Cardiology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, China.
Gastroenterology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, China.
Lipids Health Dis. 2021 May 16;20(1):50. doi: 10.1186/s12944-021-01479-9.
The albumin-to-alkaline phosphatase ratio (AAPR) is a newly developed index of liver function, but its association in patients with non-alcoholic fatty liver disease (NAFLD) has not been established. The aim of this study was to investigate the association between the AAPR and NAFLD in a non-obese Chinese population.
The study included 10,749 non-obese subjects without NAFLD at baseline and divided them into quintiles according to the AAPR. A Cox multiple regression model was used to examine the association between the AAPR and its quintiles and the incidence of NAFLD.
The average age of the study population was 43.65 ± 15.15 years old. During the 5-year follow-up, 1860 non-obese subjects had NAFLD events. In the Cox multiple regression model, after adjusting the model according to important risk factors, the AAPR and NAFLD risk were independently correlated, and with a gradual increase in the AAPR, the NAFLD risk decreased gradually (HR: 0.61, 95% CI: 0.47, 0.81; P-trend< 0.0001). Additionally, there were significant interactions between the AAPR and BMI, blood pressure and lipids (P-interaction < 0.05). Stratified analysis showed that the risk of AAPR-related NAFLD decreased in people with normal blood pressure and lipid levels, while the risk of AAPR-related NAFLD increased abnormally in people who were underweight.
This longitudinal cohort study provides the first evidence that the AAPR is an independent predictor of future NAFLD events in non-obese people. For non-obese people with a low AAPR, especially those with BMI < 18.5 kg/m, more attention should be given to the management of risk factors for NAFLD to prevent future NAFLD.
白蛋白-碱性磷酸酶比值（AAPR）是一种新开发的肝功能指标，但尚未在非酒精性脂肪性肝病（NAFLD）患者中确立其相关性。本研究旨在探讨非肥胖中国人群中 AAPR 与 NAFLD 的关系。
该研究纳入了 10749 例基线时无 NAFLD 的非肥胖受试者，并根据 AAPR 将其分为五组。采用 Cox 多重回归模型检验 AAPR 及其五分位数与 NAFLD 发生率之间的关系。
研究人群的平均年龄为 43.65±15.15 岁。在 5 年的随访期间，有 1860 例非肥胖受试者发生了 NAFLD 事件。在 Cox 多重回归模型中，根据重要的风险因素调整模型后，AAPR 与 NAFLD 风险独立相关，随着 AAPR 的逐渐升高，NAFLD 风险逐渐降低（HR：0.61，95%CI：0.47，0.81；P 趋势<0.0001）。此外，AAPR 与 BMI、血压和血脂之间存在显著的交互作用（P 交互<0.05）。分层分析显示，在血压和血脂水平正常的人群中，AAPR 相关的 NAFLD 风险降低，而在体重不足的人群中，AAPR 相关的 NAFLD 风险异常增加。
本纵向队列研究首次提供证据表明，AAPR 是预测非肥胖人群未来发生 NAFLD 事件的独立指标。对于 AAPR 较低的非肥胖人群，尤其是 BMI<18.5kg/m²的人群，应更加关注 NAFLD 风险因素的管理，以预防未来的 NAFLD。
