L,(3.0±0.8)mmol/L,(4.9±0.9)mmol/L,(5.2±0.9)mmol/L,(21.0±19.4)U/L and(8.4±0.5),respectively,P<0.001],while serum high density cholesterol(HDL-C)levels was(1.1±0.2)mmol/L,significantly lower than[(1.3±1.0)mmol/L,P<0.001]in individuals without NAFLD;in patients with NAFLD,the systolic blood pressure,diastolic blood pressure,TG,ALT and TyG index in obese group were(133.3±15.3)mm Hg,(82.0±11.3)mm Hg,(2.7±2.5)mmol/L,(46.2±31.5)U/L and(9.2±0.7),all significantly higher than[(129.5±15.7)mm Hg,(78.2±10.9)mm Hg,(2.5±2.4)mmol/L,(37.7±41.0)U/L and(9.1±0.6),P<0.05]in overweight group and[(125.9±16.4)mm Hg,(74.9±10.7)mm Hg,(2.2±2.3)mmol/L,(30.0±22.2)U/L and(9.0±0.6),P<0.05]in normal body weight group;the age and serum HDL-C level in the obese group were(42.9±12.8)years old and(1.0±0.2)mmol/L,significantly lower than[(46.6±13.6)years old and(1.1±0.2)mmol/L,P<0.05]in the overweight group and[(48.3±13.9)years old and(1.2±0.3)mmol/L,P<0.05]in the normal body weight group;the systolic blood pressure,diastolic blood pressure,blood TG,ALT and TyG index in the overweight group were significantly higher than in the normal body weight group(P<0.05),and the age and blood HDL-C level in the overweight group were significantly lower than in the normal body weitht group(P<0.05);the FPG in the obese group was(5.8±1.6)mmol/L,significantly higher than[(5.7±1.5)mmol/L,P<0.05]in the overweight group;the multivariate Logistic regression analysis showed that the older age,increased BMI,diastolic blood pressure,serum TG,FPG,TyG index,ALT and reduced HDL-C levels were the independent risk factors for NAFLD(P<0.05),the OR=1.023,1.521,1.014,0.873,0.972,3.992,1.019 and 0.404,respectively,with the TyG index having the highest OR value;the area under the ROC curve(AUC)by the TyG index for predicting NAFLD was 0.814[95%CI(0.810-0.817),P<0.001],with an optimal cut-off value of 8.67,the sensitivity of 76.1%,and the specificity of 71.4%,respectively;the AUC by the TyG index combined with BMI and ALT in predicting NAFLD was 0.899[95%CI(0.896-0.901),P<0.001].Conclusion The TyG index is an independent risk factor for NAFLD,which has good predictive efficacy for NAFLD,and the predictive performance is enhanced when it combine with BMI and ALT levels.The TyG index might helpful for early diagnosis of NAFLD in outpatient and grassroots hospitals as it is economical,practical,and easy to calculate.