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体脂成分及血脂、血糖、尿酸与非肥胖人群MAFLD的相关性研究

摘要:非肥胖MAFLD患者的体脂成分及代谢指标特点如何,以及各指标对该病的预测价值,不同的研究结论尚不一致。 目的 分析非肥胖人群代谢相关脂肪性肝病(MAFLD)的体脂成分及血脂、血糖、尿酸变化特点,明确非肥胖MAFLD的独立危险因素,探讨以上指标与非肥胖MAFLD相关性及对该病的预测价值。方法 收集2018年1月到2019年1月在南京鼓楼医院健康管理中心体检人员,根据肝脏B超结果分为脂肪肝组和非脂肪肝组,分别在两组当中根据BMI<25Kg/m2分为肥胖组和非肥胖组。最终纳入非肥胖MAFLD 129例、非肥胖健康组129例、肥胖MAFLD129例 、肥胖非MAFLD 129例。比较非肥胖MAFLD与其它3组间体脂成分及血脂、血糖、尿酸和肝功能指标,分析各指标与非肥胖MAFLD的相关性,明确非肥胖MAFLD的独立危险因素及以上指标对非肥胖MAFLD的预测价值。结果 1、非肥胖MAFLD体质指数(body mass index,BMI)、体脂肪(Body fat,BF)、体脂肪百分比(Percentage of body fat,BFR)、内脏脂肪面积(Visceral fat area,VFA)、腰围(waist circumference,WC)、腰臀比(Waist hip ratio ,WHR)较非肥胖健康组升高而低于肥胖MAFLD;总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol, LDL-C)、甘油三酯(triglyceride,TG)、谷丙转移酶(alanine aminotransferase,ALT)谷酰转肽酶(gamma-glutamyl transpeptidase,GGT)、尿酸(uric acid,UA)高于非肥胖健康组且与肥胖MAFLD无明显差异。空腹血糖(Fasting plasma glucose,FPG)、糖化血红蛋白(glycosylated hemoglobin ,HbA1C)与非肥胖健康组无明显差异。2、Kendall's相关分析显示 TC 、LDL、TG 、ALT 、GGT、UA、BFR、VFA和WHR与MAFLD呈正相关。HDL与MAFLD呈负相关。3、分组多因素Logistic回归分析:TG、ALT、UA、BFR和VFA为非肥胖MAFLD独立危险因素。4、受试者工作特征(ROC)曲线分析结果TG、ALT、UA、BFR和VFA对非肥胖MAFLD有较好的预测能力,其中以VFA对非肥胖MAFLD预测价值最大。最佳临界值男性为59.75cm2,女性为79.15cm2。 结论 非肥胖MAFLD与非肥胖健康人群相比,体脂肪及内脏脂肪增多,脂质代谢异常,尿酸水平升高,转氨酶上升。TG、ALT、UA、BFR和VFA为非肥胖MAFLD独立危险因素, ROC曲线分析显示以上指标对非肥胖MAFLD有预测能力,其中以VFA对非肥胖MAFLD预测价值最大。HDL为非肥胖MAFLD保护因素。

英文摘要:background The characteristics of body fat composition and metabolic indexes in non-obese MAFLD patients, as well as the predictive value of each index to the disease, different research conclusions are not consistent. Objective To analyze the body fat composition and the changes of blood lipid, blood glucose and uric acid in non-obese people with metabolic associated fatty liver disease (MAFLD), to clarify the independent risk factors of non-obese MAFLD, and to explore the correlation between the above indexes and non-obese MAFLD and its predictive value. Methods The physical examination personnel who underwent physical examination in the health management center of Nanjing Gulou Hospital from January 2018 to January 2019 were collected and were examined by human body composition analysis. According to the results of liver B-ultrasound, they were divided into fatty liver group and non-fatty liver group. Among the two groups, they were divided into obese group and non-obese group according to BMI < 25kg / m2. 129 cases of non-obese MAFLD, 129 cases of non-obese healthy group, 129 cases of obese MAFLD and 129 cases of obese non MAFLD were finally included. To compare the body fat composition, blood lipid, blood glucose, uric acid and liver function indexes between non-obese MAFLD and the other three groups, analyze the correlation between each index and non-obese MAFLD, and clarify the independent risk factors of non-obese MAFLD and the predictive value of the above indexes for non-obese MAFLD. Results 1. The body mass index (BMI), body fat (BF), percentage of body fat (BFR), visceral fat area (VFA), waist circumference (WC) and waist hip ratio (WHR) of non-obese MAFLD were higher than those of non-obese healthy group, but lower than those of obese MAFLD. Cholesterol (TC), low density lipoprotein cholesterol (LDL), triglyceride (TG), high density lipoprotein cholesterol (HDL), uric acid (UA), alanine aminotransferase (ALT) Glutamyl transpeptidase (GGT) was higher than that in non-obese healthy group, and there was no significant difference with obese MAFLD. There was no significant difference in fasting blood glucose (FPG) and glycosylated hemoglobin (HbA1c) between the non-obese healthy group and the non-obese healthy group. 2. Kendall's correlation analysis showed that TC, LDL, TG, ALT, GGT, UA, BFR, VFA and WHR were positively correlated with MAFLD. HDL was negatively correlated with MAFLD. 3. Multivariate logistic regression analysis showed that TG, ALT, UA, BFR and VFA were independent risk factors for non-obese MAFLD. 4. The results of receiver operating characteristic (ROC) curve analysis showed that TG, ALT, UA, BFR and VFA had good predictive ability for non-obese MAFLD, among which VFA had the greatest predictive value for non-obese MAFLD. The best critical value is 59.75cm for men and 79.15cm for women. Conclusion Compared with non-obese healthy people, non-obese MAFLD has increased body fat and visceral fat, abnormal lipid metabolism, elevated uric acid level and transaminase. TG, ALT, UA, BFR and VFA were independent risk factors for non-obese MAFLD. ROC curve analysis showed that the above indicators had the ability to predict non-obese MAFLD, among which VFA had the greatest predictive value for non-obese MAFLD. HDL is a protective factor for non-obese MAFLD.

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[V1] 2022-08-12 18:31:09 chinaXiv:202208.00090V1 下载全文
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