Department of Family Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Korea.
Department of Medicine, Hanyang University Graduate School of Medicine, Seoul 04763, Korea.
Nutrients. 2022 Jul 24;14(15):3039. doi: 10.3390/nu14153039.
We determined the relationships between metabolic score for IR (METS-IR), triglyceride-glucose (TyG) index, and homeostatic model assessment for IR (HOMA-IR) and incident advanced liver fibrosis (ALF) and assessed the abilities of the three IR indicators to predict ALF in patients with non-alcoholic fatty liver disease (NAFLD) in adults with NAFLD who were aged 40-69 years old. Among 2218 participants with NAFLD at baseline, the areas under the receiver operating characteristic curve for predicting ALF of the METS-IR was 0.744 (0.679-0.810), significantly higher than that of TyG index (0.644 (0.569-0.720)) or that of HOMA-IR (0.633 (0.556-0.710)). Among 1368 patients with NAFLD and without ALF at baseline, 260 (19.0%) patients with NAFLD progressed to ALF during the 16-year follow-up period. Multivariable Cox proportional hazard regression analysis revealed that the adjusted hazard ratio (95% confidence interval) for incident ALF in the highest tertiles of METS-IR, TyG index, and HOMA-IR compared with the lowest tertile of each IR indicator were 0.5 (0.36-0.91), 0.7 (0.49-1.00), and 1.01 (0.71-1.42), respectively. METS-IR was inversely associated with ALF in patients with NAFLD, which cautiously suggests that the risk of ALF may need to be evaluated when metabolic parameters improve in individuals with NAFLD.
我们确定了胰岛素抵抗代谢评分（METS-IR）、甘油三酯-葡萄糖（TyG）指数和胰岛素抵抗的稳态模型评估（HOMA-IR）与非酒精性脂肪性肝病（NAFLD）患者发生晚期肝纤维化（ALF）的关系，并评估了这三种胰岛素抵抗指标在年龄 40-69 岁的 NAFLD 患者中预测 ALF 的能力。在基线时有 NAFLD 的 2218 名参与者中，METS-IR 预测 ALF 的受试者工作特征曲线下面积为 0.744（0.679-0.810），明显高于 TyG 指数（0.644（0.569-0.720））或 HOMA-IR（0.633（0.556-0.710））。在基线时无 ALF 的 1368 名 NAFLD 患者中，有 260（19.0%）名 NAFLD 患者在 16 年的随访期间进展为 ALF。多变量 Cox 比例风险回归分析显示，与每个 IR 指标的最低三分位相比，METS-IR、TyG 指数和 HOMA-IR 的最高三分位发生 ALF 的调整后的危险比（95%置信区间）分别为 0.5（0.36-0.91）、0.7（0.49-1.00）和 1.01（0.71-1.42）。METS-IR 与 NAFLD 患者的 ALF 呈负相关，这谨慎地表明，当 NAFLD 个体的代谢参数改善时，可能需要评估 ALF 的风险。
