应用血清TG/HDL-C比值早期诊断非酒精性脂肪性肝病患者临床价值探讨

目的 探讨血清甘油三脂/高密度脂蛋白胆固醇比值（TG/HDL-C）和谷氨酰转肽酶（GGT）在早期诊断非酒精性脂肪性肝病（NAFLD）患者的临床价值。方法 2012年1月~2015年5月在我院经B超检查诊断为NAFLD患者120例和同期体检结果无异常的健康人120例,常规检测血生化指标,根据CT检查结果进行非酒精性脂肪肝分级。依据ROC曲线评判血清甘油三酯/高密度脂蛋白胆固醇（HDL-C）比值和谷氨酰转移酶（GGT）诊断NAFLD的价值。结果 NAFLD患者血清ALT、AST、TG、TG/HDL-C比值、GGT分别为【（39.9±4.3） U/L、（39.5±3.8） U/L、（2.4±0.4） mmol/L、（3.2±0.6）、（60.7±4.5） U/L】,均显著高于健康人【分别为（20.6±3.2） U/L、（18.0±2.9） U/L、（1.1±0.3） mmol/L、（0.9±0.4）、（27.0±3.5）U/L,P均<0.05】,HDL-C和肝/脾CT比值分别为（0.9±0.2）mmol/L和（0.6±0.2）,均显著低于健康人【（1.2±0.3） mmol/L和（0.9±0.1）,P<0.05】;20例重度NAFLD患者血清ALT、AST、TG、TG/HDL-C比值、GGT分别为（52.2±4.3） U/L、（51.8±4.0） U/L、（3.4±0.4） mmol/L、（4.8±0.5）、（77.5±3.9） U/L）,均显著高于49例中度组【分别为（45.9±4.1） U/L、（46.1±3.8） U/L、（2.8±0.3） mmol/L、（3.5±0.3）、（65.9±3.7） U/L】和51例轻度组【分别为（29.4±3.5） U/L、28.3±3.2） U/L、（1.7±0.3） mmol/L、（1.5±0.2）、（49.2±3.4） U/L】,三组间以上指标差异具有统计学意义（均P<0.05）;重度组HDL-C为（0.7±0.2） mmol/L,与中度组【（0.8±0.2） mmol/L】或轻度组【（1.1±0.2） mmol/L】比,差异无统计学意义;重度组肝/脾CT比值为（0.4±0.1）,显著低于中度组（0.6±0.1）或轻度组【（0.8±0.1）,P<0.05】;Pearson相关分析显示NAFLD患者血清TG、TG/HDL-C比值、GGT水平均与肝/脾CT比值呈负相关,与血清ALT和AST呈正相关（P<0.05）;ROC曲线显示TG/HDL-C比值的AUC面积为0.783,即以TG/HDL-C比值=1.41为截断点,对NAFLD有一定的诊断价值。结论 临床可应用血清TG/HDL-C比值对NAFLD患者进行初筛。

Diagnostic value of serum TG/HDL-C ratio in patients with nonalcoholic fatty liver disease

Objective To investigate the diagnostic value of serum TG/HDL-C ratio in patients with nonalcoholic fatty liver disease（NAFLD）. Methods 120 patients with NAFLD diagnosed by B-ultrasound examination in our hospital between January 2012 and May 2015 and 120 healthy persons with normal examination results in the same period were included in this study. Serum ALT,AST,triacylglyceride （TG）,HDL-C,TG/HDL-C ratio,GGT and liver/spleen CT ratio were compared between the two groups. Then NAFLD patients were divided into mild,moderate and severe fatty liver groups according to the liver/spleen CT ratio. Pearson correlation analysis was performed to get the correlation between TG,TG/HDL-C ratio,GGT and the degree of fatty liver disease. The ROC curve was used to analyze the diagnostic value of serum TG/HDL-C ratio in these patients. Results Serum ALT,AST,TG,TG/HDL-C ratio and GGT level in patients with NAFLD were（39.9±4.3） U/L,（39.5±3.8） U/L,（2.4±0.4） mmol/L,（3.2±0.6）,and （60.7±4.5） U/L,all significantly higher than those in the controls （20.6±3.2） U/L,（18.0±2.9） U/L,（1.1±0.3） mmol/L,（0.9±0.4）,and （27.0±3.5） U/L,respectively,P<0.05];serum HDL-C and liver/spleen CT ratio in NAFLD patients were （0.9±0.2） mmol/L and（0.6±0.2）,much lower than those in the controls （1.2±0.3） mmol/L and（0.9±0.1）,respectively,P<0.05];serum ALT,AST,TG,TG/HDL-C ratio and GGT level in 20 patients with severe fatty liver were （52.2±4.3） U/L,（51.8±4.0） U/L,（3.4±0.4） mmol/L,（4.8±0.5） and （77.5±3.9） U/L,all significantly higher than those in 49 patients with moderate （45.9±4.1） U/L,（46.1±3.8） U/L,（2.8±0.3） mmol/L,（3.5±0.3）,（65.9±3.7） U/L] or 51 patients with mild fatty liver （29.4±3.5）U/L,（28.3±3.2） U/L,（1.7±0.3） mmol/L,（1.5±0.2） and（49.2±3.4）U/L,respectively,P<0.05];serum HDL-C level in patients with severe fatty liver was （0.7±0.2） mmol/L,not significantly different as compared with that in moderate （0.8±0.2） mmol/L] or with in mild group（1.1±0.2） mmol/L,P>0.05];the CT liver/spleen ratio in patients with severe fatty liver was（0.4±0.1）,much lower than that in patients with moderate（0.6±0.1） or in with mild fatty liver（0.8±0.1）,P<0.05];Pearson correlation analysis showed that there were negative correlations between serum TG,TG/HDL-C ratio,GGT levels and CT liver/spleen ratio,and there were positive correlations between serum TG,TG/HDL-C ratio,GGT level and serum ALT and AST levels;ROC curve showed that the AUC of TG/HDL-C ratio was 0.783,and when the cut-off value was 1.41,the diagnosis of NAFLD might exist. Conclusion Serum TG/HDL-C ratio might be an alternative for diagnosis of NAFLD in clinical practice.