评估肥胖相关指标对非酒精性脂肪肝的筛查价值

目的 探讨筛查中老年人非酒精性脂肪肝(NAFLD)的最佳肥胖相关指标。方法 本项横断面研究筛选了2019年1—3月在陕西省人民医院健康管理中心参加体检的40岁及以上受试者1 281人，进行病史采集、体格检查及实验室检查，所有受试者均接受腹部B超检查。应用logistic回归分析研究各肥胖指标与NAFLD患病风险的相关性，采用ROC曲线评估肥胖指标对NAFLD患病风险的筛查价值。结果 在1 281例受试者中，335例诊断为NAFLD,NAFLD的患病率为26.15%。NAFLD组的血压、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、转氨酶、空腹血糖、空腹胰岛素、稳态模型估计的胰岛素抵抗指数、糖化血红蛋白、腰围、腰臀比、BMI、脂质蓄积指数(LAP)均明显升高，高密度脂蛋白胆固醇降低。Logistic回归分析显示，在校正了相关混杂因素后，腰围、腰臀比、BMI、LAP均与NAFLD的患病风险相关。其中LAP与NAFLD的相关性最强，与处于LAP第一分位的受试者相比，处于LAP第四分位的受试者NAFLD的患病风险显著增加(OR=18.055,95%CI:7.683～42.427,P<0.001...

Evaluation the screening value of obesity-related indices for non-alcoholic fatty liver disease

  Objective  To explore obesity-related indices suitable for screening non-alcoholic fatty liver disease (NAFLD) in middle-aged and elderly population.  Methods  This cross-sectional study screened 1 281 people aged 40 and above who attended physical examinations at the Health Management Center of Shaanxi Provincial People' s Hospital from January to March 2019. Their medical history was recorded, and they underwent physical examination and laboratory tests. All subjects underwent abdominal ultrasonography. Logistic regression was used to analyse the association between obesity index and the risk of NAFLD. ROC curve was used to evaluate the screening value of obesity indices for the risk of NAFLD.  Results  Among 1 281 subjects, 335 were diagnosed with NAFLD, with a prevalence rate of 26.15%. The blood pressure, triglyceride, total cholesterol, low density lipoprotein cholesterol, transaminase levels, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance, haemoglobin A1c, waist circumference (WC), waist-to-hip ratio (WHR), BMI and lipid accumulation product (LAP) values significantly increased in the NAFLD group, and the high-density lipoprotein cholesterol decreased. Logistic regression analysis showed that WC, WHR, BMI and LAP were significantly correlated with NAFLD after adjusting for confounding factors. Among them, LAP had the strongest correlation with NAFLD. Compared with subjects in the first quartile of LAP, subjects in the fourth quartile had a significantly increased risk of NAFLD (OR=18.055, 95% CI: 7.683-42.427, P < 0.001). The AUC of the four obesity indices were all greater than 0.7, indicating that they had high screening value for NAFLD. LAP had the highest screening value for NAFLD in males and females, with AUC 85.34 (95% CI: 81.78-88.90) in males and AUC 80.22 (95% CI: 76.95-83.48) in females.  Conclusion  LAP is closely associated with the risk of NAFLD and may be an effective tool for screening the disease in middle-aged and elderly people.