不同腹型肥胖指标对非酒精性脂肪肝严重程度预测能力的研究  

Predictive capacity of abdominal obesity indices for the severity of non-alcoholic fatty liver disease in physical examination population

作　　者：杜程钢[1] 武强[1] 孙红娟 赵庆凯 赵鑫萌 DU Cheng-gang;WU Qiang;SUN Hong-juan;ZHAO Qing-kai;ZHAO Xin-meng(Department of Health Medicine,Hainan Branch of General Hospital of Chinese PLA,Sanya 572013,Hainan,CHINA)

机构地区：[1]解放军总医院海南医院健康医学科,海南三亚572013

出　　处：《海南医学》2020年第21期2728-2733,共6页Hainan Medical Journal

基　　金：海南省三亚市医疗卫生科技创新项目(编号:2018YW10)。

摘　　要：目的了解海南地区健康体检人群的不同腹型肥胖对非酒精性脂肪肝(NAFLD)严重程度的预测能力。方法采用横断面研究,选取2017年4月至2019年1月解放军总医院海南医院健康医学科16288例体检者为研究对象,测量体质量、身高、腰围(WC)和臀围,并计算体质量指数(BMI)、腰高比(WHtR)和腰臀比(WHR),肝脏彩色超声检查脂肪肝情况,由内科医生询问酒精摄入情况和基础疾病史;Logistic多元回归分析男女性的4个肥胖指标与NAFLD严重程度之间的相关性,并用受试者工作特征(ROC)曲线和最大约登指数分析男女性的肥胖指标对NAFLD严重程度的预测能力。结果该体检人群NAFLD发生率为37.5%,其中轻度26.7%、中重度10.8%;NAFLD严重程度随着肥胖指标均数和超标率的增加而增加(趋势检验P<0.05);Logistic多元回归分析结果显示,调整年龄、性别及其他代谢指标等因素后,男性的BMI肥胖、WHR超标、WHtR超标和腰围超标与轻度NAFLD相关,而BMI超重与男性轻度NAFLD无相关性;女性的以上肥胖指标超标均与轻度NAFLD有相关性;中重度NAFLD的发病风险与男女性的肥胖指标超标均有相关性;WHtR超标的OR值最大,每增加1单位WHtR,轻度NAFLD的发病风险增加男性为2.865倍,女性1.475倍,中重度NAFLD的发病风险增加男性为3.863倍,女性5.084倍,差异有统计学意义(P<0.05);ROC曲线分析结果显示,WHtR预测NAFLD严重程度的曲线下面积(AUC)最大,轻度NAFLD男性为0.645,女性0.816,中重度NAFLD男性为0.816,女性为0.882;最大约登指数显示,WHtR对男女性轻度和中重度NAFLD的预测能力最高,轻度NAFLD的切点值男女性分别0.51(敏感度为80.2%、特异度为47.8%)和0.53(敏感度为78.6%、特异度为72.7%),中重度NAFLD的切点值男女性分别0.54(敏感度为77.5%、特异度为70.6%)和0.55(敏感度为85.8%、特异度为79.5%)。结论WHtR是预测NAFLD严重程度的最佳肥胖指标,可以作为健康人群NAFLD的自我监�Objective To evaluate the predictive capacity of abdominal obesity indices to the severity of non-alcoholic fatty liver disease(NAFLD)in physical examination population of Hainan.Methods A total of 16288 participants,who attended health examination at the Department of Health Medicine,Hainan Branch of General Hospital of Chinese PLA from Apr.2017 to Jan.2019,were enrolled for this cross-sectional study.In fasting state their weight,height,hip and waist circumference(WC)were taken by a standard measuring instrument.Body mass index(BMI),waist-to-height ratio(WHtR),and waist-to-hip ratio(WHR)were calculated.Their abdominal color Doppler were conducted,alcohol consumption and disease history were inquired by physicians.The correlationship between BMI,WC,WHR and WHtR and NAFLD was assessed by logistic regression respectively.The accuracy of BMI,WC,WHR and WHtR to predictive NAFLD were evaluated by receiver operating characteristic(ROC)curve and maximum Youden index analysis.Results The percentage detected of NAFLD was 37.5%,including 26.7%of mild and 10.8%of middle or severity.The severity of NAFLD was increased with the increase of obese index SDS or elevated percentage(P<0.05).After adjusting age,gender and other factors,multivariate logistic regression analysis showed that BMI obesity,elevated WHtR,elevated WHR,and elevated WC were the risk factors for mild NAFLD in males(P<0.05),but BMI overweight was not the risk factor in males;all the obesity indices were the risk factors for mild NAFLD in females(P<0.05).All the obesity indices were the risk factors for middle or severity NAFLD in both males and females(P<0.05).Elevated WHtR had highest OR than other obesity indices for NAFLD,each increment of 1 SD in WHtR increased the risk of mild NAFLD by 2.865 times and the risk of middle or severity NAFLD by 3.863 times in males.Similar results were also seen in females:by 1.475 times for mild NAFLD and 5.084 times for middle or severity NAFLD.ROC curves revealed the WHtR AUC predicting the degree of NAFLD was the highest

关 键 词：非酒精性脂肪肝 腹型肥胖 体质量指数 腰臀比 腰高比 腰围 预测价值 

分 类 号：R575.5[医药卫生—消化系统]