代谢相关性脂肪性肝病患者血脂分析*

目的 分析代谢相关性脂肪性肝病(MAFLD)患者血脂状况,观察应用血脂判断MAFLD程度的效能。方法 2021年1月～10月于辽宁中医药大学附属医院体检中心体检发现的MAFLD患者2210例,其中血脂正常组418例,血脂异常组1792例。建立受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估血脂预测MAFLD脂肪变程度的效能。结果 血脂异常组体质指数为(32.8±10.8 )kg/m²,显著大于血脂正常组【(28.4±11.2) kg/m²,P＜0.05】,收缩压为(146.2±21.2 )mmHg,显著高于血脂正常组【(106.3±7.3 )mmHg,P＜0.05】,舒张压为(107.3±11.6 )mmHg,显著高于血脂正常组【(88.6±5.2)mmHg,P＜0.05】,血糖为(6.4±1.9)mmol/L,显著高于血脂正常组【(6.0±1.5)mmol/L,P＜0.05】,血清ALT和GGT水平分别为(42.2±23.8)U/L和(42.5±30.9 )U/L,均显著高于血脂正常组【分别为(38.3±13.7) U/L和(39.3±18.3 )U/L,P＜0.05】;血脂异常组轻度、中度和重度MAFLD患者血清TG、TC和LDL-C水平均显著高于血脂正常组,而血清HDL-C水平显著低于血脂正常组(P＜0.05);以HDL-C=0.84mmol/L为截断点,其AUC为0.72(P＜0.001),诊断轻度MAFLD的灵敏度为84.8%,特异度为52.8%;以TG=2.71mmol/L为截断点,其AUC为0.79(P＜0.001),诊断中度MAFLD的灵敏度为75.7%,特异度为74.4%;以TG=3.35mmol/L为截断点,其AUC为0.86(P＜0.001),诊断重度MAFLD的灵敏度为90.4%,特异度为73.9%。结论 MAFLD患者病程进展与血脂状况息息相关,并且对血糖和血压等也有较大的影响。综合肝脏超声和血生化检查,MAFLD合并血脂异常患者较血脂正常者病情更为严重。积极进行临床干预,阻断病情发展,将使患者获益。

Analysis of blood lipid in patients with metabolism-related fatty liver diseases

Objective The aim of this study was to analyze the blood lipid changes in patients with metabolism-related fatty liver disease (MAFLD). Methods A total of 2210 patients with MAFLD were found in Physical Examination Center, Affiliated Hospital, Liaoning University of Chinese Traditional Medicine, from January to October 2021, including 418 individuals with normal blood lipids, and 1792 cases with abnormal blood lipids. The receiver operating characteristic curve (ROC) was established to evaluate the diagnostic efficacy of blood lipids in predicting steatosis severity of patients with MAFLD. Results The body mass index (BMI) in MAFLD patients with abnormal blood lipids was (32.8±10.8 )kg/m², significantly higher than (28.4±11.2) kg/m², P＜0.05], the systolic blood pressure was (146.2±21.2 )mmHg, significantly higher than (106.3±7.3)mmHg, P＜0.05], the diastolic blood pressure was (107.3±11.6 )mmHg, significantly higher than (88.6±5.2)mmHg, P＜0.05], the fasting plasma glucose was (6.4±1.9)mmol/L, significantly higher than (6.0±1.5)mmol/L, P＜0.05], serum ALT and GGT levels were (42.2±23.8)U/L and (42.5±30.9 )U/L, both significantly higher than (38.3±13.7) U/L and (39.3±18.3 )U/L, P＜0.05] in those with normal blood lipids; serum TG, TC and LDL-C levels in mild, moderate and severe MAFLD patients with abnormal blood lipids were significantly higher than, while serum HDL-C level was significantly lower than in those with normal blood lipids (P＜0.05); when blood HDL-C=0.84 mmol/L was set as the cut-off-value, the area under ROC curve (AUC) was 0.72(P＜0.001) in predicting mild MAFLD, with the sensitivity (Se) of 84.8% and the specificity (Sp) of 52.8%; when blood TG=2.71 mmol/L was set as the cut-off-value, the AUC was 0.79(P＜0.001) in predicting moderate MAFLD, with the Se of 75.7% and the Sp of 74.4%; when blood TG=3.35 mmol/L was set as the cut-off-value, the AUC was 0.86(P＜0.001) in predicting severe MAFLD, with the Se of 90.4% and the Sp of 73.9%. Conclusion The MAFLD progression is closely related to blood lipid metabolism disorders, and has influence on blood glucose, BMI and blood pressure. The comprehensive check-up, such as blood biochemical tests and ultrasonography could find MAFLD patients with abnormal blood lipids. The early appropriate intervention might help improve the outcomes of patients with MAFLD.