血清高密度脂蛋白胆固醇在非酒精性脂肪性肝病风险评估中的价值  

Value of serum high density lipoprotein-cholesterol in risk assessment of non-alcoholic fatty liver disease

作　　者：张力元 盛夏[1] 胡平方[1] 曾欣 谢渭芬[1] Zhang Liyuan;Sheng Xia;Hu Pingfang;Zeng Xin;Xie Weifen(Department of Gastroenterology,Changzheng Hospital,Shanghai200003,China;Department of Gastroenterology,Shanghai East Hospital Affiliated to Tongji University,Shanghai200120,China)

机构地区：[1]上海长征医院消化内科,200003 [2]同济大学附属东方医院消化内科,上海200120

出　　处：《中华消化杂志》2019年第5期317-321,共5页Chinese Journal of Digestion

基　　金：上海加强公共卫生体系建设三年行动计划(GWⅣ-27.7)Project of Three-year Plan for Construction of Public Health System in Shanghai(GWⅣ-27.7).

摘　　要：目的 探讨血清高密度脂蛋白胆固醇(H DL-C)在非酒精性脂肪性肝病(NAFLD)诊断和风险评估中的价值.方法 采用横断面研究,多阶段分层随机抽样法抽取流行病学调查人群,根据纳入和排除标准,共纳入3 312例调查对象,将其分为NAFLD组(913例)和非NAFLD组(2 399例),比较两组患者血脂水平.采用ROC曲线评价HDL-C在NAFLD中的诊断价值,建立基于HDL-C水平的二元logistic回归模型,并采用t检验和Mann-Whitney U检验进行统计学分析.结果 NAFLD组患者血清总胆固醇、三酰甘油和低密度脂蛋白胆固醇(LDL-C)水平均高于非NAFLD组[(5.24±0.92) mmol/L比(4.98±0.92) mmol/L,(1.95±1.41) mmol/L比(1.13±0.68) mmol/L,(3.31±0.84) mmol/L比(3.09±0.84) mmol/L],差异均有统计学意义(t=-7.29、-22.38、-6.84,P均<0.01);但NAFLD组患者血清HDL-C水平低于非NAFLD组[(1.30±0.33) mmol/L比(1.64±0.40) mmol/L],差异有统计学意义(t =24.93,P<0.01).NAFLD患者高胆固醇血症、高三酰甘油血症、低HDL-C血症和高LDL-C血症的发生率分别为48.0% (438/913)、44.8% (409/913)、31.0% (283/913)和82.8% (756/913),均分别高于非NAFLD组的36.8% (882/2 399)、13.2% (317/2 399)、10.5% (251/2 399)和71.8%(1 723/2 399),差异均有统计学意义(x2=34.65、385.43、206.18、42.37,P均<0.01).以HDL-C女性≤1.66 mmol/L、男性≤1.33 mmol/L为截断值,诊断NAFLD的AUC值(95% CI)分别为0.720(0.693~0.747)和0.708(0.679~0.737),灵敏度分别为79.1%和76.6%,特异度分别为55.0%和54.6%.根据HDL-C建立的2个回归模型显示,女性低水平HDL-C NAFLD的患病率是高水平HDL-C的4.584倍(95%CI3.530~5.940,P<0.01),男性低水平HDL-C NAFLD的患病率是高水平HDL-C的3.898倍(95%CI3.020~5.030,P<0.01).HDL-C低水平组ALT、AST、GGT和ALP均高于HDL-C高水平组[分别为20.10 U/L(14.40 U/L,29.40 U/L)比16.80 U/L(12.70 U/L,23.00 U/L),19.20 U/L(16.00 U/L,23.70 U/L)比19.00 U/L (16.00 U/L,22.17 U/L),22.00 U/L(14.00 U/L,34.00 U/L)比15.00 U/L(11.00 U/L,23.00 U/L)和71.00 U/L(59.00 UObjective To investigate the value of high density lipoprotein-cholesterol(HDL-C)in the diagnosis and risk assessment of non-alcoholic fatty liver disease(NAFLD).Methods A cross-sectional study and multistage stratified random sampling method were performed in epidemiological survey.According to inclusion and exclusion criteria,a total of 3 312 individuals were enrolled and divided into NAFLD group(913 cases)and non-NAFLD group(2 399 cases).The serum lipid levels were compared between the two groups.Receiver operating characteristic(ROC)curve was performed to evaluate the value of HDL-C in the diagnosis of NAFLD.The binary logistic regression models were established based on HDL-C level.The differences in liver function indexes were compared among the research objects with different HDL-C levels.T test and MannWhitney U test were performed for statistical analysis.Results The serum levels of total cholesterol,triglyceride and low density lipoprotein-cholesterol(LDL-C)of NAFLD group were all higher than those of non-NAFLD group((5.24±0.92)mmol/L vs.(4.98±0.92)mmol/L,(1.95±1.41)mmol/L vs.(1.13±0.68)mmol/L,(3.31±0.84)mmol/L vs.(3.09±0.84)mmol/L),and the differences were statistically significant(t=-7.29,-22.38 and-6.84,all P<0.01).However the serum HDL-C level of NAFLD group was lower than that of non-NAFLD group((1.30±0.33)mmol/L vs.(1.64±0.40)mmol/L),and the difference was statistically significant(t=24.93,P<0.01).The incidence of hypercholesterolemia,hypertriglyceridemia,hypo-high-density lipoprotein cholesterolemia and hyper-low-density lipoprotein cholesterolemia of NAFLD group was 48.0%(438/913),44.8%(409/913),31.0%(283/913)and 82.8%(756/913),respectively,which were significantly higher than that of non-NAFLD group(36.8%,882/2 399;13.2%,317/2 399;10.5%,251/2 399;71.8%,1 723/2 399),and the differences were statistically significant(x2=34.65,385.43,206.18 and 42.37,all P<0.01).Using the cut-off values of HDL-C≤1.66 mmol/L in female and≤1.33 mmol/L in male,the area under curve(AUC)values for NAFLD dia

关 键 词：胆固醇 HDL 非酒精性脂肪性肝病 危险因素 抗炎作用 

分 类 号：R5[医药卫生—内科学]