血浆致动脉粥样硬化指数及RC/HDL-C对瘦型代谢相关脂肪性肝病的预测价值  

Predictive value of atherogenic index of plasma and RC/HDL-C in lean metabolism-associated fatty liver disease

作　　者：葛宇 王超群 沈若宇 许明晓 葛玲玲 董旭 GE Yu;WANG Chaoqun;SHEN Ruoyu;XU Mingxiao;GE Lingling;DONG Xu(Department of Ultrasonography,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Endocrinology,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Infectious Diseases,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院超声科,上海200433 [2]海军军医大学第一附属医院内分泌科,上海200433 [3]海军军医大学第一附属医院感染科,上海200433

出　　处：《胃肠病学和肝病学杂志》2025年第3期397-401,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：上海市青年科技英才扬帆计划项目(21YF1458800)。

摘　　要：目的探讨血浆致动脉粥样硬化指数(atherogenic index of plasma,AIP)及残余胆固醇/高密度脂蛋白胆固醇比值(residual cholesterol/high-density lipoprotein cholesterol,RC/HDL-C)对瘦型代谢相关脂肪性肝病(metabolism-associated fatty liver disease,MAFLD)的预测价值。方法选择2023年7月至2023年12月在海军军医大学第一附属医院健康管理中心参加年度体检的瘦型MAFLD患者(n=200)和瘦型健康对照者(n=91),比较两组的肝肾功能、血脂、AIP及RC/HDL-C等,二元Logistic回归分析瘦型MAFLD的危险因素,采用ROC曲线分析AIP、RC/HDL-C、BMI等对瘦型MAFLD的预测价值。结果瘦型MAFLD患者的年龄大、男性占比多,血压、BMI、ALT、AST、γ-GT、AKP、Cr、UA、FBG、TG、TC、LDL-C、RC、AIP、RC/HDL-C水平均显著高于瘦型健康对照组,而HDL-C水平显著低于瘦型健康对照组(P<0.05)。二元Logistic回归分析结果显示,年龄、男性、BMI、ALT、AIP是瘦型MAFLD的独立危险因素。AIP联合ALT、BMI作为诊断模型时预测瘦型MAFLD的AUC为0.892,敏感度为86.5%,特异度为76.9%;RC/HDL-C的预测效能欠佳(AUC=0.6655,95%CI:0.6025~0.7286)。AIP与RC/HDL-C存在中等程度的相关(r^(2)=0.5122,P<0.0001),与BMI弱相关(r^(2)=0.1304,P<0.0001)。AIP越高,瘦型MAFLD的患病率越高。结论AIP与瘦型MAFLD发生风险呈正相关并是其独立危险因素,AIP联合BMI、ALT是瘦型MAFLD的有效预测指标。Objective To investigate the predictive value of atherogenic index of plasma(AIP)and residual cholesterol/high-density lipoprotein cholesterol(RC/HDL-C)in lean-type metabolism-associated fatty liver disease(MAFLD).Methods Lean MAFLD patients(n=200)and lean healthy controls(n=91)who underwent annual physical examination at the Health Management Center of the First Affiliated Hospital of Naval Medical University from Jul.2023 to Dec.2023 were selected to compare the liver and kidney functions,lipids,AIP and RC/HDL-C of two groups.Binary Logistic regression was performed to analyze the risk factors of lean MAFLD,and ROC curves were used to the predictive value of indices such as AIP,RC/HDL-C and combined BMI for lean-type MAFLD.Results Patients with lean-type MAFLD were older and more predominantly male,and their blood pressure,BMI,ALT,AST,γ-GT,AKP,Cr,UA,FBG,TG,TC,LDL-C,RC,AIP and RC/HDL-C levels were significantly higher than those of the lean-type healthy control group,whereas HDL-C level were significantly lower than those of the lean-type healthy control group(P<0.05).The results of binary Logistic regression analysis showed that age,male,BMI,ALT and AIP were independent risk factors for lean MAFLD.The AUC of AIP combined with ALT and BMI as a diagnostic model for predicting lean MAFLD was 0.892,with a sensitivity of 86.5%and a specificity of 76.9%,while the predictive efficacy of RC/HDL-C was poor(AUC=0.6655,95%CI:0.6025-0.7286).AIP was moderately correlated with RC/HDL-C(r^(2)=0.5122,P<0.0001)and weakly correlated with BMI(r^(2)=0.1304,P<0.0001).The higher the AIP,the higher the prevalence of lean MAFLD.Conclusion AIP is positively correlated with the risk of developing lean MAFLD and is an independent risk factor for it,and AIP combined with BMI and ALT is a valid predictor of lean MAFLD.

关 键 词：血浆致动脉粥样硬化指数 残余胆固醇/高密度脂蛋白胆固醇比值 代谢相关脂肪性肝病 瘦型 预测 

分 类 号：R575[医药卫生—消化系统]