肥胖相关指标在代谢相关脂肪性肝病风险预测中的应用价值

作者： style="font-size: 12px ">彭璐 1 周语嫣 2 胡林慧 1 王艳 1

单位：1. 北京大学第一医院 感染疾病科 北京 100034 2. 桂林医科大学 公共卫生学院 广西 桂林 541004

关键词：内脏脂肪质量 代谢相关脂肪性肝病 诊断

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出版年,卷(期):页码：2026,18(1):62-71

摘要：

摘要：目的 探讨肥胖相关指标在代谢相关脂肪性肝病（metabolic associated fatty liver disease，MAFLD）风险预测中的价值。方法 从 2017—2018 年美国国家健康与营养调 查（National Health and Nutrition Examination Survey，NHANES）数据库中筛选 2 194 例 研究对象。根据是否患有 MAFLD 分为 MAFLD 组（1 143 例）和非 MAFLD 组（1 051 例）。 采用多因素 Logistic 回 归 模 型 评 估 体 重 指 数（body mass index，BMI）、 腰 围、 内 脏 脂 肪 含 量（visceral fat mass，VFM）、 瘦 体 质 量（lean body mass，LBM）与内 脏脂肪比［ln（LBM/VFM）］是否为 MAFLD 发生的危险因素。采用限制性立方样 条（restricted cubic spline，RCS）回归评估肥胖相关指标与 MAFLD 间的剂量反应 关系。采用受试者工作特征（receiver operator characteristic，ROC）曲线评估肥胖相 关指标在诊断不同亚组 MAFLD 中的效能。结果 多变量校正回归分析显示，较高的 VFM （OR = 1.007，95%CI：1.005～1.009，P＜0.001）、腰围（OR = 1.11，95%CI：1.09～1.13， P ＜ 0.001）和 BMI（OR = 1.27，95%CI：1.21～1.34，P ＜ 0.001）是 MAFLD 发生的独 立危险因素。其中，VFM 每增加 1 单位，MAFLD 发生风险增加 0.7%。在男性、＞ 40 岁 及≤ 40 岁亚组中，VFM 预测 MAFLD 的 ROC 曲线下面积（0.871、0.853、0.857）高 于腰围（0.837、0.816、0.854）、ln（VFM/LBM）（0.801、0.723、0.750）及 BMI（0.823、 0.804、0.841）。VFM 在非肥胖型人群（BMI ＜ 25 kg/m2 ）中的 ROC 曲线下面积为 0.846， 而腰围对女性 MAFLD 的预测能力优于 VFM、BMI 及 ln（VFM/LBM）（ROC 曲线下 面积：0.839 比 0.827 比 0.817 比 0.746）。结论 相较于腰围、BMI 等传统指标，VFM 对 MAFLD 发生的预测能力更佳，在男性、＞ 40 岁、≤ 40 岁及非肥胖型 MAFLD 人群中 均表现出较高的预测价值，而在女性亚组中，腰围对 MAFLD 的诊断价值更高。

Abstract: Objective To investigate the value of obesity-related indicators in the risk prediction of metabolic associated fatty liver disease (MAFLD). Methods A total of 2194 subjects were selected from the 2017—2018 National Health and Nutrition Examination Survey (NHANES) database. These subjects were divided into the MAFLD group (1143 cases) and the non MAFLD group (1051 cases). Multivariate Logistic regression model was used to evaluate whether body mass index (BMI), waist circumference, visceral fat mass (VFM), lean body mass (LBM) and visceral fat ratio [ln (LBM/VFM)] were risk factors for MAFLD. Restricted cubic spline (RCS) regression was applied to assess the dose-response relationship between obesity-related indicators and MAFLD. The receiver operating characteristic (ROC) curve was utilized to evaluate the diagnostic efficacy of obesity-related indicators for MAFLD in different subgroups. Results Multivariable adjusted regression analysis showed that VFM (OR = 1.007, 95%CI: 1.005～1.009, P ＜ 0.001), waist circumference (OR = 1.11, 95%CI: 1.09～1.13, P ＜ 0.001) and BMI (OR = 1.27, 95%CI: 1.21～1.34, P ＜ 0.001) were identified as independent risk factors for MAFLD. Specifically, for each 1-unit increment in VFM, the risk of MAFLD onset was increased by 0.7%. In male, ＞ 40 years, and ≤ 40 years subgroups, the areas under the ROC curve of VFM for predicting MAFLD (0.871, 0.853, 0.857) were higher than those of waist circumference (0.837, 0.816, 0.854), ln (VFM/LBM) (0.801, 0.723, 0.750) and BMI (0.823, 0.804, 0.841), respectively. In non-obese population (BMI ＜ 25 kg/m2 ), the area under the ROC curve of VFM was 0.846, while waist circumference had better predictive ability for MAFLD in women than VFM, BMI, and ln (VFM/LBM) (areas under the ROC curve: 0.839 vs. 0.827 vs. 0.817 vs. 0.746). Conclusions Compared to traditional indicators such as waist circumference and BMI, VFM demonstrated better predictive ability for the occurrence of MAFLD. It showed high predictive value in males, individuals aged ＞ 40 years and ≤ 40 years, and non-obese MAFLD populations. However, in the female subgroup, waist circumference had higher diagnostic value for MAFLD.

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