体检人群中血浆致动脉粥样硬化指数对代谢相关脂肪性肝病的预测价值  

Predictive value of plasma atherosclerosis index on metabolic associated fatty liver disease in physical examination population

作　　者：张晓雨 孙浩翔 雷玉婷 王小雪[3] 金长清[3] 王影[2] 王珩[4] Zhang Xiaoyu;Sun Haoxiang;Lei Yuting;Wang Xiaoxue;Jin Changqing;Wang Ying;Wang Heng(Health Management College,Anhui Medical University,Hefei 230022,China;Department of General Practice,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Health Management Center,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学卫生管理学院,合肥230022 [2]安徽医科大学第一附属医院全科医学科,合肥230022 [3]安徽医科大学第一附属医院健康管理中心,合肥230022 [4]安徽医科大学第一附属医院,合肥230022

出　　处：《中华健康管理学杂志》2023年第6期437-443,共7页Chinese Journal of Health Management

基　　金：国家重点研究发展计划(2020YFC2006500)。

摘　　要：目的探讨体检人群中血浆致动脉粥样硬化指数(AIP)对代谢相关脂肪性肝病(MAFLD)的预测价值。方法本研究为横断面研究,选取2021年1—12月在安徽医科大学第一附属医院健康管理中心完成体检且所查项目满足研究完整性的97076例受检者,符合MAFLD诊断标准的31176例作为MAFLD组,非MAFLD组65900例;收集两组的实验室指标、身高、体重、血压以及肝脏超声等指标,并计算AIP。计量资料采用t检验、计数资料采用χ^(2)检验比较两组的差异,利用单因素和多因素logistic回归分析MAFLD的影响因素。将两组人群按性别及年龄分组,采用比较绘制受试者工作特征(ROC)曲线方式评价AIP在不同群体中预测效能的差异。结果MAFLD组的平均年龄(47.3岁,Z=-31.734)、男性比例(76.9%,χ^(2)=7837.54)和AIP平均值(0.23,Z=-155.089)均高于非MAFLD组(均P<0.001);按年龄、性别、体重指数(BMI)、是否高血压、糖化血红蛋白(HbA1c)、甘油三酯、空腹血糖(FBG)分层后,两组之间的AIP差异均有统计学意义(均P<0.001)。多因素回归分析显示,丙氨酸氨基转移酶(OR=1.024)、天冬氨酸氨基转移酶(OR=0.974)、sCr(OR=0.975)、血尿酸(OR=1.004)、HbA1c(OR=1.231)、血红蛋白(OR=1.011)、血小板(OR=1.002)、FBG(OR=1.131)、BMI(OR=1.419)、AIP(OR=11.318)、收缩压(OR=1.002)、舒张压(OR=1.012)是代谢相关脂肪性肝病的独立危险因素(均P<0.001)。在整体人群中,AIP的AUC为0.808,截断值为2.045、灵敏度为74.5%、特异度72.4%;在性别分组中,女性的AUC高于男性(0.815比0.764),两组的截断值、灵敏度、特异度分别为-0.044比0.091、75.6%比72.2%、73.3%比67.6%;在年龄分组中,18~44岁人群的AUC最大(0.848),截断值为0.034,灵敏度为79.1%,特异度为75.3%;各组ROC曲线分析差异均有统计学意义。结论AIP是MAFLD的独立危险因素,对于该疾病的发生具有较好的预测价值,并且在女性及年轻群体(18~44岁)中的预测效能更好。Objective To investigate the predictive value of plasma atherosclerosis index(AIP)on metabolic associated fatty liver disease(MAFLD)in physical examination population.Methods It was a cross-sectional study.Total of 97076 people who completed physical examination in the Health Management Center of the First Affiliated Hospital of Anhui Medical University from January to December 2021 and met the integrity of the study were selected as study subjects.Of the subjects,31176 people who met the diagnostic criteria of MAFLD were set as the MAFLD group,and the other 65900 people were set as the non-MAFLD group.Laboratory indexes,height,weight,blood pressure,liver ultrasound and other indicators in the two groups were collected,and the AIP was calculated.The t-test was used for measurement data and chi-square test was used for counting data to compare the differences between the two groups.Univariate and multivariate logistic regression were used to analyze the influencing factors of MAFLD.The two groups were grouped further according to gender and age,and the difference of AIP prediction efficiency in different groups was evaluated by receiver operating characteristic(ROC)curve.Results The average age(47.3 years,Z=-31.734),male proportion(76.9%,χ^(2)=7837.54)and the average value of AIP(0.23,Z=-155.089)in MAFLD group were all higher than those in non-MAFLD group(all P<0.001).After stratified by age,gender,body mass index(BMI),hypertensive or not,hemoglobin A1c(HbA1c),triglyceride(TG),fasting blood glucose(FBG),the difference of AIP between the two groups was still statistically significant(all P<0.001).Multifactorial regression analysis showed that alanine aminotransferase(ALT)(OR=1.024),aspartate aminotransferase(AST)(OR=0.974),serum creatinine(sCr)(OR=0.975),serum uric acid(OR=1.004),HbA1c(OR=1.231),hemoglobin(HB)(OR=1.011),platelet(PLT)(OR=1.002),FBG(OR=1.131),BMI(OR=1.419),AIP(OR=11.318),systolic blood pressure(OR=1.002),and diastolic blood pressure(OR=1.012)were independent risk factors for MAFLD(all P<0.001).In th

关 键 词：血脂异常 脂肪肝 动脉粥样硬化 代谢 

分 类 号：R575.5[医药卫生—消化系统]