Jiang Z G, Tsugawa Y, Tapper E B, Lai M, Afdhal N, Robson S C, Mukamal K J
Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Aliment Pharmacol Ther. 2015 Jul;42(1):106-16. doi: 10.1111/apt.13216. Epub 2015 Apr 27.
Elevated fasting triglyceride is often associated with metabolic syndrome and non-alcoholic fatty liver disease (NAFLD), the most common form of chronic liver disease. On the other hand, as liver disease progresses, patients may develop hepatocellular dysfunction that impairs triglyceride production.
To test the hypothesis that lower fasting triglyceride levels may paradoxically indicate more advanced liver disease.
A cross-sectional analysis of 11 947 adults aged 20 years or older without chronic viral hepatitis from the National Health and Nutrition Examination Survey 1999-2010 was performed to analyze the relationships between fasting triglyceride levels and five validated non-invasive indices of liver fibrosis, including Fibrosis 4 Score (FIB4), NAFLD Fibrosis Score (NFS), Ast-Platelet Ration Index, AST/ALT ratio and BARD.
Low-fasting triglyceride levels were consistently associated with elevated liver fibrosis indices. Individuals in the lowest quintile of triglycerides (TG) had an adjusted odds ratio (OR) of 3.0 (95% CI, 1.7-5.2; P < 0.001) for advanced fibrosis estimated by FIB4 score and OR of 1.8 (95% Cl, 1.2-2.7; P = 0.009) estimated by NFS, compared to individuals in the highest quintile. This association remained highly significant when restricted to individuals with abnormal LFTs from suspected NAFLD. This inverse relationship was continuous, and more pronounced among men and whites (P interaction <0.001 and 0.008 respectively), but not modified by age or body mass index. In addition, fasting TG had a stronger, more direct association with liver fibrosis indices than did albumin or total bilirubin.
Fasting triglyceride levels were inversely associated with liver fibrosis indicators in American adults, especially among white men. Our findings suggest that sequential lipid measurements may serve as a useful disease marker in the management of chronic liver disease patients.
空腹甘油三酯升高常与代谢综合征及非酒精性脂肪性肝病（NAFLD，最常见的慢性肝病形式）相关。另一方面，随着肝病进展，患者可能出现肝细胞功能障碍，损害甘油三酯生成。
检验空腹甘油三酯水平降低可能反常地提示肝病更严重这一假说。
对1999 - 2010年美国国家健康与营养检查调查中11947名20岁及以上无慢性病毒性肝炎的成年人进行横断面分析，以分析空腹甘油三酯水平与五项经验证的肝纤维化非侵入性指标之间的关系，包括纤维化4评分（FIB4）、NAFLD纤维化评分（NFS）、天冬氨酸氨基转移酶-血小板比值指数、AST/ALT比值和BARD。
空腹甘油三酯水平低始终与肝纤维化指标升高相关。甘油三酯（TG）最低五分位数的个体，根据FIB4评分估计的晚期纤维化校正比值比（OR）为3.0（95%可信区间，1.7 - 5.2；P < 0.001），根据NFS估计的OR为1.8（95%可信区间，1.2 - 2.7；P = 0.009），而最高五分位数的个体则无此情况。当仅限于疑似NAFLD且肝功能检查异常的个体时，这种关联仍然非常显著。这种负相关关系是连续的，在男性和白人中更明显（分别为P相互作用<0.001和0.008），但不受年龄或体重指数影响。此外，空腹TG与肝纤维化指标的关联比白蛋白或总胆红素更强、更直接。
在美国成年人中，空腹甘油三酯水平与肝纤维化指标呈负相关，尤其是在白人男性中。我们的研究结果表明，连续的血脂测量可能是慢性肝病患者管理中的一种有用的疾病标志物。
