脂質蓄積指數對非酒精性脂肪性肝病合并代謝綜合征的預測價值

游文一　李林蔓

摘要：目的 ?探討脂質蓄積指數（LAP）對非酒精性脂肪性肝疾病（NAFLD）合并代謝綜合征（MS）的預測價值。方法 ?選取2018年12月～2019年8月重慶醫科大學附屬第一醫院健康體檢部健康體檢的NAFLD患者1150例設為NAFLD組，另選取同期健康體檢者1150例設為對照組;比較兩組人體測量學及血液學指標水平，采用受試者工作特征曲線（ROC）評估LAP預測NAFLD合并MS的價值。結果 ?NAFLD組BMI、腰圍、收縮壓、舒張壓、FPG、ALT、AST、GGT、TC、TG、HDL-C、LDL-C均高于對照組，差異有統計學意義（P<0.05）;兩組年齡、ALP比較，差異無統計學意義（P>0.05）;NAFLD組與代謝綜合征相關的各組分超標發生率均高于對照組，差異有統計學意義（P<0.05）;ROC曲線顯示，LAP預測NAFLD合并MS的曲線下面積為0.806（95%CI：0.779～0.833），其診斷最佳界值為83.27，敏感度為86.21%，特異度為79.35%，約登指數為0.66。結論 ?LAP可用于預測NAFLD合并MS，可對人群健康初步評估，且其測量方法簡便、易行，適合于大規模篩查，可在基層醫院進一步推廣。

關鍵詞：脂質蓄積指數;非酒精性脂肪性肝疾病;代謝綜合征

中圖分類號：R73 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.18.019

文章編號：1006-1959（2020）18-0062-04

The Predictive Value of Lipid Accumulation Index for Non-alcoholic

Fatty Liver Disease with Metabolic Syndrome

YOU Wen-yi1，LI Lin-man2

（1.Department of Infectious Diseases，People's Hospital of Yubei District，Chongqing 401120，China;

2.Health Management Center，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400016，China）

Abstract：Objective ?To explore the predictive value of lipid accumulation index （LAP） for non-alcoholic fatty liver disease （NAFLD） combined with metabolic syndrome （MS）.Methods ?1150 cases of NAFLD patients undergoing physical examinations from the Health Examination Department of the First Affiliated Hospital of Chongqing Medical University from December 2018 to August 2019 were selected as the NAFLD group， and 1150 cases of healthy physical examination patients during the same period were selected as the control group; the two groups were compared. The level of measurement and hematology indicators， the receiver operating characteristic curve （ROC） was used to evaluate the value of LAP in predicting NAFLD with MS.Results ?BMI， waist circumference， systolic blood pressure， diastolic blood pressure， FPG， ALT， AST， GGT， TC， TG， HDL-C and LDL-C in the NAFLD group were all higher than those in the control group，the difference was statistically significant （P<0.05）; Compared with age and ALP， the difference was not statistically significant （P>0.05）; the incidence rate of each component related to metabolic syndrome in the NAFLD group was higher than that in the control group，the difference was statistically significant （P<0.05）; ROC curve showed ， LAP predicts that the area under the curve of NAFLD combined with MS was 0.806 （95%CI： 0.779～0.833）， the best diagnostic cutoff was 83.27， the sensitivity was 86.21%， the specificity was 79.35%， and the Youden index was 0.66.Conclusion ?LAP could be used to predict NAFLD combined with MS， and could be used for preliminary assessment of population health， and its measurement method was simple and easy to implement， suitable for large-scale screening， and could be further promoted in primary hospitals.

Key words：Lipid accumulation index;Non-alcoholic fatty liver disease;Metabolic syndrome

近年來，隨著我國經濟的高速發展，人們生活方式和作息規律發生了極大變化，超重和肥胖人數不斷增加。而非酒精性脂肪性肝?。╪on-alcoholic fattyliver disease，NAFLD）的發病又與腹型肥胖密切相關，因此NAFLD的發病率也逐年增加。據調查，我國部分地區NAFLD的患病率達15%～20%，NAFLD已取代乙型肝炎成為我國最常見慢性肝臟疾病[1，2]。NAFLD不僅僅導致肝臟病變，引發肝硬化、肝細胞癌和肝功能衰竭，而且與代謝綜合征（metabolic syndrome，MS）、2糖尿病及心血管疾病的發生關系密切[3]。NAFLD與MS存在許多共同的病理生理機制，兩者都是糖尿病和心血管疾病的獨立危險因素。此外，研究表明，合并MS的NAFLD患者更有可能是非酒精性脂肪性肝炎（non-alcoholic steatohepatitis，NASH）[4]。因此，早期準確篩選出NAFLD合并MS人群并進行早期干預，對于防治早期NASH、降低糖尿病和心血管疾病患病風險具有重要意義。脂質蓄積指數（lipid accumulation index ，LAP）是Kahn等[5]于2005年利用美國國家營養調查的1500萬人的健康資料經統計分析計算得出的新的體脂指標。……