摘要
【目的】探讨慢性乙型病毒性肝炎(CHB)代谢相关脂肪性肝病(MAFLD)的中医体质分布特点,探索MAFLD与中医体质、人体成分的相关性,并确定其在CHB患者中对合并MAFLD的预测价值。【方法】采用回顾性研究方法,收集2022年1月至2023年12月期间于广东省中西医结合医院肝病科门诊就诊且符合CHB诊断标准的235例患者临床资料。根据受控衰减系数(controlled attenuation parameter,CAP)值将患者分为non-MAFLD组(<238 dB/m)134例和MAFLD组(≥238 dB/m)101例,观察2组患者的中医体质类型分布差异;根据体质量指数(BMI)值,将患者分为非肥胖组(<24.0 kg/m2)141例和超重/肥胖组(≥24.0 kg/m2)94例。运用Logistic回归分析CHB合并MAFLD的临床独立风险因素,采用多因素Logistic回归分析影响因素,并采用受试者工作特征(ROC)曲线分析影响因素对MAFLD的预测价值并确定其最佳截断值。【结果】(1)MAFLD组患者的体质构成中,以平和质(36.6%)、湿热质(20.8%)、痰湿质(14.9%)为主,3种体质的占比为72.3%。(2)MAFLD患者中,超重/肥胖组γ-谷氨酰转肽酶(γ-GT)、BMI、全身脂肪量(TBFM)、全身肌肉量(TMM)、人体总水分(TBW)、细胞内液(ICW)、细胞外液(ECW)、体脂肪率(BFR)、内脏脂肪面积(VFA)、基础代谢量(BM)、躯干脂肪量(TFM)水平显著高于非肥胖组,差异均有统计学意义(P<0.05或P<0.01)。(3)多因素Logistic回归分析结果显示,白细胞计数(WBC)、血尿酸(UA)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、VFA是CHB人群中患MAFLD的临床影响因素。(4)ROC曲线分析结果显示,在CHB人群中年龄、TG、UA、VFA的ROC曲线下面积(AUC)分别为0.532、0.680、0.738、0.859;在CHB人群、非肥胖CHB人群和超重/肥胖CHB人群的VFA的最佳临界值分别为74.98、66.5和112.2 cm^(2);在平和质、痰湿质、湿热质人群的VFA的最佳临界值分别为85.50、66.50和74.98 cm^(2)。各人群中VFA的AUC值均明显高于年龄、TG、UA,且多因素联合预测均高于其他单因素的预测价值。【结论】在CHB患者中VFA预测MAFLD风险的AUC值最高,随着VFA的切点水平增加,MAFLD发生的可能性增加;在非肥胖人群和超重/肥胖人群和不同中医体质人群的VFA的最佳临界值有所不同。
Objective To investigate the distribution of traditional Chinese medicine(TCM)constitution in chronic hepatitis B(CHB)patients complicated with metabolism associated fatty liver disease(MAFLD),and to explore the correlation of the complication of MAFLD with TCM constitution and body composition,thus to determine their predictive values for the complication of MAFLD in CHB patients.Methods A retrospective study was adopted.The study started from the collection of the clinical data of 235 outpatients who attended the Department of Hepatology of Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to December 2023,and was diagnosed as CHB following the diagnostic criteria.According to the controlled attenuation parameter(CAP)value,134 cases of CHB patients were allocated to the non-MAFLD group(CAP<238 dB/m)and 101 cases were allocated to the MAFLD group(CAP≥238 dB/m).And then the distribution of TCM constitution in the two groups was observed.In addition,according to the body mass index(BMI)value,the patients were divided into the non-obese group(141 cases,BMI<24.0 kg/m2)and the overweight/obese group(94 cases,BMI≥24.0 kg/m2).And then the logistic regression was used to analyze the independent risk factors for the complication of MAFLD in CHB patients,multivariate logistic regression was used to analyze the influencing factors,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of the influencing factors for the complication of MAFLD in CHB patients and to determine their optimal cut-off values.Results(1)The constitutions of CHB patients in the MAFLD group were predominated by balanced constitution(36.6%),damp-heat constitution(20.8%),and phlegm-damp constitution(14.9%),which accounted for 72.3%in total.(2)In CHB patients complicated with MAFLD,the overweight/obese group had higher levels ofγ-glutamyl-transpeptidase(γ-GT),BMI,total body fat mass(TBFM),total muscle mass(TMM),total body water(TBW),interacel1ular water(ICW),extracellular water(ECW),body fat ratio(BFR),visceral fat area(VFA),basal metabolism(BM),and trunk fat mass(TFM)than the non-obese group,and the differences were statistically significant(P<0.05 or P<0.01).(3)The results of multivariate logistic regression analysis showed that the white blood cell(WBC)count,blood uric acid(UA),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),and VFA were the influencing factors for the complication of MAFLD in the CHB patients in clinic.(4)The results of ROC curve analysis showed that in CHB patients,the areas under the ROC curve(AUC)for age,TG,UA,and VFA were 0.532,0.680,0.738,and 0.859 respectively;the optimal cut-off values of VFA in CHB patients,non-obese CHB patients,and overweight/obese CHB patients were 74.98,66.5 and 112.2 cm^(2) respectively,and the optimal cut-off values of VFA in patients with balanced constitution,phlegm-damp constitution,and damp-heat constitution were 85.50,66.50,and 74.98 cm^(2) respectively.The AUC values of VFA in various populations were significantly higher than those of age,TG,and UA,and the combined prediction by multivariate analysis has higher predictive value than that by univariate analysis.Conclusion The AUC value of VFA for predicting the risk of MAFLD is the highest in patients with CHB,and the possibility of the complication of MAFLD increased with the increase of the cut-off point level of VFA.The optimal cut-off values of VFA varies in non-obese group and overweight/obese group of CHB patients and in CHB patients with different TCM constitution.
作者
何艳婷
童丽君
李佩玲
谢维宁
HE Yan-Ting;TONG Li-Jun;LI Pei-Ling;XIE Wei-Ning(Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine,Foshan 528200 Guangdong,China;Nanhai Hospital of Traditional Chinese Medicine,Jinan University,Foshan 528200 Guangdong,China;Dept.of Infectious Disease,Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine,Foshan 528200 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2024年第11期2839-2849,共11页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
广东省基础与应用基础研究基金项目(编号:2023A1515140125)
广东省卫生健康委员会医学科研基金项目(编号:B2021265)
广东省中医药局科研项目(编号:20191053)。
关键词
慢性乙型病毒性肝炎
代谢相关脂肪性肝病
中医体质
人体成分
肥胖
chronic hepatitis B
metabolism associated fatty liver disease
traditional Chinese medicine constitution
body composition
obese