Fetuin-A、Fetuin-B及胰岛素抵抗指数对非酒精性脂肪性肝病的预测价值

Value of Fetuin-A,Fetuin-B,and insulin resistance index in predicting nonalcoholic fatty liver disease

目的探讨血清Fetuin-A、Fetuin-B联合胰岛素抵抗指数(HOMA-IR)对非酒精性脂肪性肝病(NAFLD)的预测价值。方法连续选取2020年6月—2021年6月大理大学第一附属医院消化内科就诊的120例NAFLD患者和体检中心的120例健康体检人群为研究对象,收集其临床数据资料,并检测血清Fetuin-A、Fetuin-B水平。计量资料两组间比较采用成组t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。多因素Logistic回归分析NAFLD患者的危险因素。构建受试者工作特征曲线(ROC曲线)评估Fetuin-A、Fetuin-B联合HOMA-IR对NAFLD患者的预测效能。结果NAFLD组患者的体质量指数、收缩压、舒张压、ALT、AST、空腹血糖、空腹胰岛素、甘油三酯、HOMA-IR、Fetuin-A和Fetuin-B等均高于健康对照组(P值均<0.05)。多因素Logistic回归分析显示Fetuin-A(OR=1.010,95%CI:1.001~1.020,P<0.05)、Fetuin-B(OR=1.113,95%CI:1.021~1.214,P<0.05)和HOMA-IR(OR=24.053,95%CI:2.624~220.470,P<0.05)是NAFLD的独立危险因素。ROC曲线显示,Fetuin-A、Fetuin-B、HOMA-IR、Fetuin-A联合Fetuin-B、Fetuin-A联合HOMA-IR、Fetuin-B联合HOMAIR以及三者联合预测NAFLD的ROC曲线下面积分别为0.637(95%CI:0.551~0.722)、0.853(95%CI:0.796~0.912)、0.837(95%CI:0.763~0.912)、0.853(95%CI:0.795~0.911)、0.843(95%CI:0.770~0.916)、0.922(95%CI:0.877~0.967)和0.922(95%CI:0.877~0.966)。结论Fetuin-A、Fetuin-B对NAFLD有一定的预测价值,Fetuin-B联合HOMA-IR的预测价值更高。

Objective To investigate the value of serum Fetuin-A and Fetuin-B combined with Homeostasis Model Assessment of Insulin Resistance(HOMA-IR)in predicting nonalcoholic fatty liver disease(NAFLD).Methods A total of 120 patients with NAFLD who attended Department of Gastroenterology,The First Affiliated Hospital of Dali University,from June 2020 to June 2021,and 120 healthy individuals who underwent physical examination at Physical Examination Center during the same period of time were enrolled as subjects,and clinical data were collected from all subjects.The serum levels of Fetuin-A and Fetuin-B were measured.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups;the multivariate Logistic regression analysis was used to assess the risk factors for NAFLD.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive efficacy of Fetuin-A and Fetuin-B combined with HOMA-IR in NAFLD patients.Results Compared with the healthy control group,the NAFLD group had significantly higher levels of body mass index,systolic blood pressure,diastolic blood pressure,alanine aminotransferase,aspartate aminotransferase,fasting blood glucose,fasting insulin,triglycerides,HOMA-IR,Fetuin-A,and Fetuin-B(all P<0.05).The multivariate Logistic regression analysis showed that Fetuin-A(odds ratio[OR]=1.010,95%confidence interval[CI]:1.001—1.020,P<0.05),Fetuin-B(OR=1.113,95%CI:1.021—1.214,P<0.05),and HOMA-IR(OR=24.053,95%CI:2.624—220.470,P<0.05)were independent risk factors for NAFLD.The ROC curve analysis showed that Fetuin-A,Fetuin-B or HOMA-IR alone had an area under the ROC curve(AUC)of 0.637(95%CI:0.551—0.722),0.853(95%CI:0.796—0.912),and 0.837(95%CI:0.763—0.912),respectively,and Fetuin-A combined with Fetuin-B,Fetuin-A combined with HOMA-IR,and Fetuin-B combined with HOMA-IR had an AUC of 0.853(95%CI:0.795—0.911),0.843(95%CI:0.770—0.916),0.922(95%CI:0.877—0.967),respectively,while the combination of these three indicators had an AUC of 0.922(95%CI:0.877—0.966).Conclusion Fetuin-A and Fetuin-B have a certain value in predicting NAFLD,and Fetuin-B combined with HOMA-IR tends to have a higher predictive value.