肥胖测量指标在预测代谢相关脂肪性肝病健康风险中的应用价值  

Application value of obesity measures in predicting health risk of metabolic-associated fatty liver disease(MAFLD)

作　　者：刘璇 苏比德·阿力木江 邹媛[3] 韩雷[3] 刘波 LIU Xuan;Subide Alimujiang;ZOU Yuan;HAN Lei;LIU Bo(School of Healthcare,Xinjiang Medical University,Urumqi 830017,China;School of Public Health,Xinjiang Medical University,Urumqi 830017,China;Center of Health Management,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Administration of Traditional Chinese Medicine of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆医科大学健康管理学院,乌鲁木齐830017 [2]新疆医科大学公共卫生学院,乌鲁木齐830017 [3]新疆医科大学第一附属医院健康管理中心,乌鲁木齐830054 [4]新疆维吾尔自治区中医药管理局,乌鲁木齐830001

出　　处：《新疆医科大学学报》2024年第8期1166-1173,共8页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区创新环境(人才、基地)建设专项项目(PT2207)。

摘　　要：目的评估肥胖测量指标对代谢相关脂肪性肝病(Metabolic-associated fatty liver disease,MAFLD)健康风险的预测价值。方法选取2023年6月1日-12月31日在新疆医科大学第一附属医院健康管理中心体检的49155例体检者,根据诊断标准,将其分为MAFLD组和非MAFLD组,并计算体质指数(BMI)、腰臀比(WHR)、内脏脂肪指数(VAI)、脂质蓄积指数(LAP)。BMI分为正常、超重、肥胖组;腰围(WC)分为正常、中心性肥胖前期和中心性肥胖组。采用Logistic回归模型分析性别亚组中肥胖测量指标及生化指标的差异。绘制受试者工作特征(ROC)曲线评估各指标对MAFLD的预测价值。结果共检出MAFLD 23765例(48.35%),其中男性18030例(75.87%),女性5735例(24.13%)。同一性别中,MAFLD组除高密度脂蛋白胆固醇(HDL-C)水平低于非MAFLD组外,其余指标水平均高于非MAFLD组(P均<0.001);校正混杂因素后Logistic模型显示,MAFLD发生风险随BMI、WC、WHR、VAI、LAP水平增高而增高;ROC分析发现,BMI、WHR、VAI和LAP预测不同性别组MAFLD的曲线下面积(AUC)均大于0.7,其中LAP的AUC值最大,且预测女性的AUC值[0.896(0.891~0.900)]大于男性AUC值[0.831(0.826~0.836)],最佳截断值为25.49、39.26(P均<0.05);BMI×LAP联合模型在不同性别中预测价值最高,AUC值分别为男性0.846(0.841~0.850)、女性0.908(0.904~0.913)(P均<0.05)。结论MAFLD发生风险随BMI、WHR、VAI、LAP水平升高而增高,LAP相较于其他指标预测价值更高,尤其在女性中。BMI×LAP可作为不同性别中MAFLD健康风险评估的有力工具。Objective:To evaluate the predictive value of obesity measures on the health risk of metabolic-associated fatty liver disease(MAFLD).Methods:A cohort of 49155 individuals who underwent physical examinations at the Health Management Center of the hospital from June 1 to December 31,2023 was selected.Subjects were categorized into MAFLD and non-MAFLD groups and assessed for body mass index(BMI),waist hip ratio(WHR),visceral fat index(VAI)and lipid accumulation product(LAP).BMI was stratified into normal,overweight,and obese categories;waist circumference(WC)into normal,early and established central obesity.Logistic regression differentiated gender-based obesity metrics and biochemical profiles.The ROC curve assessed predictive accuracy for MAFLD.Results:A total of 23765 cases(48.35%)of MAFLD were detected,including 18030 males(75.87%)and 5735 females(24.13%).In the same gender,the levels of other indicators in MAFLD group were higher than those in non MAFLD group(all P<0.001),except the level of high density lipoprotein cholesterol(HDL-C)was lower than that in non MAFLD group.Adjusted for confounders,MAFLD risk correlated positively with BMI,WC,WHR,VAI,and LAP.ROC analysis showed that the area under the curve(AUC)of BMI,WHR,VAI and LAP in predicting MAFLD in different gender groups were greater than 0.7,the AUC value of LAP was the largest,and the AUC value of women[0.896(0.891~0.900)]was higher than that of men[0.831(0.826~0.836)],and the best cut-off values were 25.49 and 39.26(P<0.05).The BMI×LAP model offered superior predictive accuracy across genders,with AUC values of 0.846(0.841~0.850)for males and 0.908(0.904~0.913)for females(all P<0.05).Conclusion:The risk of MAFLD increases with higher levels of BMI,WHR,VAI,and LAP,with LAP showing a higher predictive value than other indicators,particularly in women.BMI×LAP becomes a powerful tool for different gender MAFLD health risk assessment.

关 键 词：代谢相关脂肪性肝病 肥胖 内脏脂肪指数 脂质蓄积指数 预测 

分 类 号：R575.5[医药卫生—消化系统]