脂肪肝诊断标准的变更对心血管疾病风险分层管理的价值分析  

The value of changes in diagnostic criteria for fatty liver in stratified management of cardiovascular risk

作　　者：吴婉雯 李晓伟 崔立红 Wu Wan-Wen;Li Xiao-Wei;Cui Li-Hong(The Second School of Clinical Medicine,Southern Medical University,Guangzhou 510280,China;Department of Gastroenterology,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]南方医科大学第二临床医学院,广州510280 [2]解放军总医院第六医学中心消化内科,北京100048

出　　处：《解放军医学杂志》2021年第5期486-491,共6页Medical Journal of Chinese People's Liberation Army

基　　金：海军后勤科研计划课题(CHJ12J027);首都卫生发展科研专项(首发2020-2-5113)。

摘　　要：目的探讨非酒精性脂肪性肝病(NAFLD)诊断标准变更为代谢相关脂肪性肝病(MAFLD)对心血管疾病风险分层管理的临床价值。方法选取2019年2月-2020年9月解放军总医院第六医学中心消化内科收治的经超声检查诊断为脂肪肝的患者234例,收集其人体学指标、慢性疾病病史[高血压、2型糖尿病(T2DM)]、肝功能、血脂、血红蛋白、血小板、血尿酸、血尿素、胆汁酸、空腹血糖及非酒精性脂肪肝纤维化评分(NFS)等情况,根据脂肪肝诊断标准的不同进行分析,其中符合NAFLD诊断标准者作为NAFLD组(157例),符合MAFLD诊断标准者作为MAFLD组(213例),再将MAFLD组患者分为有无T2DM、有无饮酒组,比较各组临床资料。结果NAFLD组的男性、高血压、合并T2DM患者比例,以及谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、血红蛋白水平等均低于MAFLD组,高密度脂蛋白胆固醇(HDL-C)水平高于MAFLD组,差异有统计学意义(P<0.05)。MAFLD组中合并T2DM 75例,不合并T2DM 138例。合并T2DM组中高血压患者比例及ALT、AST、GGT、碱性磷酸酶(ALP)水平等均高于不合并T2DM组,无肝纤维化(NFS<–1.455)比例低于不合并T2DM组,差异有统计学意义(P<0.05),两组的年龄、性别及BMI水平差异无统计学意义(P>0.05)。MAFLD组中饮酒者70例,不饮酒者143例。饮酒组的年龄小于不饮酒组,男性、高血压、合并T2DM患者比例,以及BMI、ALT、AST、GGT、前白蛋白、TG、TC、LDL-C、血红蛋白、尿酸及空腹血糖水平等均高于不饮酒组,差异有统计学意义(P<0.05)。结论与NAFLD诊断标准相比,MAFLD诊断标准更易于识别心血管疾病高危人群,有助于对其进行有针对性的管理。Objective To investigate the clinical value of changing the diagnostic criteria for non-alcoholic fatty liver disease(NAFLD)to metabolism-associated fatty liver disease(MAFLD)in the risk-stratification and management of cardiovascular disease.Methods A total of 234 patients with fatty liver diagnosed by ultrasound examination were selected from February 2019 to September 2020 in the Gastroenterological Department of the Sixth Medical Center of Chinese PLA General Hospital.All the enrolled patients were collected of the anthropological parameters,history of chronic diseases[hypertension,type 2 diabetes mellitus(T2DM)],liver function,blood lipid,hemoglobin,platelet,blood uric acid,blood urea,bile acid,fasting blood glucose and nonalcoholic fatty liver disease fibrosis score(NFS).According to the different diagnostic criteria of fatty liver,157 patients who met the diagnostic criteria of NAFLD were classified as NAFLD group and 213 patients who met the diagnostic criteria of MAFLD were classified as MAFLD group.The MAFLD group was regrouped and compared according to the presence or absence of T2DM and alcohol consumption.Results The proportion of male patients,hypertension,T2DM and the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and the hemoglobin in the NAFLD group were lower than those in the MAFLD group;and the level of high density lipoprotein cholesterol(HDL-C)in the NAFLD group was higher than that in the MAFLD group,the difference was statistically significant(P<0.05).In the MAFLD group,75 patients were combined with T2DM and 138 had no T2DM.The proportion of patients with hypertension and the levels of ALT,AST,GGT and alkaline phosphatase(ALP)in patients with T2DM were higher than those without T2DM,and the proportion of patients without liver fibrosis(NFS<–1.455)was lower than those without T2DM,the difference was statistically significant(P<0.05).There were no signific

关 键 词：非酒精性脂肪性肝病 代谢相关脂肪性肝病 心血管疾病 诊断标准 

分 类 号：R575[医药卫生—消化系统]