Page 32 - 2023-06-中国全科医学

2023年2月 第26卷 第6期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·673·

2.Rollins School of Public Health，Emory University，Atlanta 30314，USA
WANG Yingjie and CHENG Haoran are co-first authors
*
Corresponding author：ZHOU Weihong，Professor；E-mail：njzhouwh@126.com
【Abstract】 Background The prevalence of metabolic-associated fatty liver disease（MAFLD）has increased
rapidly. And there is no conclusion on body fat composition，characteristics of metabolic indicators，and their predictive values
for MAFLD in non-obese populations. Objective To identify the risk factors for MAFLD by comparing body fat composition and
key metabolic indicators（blood lipids，blood sugar，uric acid）between obese and non-obese MAFLD patients，and to assess
their associations with MAFLD as well as their predictive values for MAFLD in non-obese patients. Methods Physical examinees
with and without liver B-ultrasound-detected fatty liver were recruited from Health Management Center，Nanjing Drum Tower
Hospital from January 2018 to January 2019 after excluding those with non-MAFLD，and divided into obese group（including
129 cases with MAFLD，and 129 without fatty liver）and non-obese group（including 129 without fatty liver cases，and 129
with MAFLD）by BMI. The body fat composition and metabolic indices in non-obese MAFLD cases were compared with those
of the other three subgroups. The correlation of each index with MAFLD in non-obese cases was analyzed. The independent risk
factors of MAFLD in non-obese cases were identified by using Logistic regression. The predictive value of each index for MAFLD
in non-obese was assessed using the receiver operating characteristic（ROC）curve. Results （1）Comparison of body fat
composition and metabolic indicators: compared with non-obese without fatty liver cases，non-obese cases with MAFLD had
greater average BMI，body fat（BF），body fat ratio （BFR），visceral fat area（VFA），waist circumference（WC），
waist-hip-ratio（WHR），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），
uric acid（UA），alanine transaminase （ALT）and gamma-glutamyl transpeptidase （GGT），and lower high-density
lipoprotein cholesterol （HDL-C）（P<0.05）. In comparison with obese cases with MAFLD，non-obese cases with MAFLD
had lower average BMI，BF，VFA，WC，WHR，fasting plasma glucose（FPG），and glycosylated hemoglobin （HbA 1c ）
（P<0.05）. Non-obese cases with MAFLD had lower average BMI，BF and WC，and higher average TG，UA，ALT and GGT
than obese cases without fatty liver（P<0.05）. Non-obese female cases with MAFLD had greater average age，BF，BFR and
VFA and lower WC，VA，GGT than non-obese male cases with MAFLD （P<0.05）. （2）Kendall's rank correlation analysis
showed that the risk of MAFLD in non-obese cases increased with the growth of BFR，VFA，WHR，TC，TG，LDL-C，UA，
ALT，and GGT （r=0.099，0.092，0.136，0.095，0.176，0.092，0.114，0.125，0.142，P<0.05），but decreased with
the growth of HDL-C （r=-0.112，P<0.05）. （3）Multivariate Logistic regression analysis showed that TG，ALT，UA，BFR
and VFA were risk factors of MAFLD in non-obese cases.（4）The results of ROC analysis of the performance of five indicators
predicting MAFLD in non-obese cases were as follows: BFR had an AUC of 0.853〔95%CI（0.807，0.898）〕，with 0.789
sensitivity，0.770 specificity when 22.30% was chosen as the optimal cut-off value；VFA had an AUC of 0.938〔95%CI（0.906，
2
0.970）〕，with 0.852 sensitivity，0.904 specificity when 61.45 cm was chosen as the optimal cut-off value；TG had an AUC of 0.807
〔95%CI（0.754，0.860）〕，with 0.822 sensitivity，0.713 specificity when 1.02 mmol/L was chosen as the optimal cut-off
value；UA had an AUC of 0.665〔95%CI（0.599，0.731）〕，with 0.605 sensitivity，0.682 specificity when 356.00 μmol/L
was chosen as the optimal cut-off value；ALT had an AUC of 0.752〔95%CI（0.692，0.812）〕，with 0.814 sensitivity，
0.770 specificity when 18.35 U/L was chosen as the optimal cut-off value. Conclusion Compared with non-obese people without
fatty liver，non-obese people with MAFLD had increased BF and visceral fat，abnormal lipid metabolism，elevated levels of
UA and transaminase. The risk of MAFLD in non-obese people increased with the increase in TG，ALT，UA，BFR and VFA，
but decreased with the increase in HDL-C. BFR，VFA，TG，UA and ALT could partially predict and diagnose MAFLD in non-
obese people，providing evidence for the delivery of interventions as soon as possible.
【Key words】 Fatty liver；Nonobese metabolic fatty liver disease；Blood lipid；Blood glucose；Uric acid；Visceral
fat；Risk factors；Sensitivity；Specificity；Root cause analysis；Diagnosis

近 30 年来，与肥胖、2 型糖尿病、代谢综合征 少动的生活方式，我国一般人群中 MAFLD 的患病率逐
相 关 的 代 谢 相 关 性 脂 肪 性 肝 病（metabolic associated 年上升，达到 29.81% ［2］ 。MAFLD 已经成为我国第一
fatty liver disease，MAFLD） 的 患 病 率 增 长 迅 速， 目 大慢性肝病，在慢性肝病的病因构成中达到 50% ［3］ 。
前全球的患病率达到 25.24% ［1］ ，亚洲地区患病率为 MAFLD 不仅可以引起脂肪性肝炎及肝纤维化、肝癌，
29.62% ［2］ 。在中国，随着人们饮食习惯快餐化，高热 MAFLD 相关代谢紊乱导致的心脑血管疾病、慢性肾脏
量、高脂肪、高果糖的膳食结构越来越普遍，以及久坐 病、胰岛素抵抗相关的恶性肿瘤等肝外并发症对人们健