残余胆固醇/高密度脂蛋白胆固醇比值与代谢相关脂肪性肝病相关性的研究

Correlation between ratio of remnant cholesterol to high-density lipoprotein cholesterol and metabolism-associated fatty liver disease

目的探讨残余胆固醇/高密度脂蛋白胆固醇(RC/HDL-C)比值与代谢相关脂肪性肝病(MAFLD)的相关性。方法选择2018年1月至2021年12月在西安医学院第一附属医院消化内科住院的662例患者,分为MAFLD组(n=282)和非MAFLD组(n=380),比较2组的RC、RC/HDL-C比值和相关血液生物化学指标,以及瞬时弹性成像技术(Fibroscan)检测指标脂肪衰减程度(CAP)和肝脏硬度(LSM);采用四分位数法,按照RC/HDL-C比值将受试者分为4组(Q1~Q4组),比较各组基线资料。采用logistic回归模型分析法探讨不同RC/HDL-C比值患者的MAFLD发生风险。结果MAFLD组的RC/HDL-C比值、RC、CAP、LSM、BMI、收缩压(SBP)、舒张压(DBP)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、ALT、AST、GGT、尿酸(UA)、肌酐(Cr)、空腹血糖(FBG)水平均显著高于非MAFLD组,而HDL-C水平显著低于非MAFLD组(P均<0.05)。按照RC/HDL-C比值四分位数分组后,结果显示与Q1组相比,Q4组中CAP正常者的占比较低,而Q4组中CAP轻、中、重度者的占比均较高(P均<0.05);LSM风险与RC/HDL-C比值变化不明显相关(P>0.05);随着RC/HDL-C比值增高,MAFLD患者、男性及吸烟者的占比均逐渐增高(P均<0.05);RC/HDL-C比值较高的受试者有较高的BMI、TG、TC、LDL-C、RC、ALT、AST、GGT、Gr、UA、FBG水平,但HDL-C水平随RC/HDL-C比值增高而逐渐降低(P均<0.05)。RC/HDL-C比值随着肝脂肪变性程度加重而逐渐增高(P<0.05)。多因素logistic回归模型分析结果显示,调整相关危险因素后,Q4组的MAFLD发生风险为Q1组的2.589倍(95%CI:1.474~4.547,P=0.001)。结论RC/HDL-C比值与MAFLD发生风险呈正相关,肝脂肪变性程度随着RC/HDL-C比值增高而加重,MAFLD患者的RC/HDL-C比值随着肝脂肪变性程度加重而逐渐增高。RC/HDL-C比值可能是MAFLD的有效预测指标。

Objective This paper attempts to investigate the correlation between the ratio of remnant cholesterol to high-density lipoprotein cholesterol(RC/HDL-C)and metabolism-associated fatty liver disease(MAFLD).Methods A total of 662 subjects who were hospitalized in the Department of Gastroenterology in the First Affiliated Hospital of Xi'an Medical University from January 2018 to December 2021 were enrolled and assigned into the MAFLD group(n=282),and the non MAFLD group(n=380).The RC,the RC/HDL-C ratio,the related blood biochemical indicators,as well as the instantaneous elastography(Fibroscan)detection indicators such as the degree of fat attenuation(CAP)and liver hardness(LSM)of the two groups were compared.The quartile method was used.Based on the RC/HDL-C ratio,the subjects were divided into four groups(Q1 to Q4 groups),the baseline data were compared between each group.The logistic regression analysis was used to investigate the risk of MAFLD in patients with different RC/HDL-C ratios.Results The RC/HDL-C ratio,RC,CAP,LSM,BMI,systolic blood pressure(SBP),diastolic blood pressure(DBP),triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),ALT,AST,GGT,uric acid(UA),creatinine(Cr),and fasting blood glucose(FBG)levels of the MAFLD group are significantly higher than those of the non MAFLD group,while the HDL-C levels is significantly lower than those of the non MAFLD group(P<0.05).Compared with the Q1 group,the proportion of patients with normal CAP of the Q4 group is relatively low,while that of patients with mild,moderate,and severe CAP of the Q4 group are higher(P<0.05).There is no significant correlation between LSM risk and changes in RC/HDL-C ratio(P>0.05).As the RC/HDL-C ratio increases,the proportion of MAFLD patients,males,and smokers gradually increases(P<0.05).Subjects with higher RC/HDL-C ratios have higher levels of BMI,TG,TC,LDL-C,RC,ALT,AST,GGT,Gr,UA,and FBG,but the HDL-C levels gradually decrease with increasing RC/HDL-C ratios(P<0.05).The RC/HDL-C ratio gradually increases with the severity of liver steatosis(P<0.05).The results of multivariate logistic regression analysis show that after adjusting relevant risk factors,the risk of MAFLD in the Q4 group is 2.589 times higher than that in the Q1 group(95%CI:1.474-4.547,P=0.001).Conclusions The RC/HDL-C ratio is positively correlated to the risk of MAFLD.The severity of liver steatosis increases with the increase of the RC/HDL-C ratio,while the RC/HDL-C ratio in MAFLD patients gradually increases with the severity of liver steatosis.The RC/HDL-C ratio may be an effective predictor of MAFLD.