内脏脂肪指数和脂质蓄积指数对非超重/肥胖者代谢相关脂肪性肝病的预测价值

Predictive value of visceral fat index and lipid accumulation product on metabolic associated fatty liver disease in the population without overweight/obesity

目的探讨内脏脂肪指数(VAI)和脂质蓄积指数(LAP)对非超重/肥胖者代谢相关脂肪性肝病(MAFLD)的预测价值。方法本研究为横断面研究,选取2021年1至12月哈尔滨医科大学附属第二医院体检中心的体检数据进行回顾性分析,按纳入和排除标准,最终4304例18~75岁非超重/肥胖者作为研究对象。依据MAFLD诊断标准,将研究对象分为MAFLD组和非MAFLD组,比较两组血压、血脂、血糖等临床指标以及体重指数(BMI)、VAI、LAP肥胖测量指标之间的差异。将BMI、VAI、LAP按照各自的四分位数分为A、B、C、D 4组,分别计算这些指标4组内非超重/肥胖者MAFLD检出率,采用Spearman秩相关分析评估BMI、VAI、LAP与非超重/肥胖者MAFLD的相关性,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)评价各指标对非超重/肥胖者MAFLD的预测能力。结果本研究体检人群中,非超重/肥胖者MAFLD的检出率为10.87%。在非超重/肥胖者中,MAFLD组的收缩压/舒张压、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、空腹血糖(FPG)均显著高于非MAFLD组(分别为131/80比113/70 mmHg,5.29比4.65 mmol/L,3.21比2.75 mmol/L,1.87比0.89 mmol/L,5.60比4.95 mmol/L),但MAFLD组的高密度脂蛋白胆固醇(HDL-C)显著低于非MAFLD组(1.19比1.49 mmol/L);MAFLD组的肥胖测量指标BMI、VAI、LAP均显著高于非MAFLD组(分别为22.10比20.70 kg/m^(2),2.64比1.00,36.27比12.48)(均P<0.001)。非超重/肥胖者MAFLD检出率随各指标四分位数分组增高均呈线性增高;Spearman秩相关分析显示各指标与非超重/肥胖者MAFLD的相关系数分别为LAP(0.427)>VAI(0.406)>BMI(0.282);ROC分析显示LAP对非超重/肥胖者MAFLD的预测准确性更高,AUC值高达0.896(0.886~0.905),最佳截断值为20.75,灵敏度和特异度分别为85.9%和79.0%,其次为VAI(AUC为0.876),最后为BMI(AUC为0.761)。结论VAI和LAP对非超重/肥胖者MAFLD均具有很好的预测能力,与VAI相比,LAP对非超重/肥胖者MAFLD预测准确性更高。

Objective To investigate the value of visceral fat index(VAI)and lipid accumulation product(LAP)on predicting metabolic associated fatty liver disease(MAFLD)in the population without overweight/obesity.Methods This study is a cross-sectional study.The physical examination data derived from International Physical Examination and Health Center of the Second Affiliated Hospital of Harbin Medical University from January to December 2021 were collected.According to the inclusion and exclusion criteria,a total of 4304 subjects without overweight/obesity aged from 18-75 were included in this study.The subjects were divided into two groups with MAFLD or without MAFLD,according to the diagnostic criteria of MAFLD provided by The Asian Pacific Association for the Study of the liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease.Comparison of the clinical parameters(blood pressure,lipid,glucose)and obesity measurement indexes(BMI,VAI,LAP)between the two groups was analyzed.All subjects were respectively divided into four groups according to BMI,VAI and LAP quartile,which were defined as A,B,C,D.The prevalence of MAFLD in the population without overweight/obesity in quartile area groups of different obesity measurement indexes was calculated.Spearman′s rank correlation was used to evaluate the correlation between BMI,LAP,VAI and MAFLD in the population without overweight/obesity,respectively.Meanwhile,receiver operating characteristics(ROC)curves were used to calculate area under the curve(AUC)and evaluate the accuracy of BMI,VAI and LAP on predicting for MAFLD in the population without overweight/obesity.Results The prevalence of MAFLD in the population without overweight/obesity was 10.87%.In the population without overweight/obesity,the clinical data blood pressure,total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),triglyceride(TG)and fasting plasma glucose(FPG)in the group with MAFLD were significantly higher than those of the group without MAFLD(131/80 vs 113/70 mmHg,5.29 vs 4.65 mmol/L,3.21 vs 2.75 mmol/L,1.87 vs 0.89 mmol/L,5.60 vs 4.95 mmol/L;P<0.001),but high density lipoprotein cholesterol(HDL-C)of the group with MAFLD was significantly lower than that of the group without MAFLD(1.19 vs 1.49 mmol/L;P<0.001).The obesity measurement indexes(BMI,VAI,LAP)in the group with MAFLD were significantly higher than those of the group without MAFLD(22.10 vs 20.70 kg/m^(2),2.64 vs 1.00,36.27 vs 12.48;all P<0.001).In the population without overweight/obesity,the prevalence of MAFLD was increased with the increase of BMI,VAI and LAP quartile area,and there was a linear correlation between MAFLD and obesity measurement indexes above.Spearman′s rank correlation analysis showed that correlation coefficient between obesity measurement indexes and MAFLD in the population without overweight/obesity was respectively LAP(0.427)>VAI(0.406)>BMI(0.282).ROC curve analysis showed that in the population without overweight/obesity,LAP had the highest accuracy on predicting MAFLD,with the AUC value of 0.896(0.886-0.905),the optional cut-off value was 20.75,sensitivity and specificity was 85.9%and 79.0%,respectively.VAI(0.876)took the second place and BMI(0.761)located lastly.Conclusions Both VAI and LAP have good prediction ability for MAFLD in the population without overweight/obesity.However,compared with VAI,LAP has higher accuracy on predicting MAFLD in the population without overweight/obesity.