心脏代谢指数与代谢相关脂肪性肝病的相关性分析
DOI: 10.3969/j.issn.1001-5256.2022.10.010
Correlation between cardiometabolic index and metabolic-associated fatty liver disease
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摘要:
目的 研究心脏代谢指数(CMI)与代谢相关脂肪性肝病(MAFLD)的相关性。 方法 随机纳入2018年1月—2020年12月西安医学院第一附属医院消化内科收治的480例受试者,分为MAFLD组(n=202)和非MAFLD组(n=278),比较两组CMI及相关生化指标、瞬时弹性成像技术(FibroScan)检测指标差异。计量资料符合正态分布的两组间比较采用t检验,不符合正态分布的两组间比较用Mann-Whitney U检验;计数资料两组间比较采用χ2检验。将CMI按四分位数水平分为4组(Q1 ~ Q4),采用Kruskal- Wallis H检验比较各组间脂肪衰减程度(CAP)和肝脏硬度(LSM)分布情况;采用Logistic回归分析计算不同CMI水平MAFLD发生风险。 结果 MAFLD组CMI、CAP、LSM、体质量、腰围、BMI、收缩压、舒张压、TG、TC、LDL-C、ALT、AST、GGT、尿酸(UA)、空腹血糖(FBG)水平均显著高于非MAFLD组,而高密度脂蛋白胆固醇(HDL-C)水平显著低于非MAFLD组(P值均<0.01)。不同CMI四分位水平分组中CAP程度差异有统计学意义(χ2=15.220,P=0.002)。多因素logistic回归显示,调整相关危险因素后,Q4组MAFLD发生风险为Q1组的3.521(95%CI:1.415~8.764)倍(P<0.01)。 结论 较高的CMI与MAFLD发生风险呈显著正相关,随着CMI四分位数水平的增加,MAFLD患者逐渐增多且发生纤维化的风险显著增加。此外,定期检查和评价CMI可能有助于控制MAFLD的发生。 Abstract:Objective To analyze association of the cardiometabolic index (CMI) with risk of metabolism-associated fatty liver disease (MAFLD). Methods This study recruited 480 individuals from Inpatient Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical College from January 2018 to December 2020 and divided into MAFLD (n=202) and non-MAFLD groups (n=278) for comparison of the CMI and related biochemical and FibroScan parameters. The independent samples t-test was performed for comparison of normally distributed continuous data, while the Mann-Whitney U test was performed for comparison of non-normally distributed continuous data and the chi-square test was used for comparison of categorical data between these two groups of individuals. These individuals were then divided into Q1-Q4 subgroups based on their CMI and then subjected to the Kruskal-Wallis H test to compare the distribution of the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) between these two groups of patients. Finally, a Logistic regression analysis was performed to calculate MAFLD risk at different CMI scores (Q1-Q4). Results Compared with the non-MAFLD individuals, the MAFLD group had significantly higher levels of CMI, CAP, LSM, body weight, waist circumference, body mass index, systolic and diastolic blood pressure, triglyceride, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, serum uric acid, and fasting blood glucose, but significantly lower high-density lipoprotein cholesterol level (all P < 0.01). Moreover, there was significant difference in the CAP among different CMI quartile levels in these individuals (χ2=15.220, P=0.002). The multivariate logistic regression analytic data revealed that the CMI in the Q4 was an independent predictor for MAFLD risk vs. the CMI in the Q1 quantile ones (95% confidence interval, 1.415-8.764, OR=3.521; P < 0.01) after adjustment for related risk factors. Conclusion A higher CMI score (Q4) was associated with a MAFLD risk and a gradual increase in the CMI score was with the increased number of MAFLD patients and fibrosis risk, indicating that a routine health check-up and measurement of CMI could help to identify and control MAFLD early. -
表 1 受试者基线资料分析
Table 1. Analysis of baseline data of subjects
指标 MAFLD组(n=202) 非MAFLD组(n=278) 统计值 P值 年龄(岁) 51.21±11.13 52.19±12.81 t=0.876 0.381 性别[例(%)] χ2=2.335 0.127 男 108(45.6) 129(54.4) 女 94(38.7) 149(61.3) 身高(cm) 167.00(160.00~172.00) 165.00(159.75~170.00) Z=-1.944 0.052 体质量(kg) 70.00(62.00~77.00) 59.50(52.00~66.00) Z=-9.612 <0.001 WC(cm) 90.45±8.90 82.87±8.74 t=-9.303 <0.001 BMI(kg/m2) 25.26±2.73 21.94±2.64 t=-13.414 <0.001 SBP(mmHg) 118.45±10.86 115.11±12.76 t=-3.010 0.003 DBP(mmHg) 74.42±7.50 71.51±7.17 t=-4.294 <0.001 吸烟[例(%)] 65(47.8) 71(52.2) χ2=2.539 0.111 饮酒[例(%)] 42(45.7) 50(54.3) χ2=0.595 0.441 TG(mmol/L) 1.72(1.22~2.40) 1.18(0.88~1.56) Z=-8.151 <0.001 TC(mmol/L) 4.37±0.83 4.12±0.83 t=-3.213 0.001 HDL-C(mmol/L) 1.13(0.96~1.29) 1.24(1.05~1.45) Z=-4.616 <0.001 LDL-C(mmol/L) 2.92±0.64 2.70±0.62 t=-3.846 <0.001 LP(a)(mg/L) 109.00(69.00~276.50) 116.50(71.75~262.75) Z=-1.414 0.888 ALT(U/L) 18.50(14.00~30.00) 14.00(11.00~20.00) Z=-5.770 <0.001 AST(U/L) 21.00(18.00~26.00) 19.00(17.00~23.00) Z=-3.690 <0.001 GGT(U/L) 24.00(16.00~40.00) 16.00(12.00~22.00) Z=-7.619 <0.001 Alb(g/L) 41.56±3.77 40.97±3.87 t=-1.666 0.096 TBA(μmol/L) 3.45(1.90~6.08) 3.15(1.60~5.20) Z=-1.429 0.153 Cr(μmol/L) 63.00(52.28~73.23) 61.35(53.00~71.00) Z=-0.901 0.368 UA(μmol/L) 319.00(276.75~395.00) 281.00(230.50~331.00) Z=-5.635 <0.001 FBG(mmol/L) 4.99(4.72~5.43) 4.85(4.50~5.21) Z=-3.986 <0.001 WBC(×109/L) 5.42(4.51~6.71) 5.17(4.27~6.37) Z=-2.058 0.040 NE(×109/L) 3.02(2.46~3.78) 2.93(2.24~3.83) Z=-0.869 0.385 PLT(×109/L) 206.78±58.40 198.64±53.51 t=-1.582 0.114 CMI 0.81(0.53~1.30) 0.48(0.30~0.69) Z=-9.216 <0.001 CAP(dB/m) 292.43±36.57 210.63±45.58 t=-21.052 <0.001 LSM(kPa) 4.40(3.70~5.30) 3.90(3.40~4.70) Z=-4.406 <0.001 表 2 MAFLD受试者不同CMI水平与CAP、LSM的分布情况
Table 2. CAP and LSM distribution of different CMI levels in MAFLD
组别 CAP[例(%)] LSM[例(%)] 轻度(n=55) 中度(n=56) 重度(n=91) 低风险(n=194) 高风险(n=8) Q1组 8(14.5) 8(14.3) 2(2.2) 18(9.3) 0 Q2组 14(25.5) 11(19.6) 15(16.5) 40(20.6) 0 Q3组 18(32.7) 17(30.4) 25(27.5) 57(29.4) 3(37.5) Q4组 15(27.3) 20(35.7) 49(53.8) 79(40.7) 5(62.5) χ2值 15.220 3.422 P值 0.002 0.331 表 3 不同CMI水平MAFLD发生风险的Logistic回归分析
Table 3. Logistic regression analysis of MAFLD risk at different CMI levels
CMI水平分组 模型1 模型2 模型3 OR(95%CI) P值 OR(95%CI) P值 OR(95%CI) P值 Q1组 1.000 1.000 1.000 Q2组 2.953(1.571~5.550) 0.001 1.804(0.902~3.608) 0.095 1.622(0.770~3.420) 0.204 Q3组 5.260(2.850~9.708) <0.001 2.468(1.237~4.921) 0.010 2.177(0.984~4.817) 0.055 Q4组 12.739(6.763~23.996) <0.001 4.725(2.295~9.730) <0.001 3.521(1.415~8.764) 0.007 -
[1] LIN H, ZHANG X, LI G, et al. Epidemiology and clinical outcomes of metabolic (dysfunction)-associated fatty liver disease[J]. J Clin Transl Hepatol, 2021, 9(6): 972-982. DOI: 10.14218/JCTH.2021.00201. [2] CAI LY, WANG WJ, LIANG YX, et al. Research progress in the relationship between metabolic associated fatty liver disease and metabolic syndrome[J]. Chin J New Clin Med, 2021, 14(7): 730-734. DOI: 10.3969/j.issn.1674-3806.2021.07.22.蔡联英, 王文娟, 梁运啸, 等. 代谢相关脂肪性肝病与代谢综合征相关性的研究进展[J]. 中国临床新医学, 2021, 14(7): 730-734. DOI: 10.3969/j.issn.1674-3806.2021.07.22. [3] SHI WR, WANG HY, CHEN S, et al. Estimate of prevalent diabetes from cardiometabolic index in general Chinese population: a community-based study[J]. Lipids Health Dis, 2018, 17(1): 236. DOI: 10.1186/s12944-018-0886-2. [4] LIU X, WU Q, YAN G, et al. Cardiometabolic index: a new tool for screening the metabolically obese normal weight phenotype[J]. J Endocrinol Invest, 2021, 44(6): 1253-1261. DOI: 10.1007/s40618-020-01417-z. [5] ESLAM M, NEWSOME PN, SARIN SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73(1): 202-209. DOI: 10.1016/j.jhep.2020.03.039. [6] YU C, WANG M, ZHENG S, et al. Comparing the diagnostic criteria of MAFLD and NAFLD in the Chinese population: a population-based prospective cohort study[J]. J Clin Transl Hepatol, 2022, 10(1): 6-16. DOI: 10.14218/JCTH.2021.00089. [7] XUE R, FAN JG. Brief introduction of an international expert consensus statement: A new definition of metabolic associated fatty liver disease[J]. J Clin Hepatol, 2020, 36(6): 1224-1227. DOI: 10.3969/j.issn.1001-5256.2020.06.007.薛芮, 范建高. 代谢相关脂肪性肝病新定义的国际专家共识简介[J]. 临床肝胆病杂志, 2020, 36(6): 1224-1227. DOI: 10.3969/j.issn.1001-5256.2020.06.007. [8] SHENG G, LU S, XIE Q, et al. The usefulness of obesity and lipid-related indices to predict the presence of non-alcoholic fatty liver disease[J]. Lipids Health Dis, 2021, 20(1): 134. DOI: 10.1186/s12944-021-01561-2. [9] DUAN SJ, LIU ZJ, CHEN JL, et al. Value of lipid accumulation product and visceral fat index in predicting non-alcoholic fatty liver disease[J]. J Clin Hepatol, 2022, 38(1): 129-134. DOI: 10.3969/j.issn.1001-5256.2022.01.020.段绍杰, 刘尊敬, 陈佳良, 等. 脂质蓄积指数、内脏脂肪指数对非酒精性脂肪性肝病的预测价值[J]. 临床肝胆病杂志, 2022, 38(1): 129-134. DOI: 10.3969/j.issn.1001-5256.2022.01.020. [10] WANG J, SU Z, FENG Y, et al. Comparison of several blood lipid-related indexes in the screening of non-alcoholic fatty liver disease in women: a cross-sectional study in the Pearl River Delta region of southern China[J]. BMC Gastroenterol, 2021, 21(1): 482. DOI: 10.1186/s12876-021-02072-1. [11] JIN T, CAO HH, ZHANG B, et al. Association of EGR1, UACR and CMI with non-alcoholic fatty liver disease in type 2 diabetic patients[J]. Hainan Med J, 2021, 32(23): 3003-3007. DOI: 10.3969/j.issn.1003-6350.2021.23.003.金婷, 曹含弘, 张斌, 等. 2型糖尿病患者EGR1、UACR及CMI指数与非酒精性脂肪性肝病的关系[J]. 海南医学, 2021, 32(23): 3003-3007. DOI: 10.3969/j.issn.1003-6350.2021.23.003. [12] LI YY, ZHAO L, DENG X, et al. Relationship between cardiometabolic index and risk of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus[J]. Chin Gen Pract, 2021, 24(15): 1883-1888. DOI: 10.12114/j.issn.1007-9572.2021.00.433.李彦彦, 赵丽, 邓霞, 等. 2型糖尿病患者心脏代谢指数与非酒精性脂肪性肝病的关系研究[J]. 中国全科医学, 2021, 24(15): 1883-1888. DOI: 10.12114/j.issn.1007-9572.2021.00.433. [13] ZOU J, XIONG H, ZHANG H, et al. Association between the cardiometabolic index and non-alcoholic fatty liver disease: insights from a general population[J]. BMC Gastroenterol, 2022, 22(1): 20. DOI: 10.1186/s12876-022-02099-y. [14] LIU Y, WANG W. Sex-specific contribution of lipid accumulation product and cardiometabolic index in the identification of nonalcoholic fatty liver disease among Chinese adults[J]. Lipids Health Dis, 2022, 21(1): 8. DOI: 10.1186/s12944-021-01617-3. [15] YANG Y, WANG B, YUAN H, et al. Triglycerides to high-density lipoprotein cholesterol ratio is the best surrogate marker for insulin resistance in nonobese middle-aged and elderly population: a cross-sectional study[J]. Int J Endocrinol, 2021, 2021: 6676569. DOI: 10.1155/2021/6676569. [16] POLYZOS SA, KOUNTOURAS J, MANTZOROS CS. Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics[J]. Metabolism, 2019, 92: 82-97. DOI: 10.1016/j.metabol.2018.11.014. [17] WANG YH, GAO Y. Research progress in diagnosis and treatment of non-alcoholic fatty liver disease combinated with type 2 diabetes mellitus[J]. J Jilin Univ(Med Edit), 2020, 46(6): 1324-1331. DOI: 10.13481/j.1671-587x.20200634.王雨涵, 高影. 非酒精性脂肪性肝病并发2型糖尿病诊断和治疗的研究进展[J]. 吉林大学学报(医学版), 2020, 46(6): 1324-1331. DOI: 10.13481/j.1671-587x.20200634. [18] SIMOES I, JANIKIEWICZ J, BAUER J, et al. Fat and sugar-a dangerous duet. a comparative review on metabolic remodeling in rodent models of nonalcoholic fatty liver disease[J]. Nutrients, 2019, 11(12): 2871. DOI: 10.3390/nu11122871. [19] ALVES-BEZERRA M, COHEN DE. Triglyceride metabolism in the liver[J]. Compr Physiol, 2017, 8(1): 1-8. DOI: 10.1002/cphy.c170012. [20] XIN Y, WANG Y, CHI J, et al. Elevated free fatty acid level is associated with insulin-resistant state in nondiabetic Chinese people[J]. Diabetes Metab Syndr Obes, 2019, 12: 139-147. DOI: 10.2147/DMSO.S186505. [21] ZIOLKOWSKA S, BINIENDA A, JABKOWSKI M, et al. The interplay between insulin resistance, inflammation, oxidative stress, base excision repair and metabolic syndrome in nonalcoholic fatty liver disease[J]. Int J Mol Sci, 2021, 22(20): 11128. DOI: 10.3390/ijms222011128. [22] SAKURAI Y, KUBOTA N, YAMAUCHI T, et al. Role of insulin resistance in MAFLD[J]. Int J Mol Sci, 2021, 22(8): 4156. DOI: 10.3390/ijms22084156. [23] HEEREN J, SCHEJA L. Metabolic-associated fatty liver disease and lipoprotein metabolism[J]. Mol Metab, 2021, 50: 101238. DOI: 10.1016/j.molmet.2021.101238. [24] YU L, LI Y, DU C, et al. Pattern recognition receptor-mediated chronic inflammation in the development and progression of obesity-related metabolic diseases[J]. Mediators Inflamm, 2019, 2019: 5271295. DOI: 10.1155/2019/5271295. [25] LIU J, LI YJ, RAO ZY. Correlation analysis of FibroScan measurements and body composition measure-ments in patients with nonalcoholic fatty liver disease[J]. Chin J Integr Tradit West Med Liver Dis, 2021, 31(12): 1108-1111. DOI: 10.3969/j.issn.1005-0264.2021.12.013.刘婧, 李燕菊, 饶志勇. 非酒精性脂肪性肝病患者FibroScan指标与人体成分指标相关性分析[J]. 中西医结合肝病杂志, 2021, 31(12): 1108-1111. DOI: 10.3969/j.issn.1005-0264.2021.12.013. [26] LIN MS, LIN TH, GUO SE, et al. Waist-to-height ratio is a useful index for nonalcoholic fatty liver disease in children and adolescents: a secondary data analysis[J]. BMC Public Health, 2017, 17(1): 851. DOI: 10.1186/s12889-017-4868-5.
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