血清生物标志物与非酒精性肝病之间的关联：一项针对地中海肥胖患者的临床研究结果。

Associations between serum biomarkers and non-alcoholic liver disease: Results of a clinical study of Mediterranean patients with obesity.

作者信息

De Nucci Sara, Castellana Fabio, Zupo Roberta, Lampignano Luisa, Di Chito Martina, Rinaldi Roberta, Giannuzzi Vito, Cozzolongo Raffaele, Piazzolla Giuseppina, Giannelli Gianluigi, Sardone Rodolfo, De Pergola Giovanni

机构信息

Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology-IRCCS "Saverio de Bellis", Castellana Grotte, Italy.

Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology-IRCCS "Saverio de Bellis", Castellana Grotte, Italy.

出版信息

Front Nutr. 2022 Sep 8;9:1002669. doi: 10.3389/fnut.2022.1002669. eCollection 2022.

DOI:10.3389/fnut.2022.1002669

PMID:36159489

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9493452/

Abstract

BACKGROUND

Transient elastography is an ultrasound-based method to detect non-alcoholic fatty liver disease (NAFLD). Despite the simultaneously rising prevalence of fatty liver and metabolic disease, further information about metabolic risk indicators of fatty liver is still necessary.

METHODS

A Southern Italian population sample with obesity ( = 87) was cross-sectionally explored for associations among the presence of NAFLD, assessed by FibroScan, and clinical, biochemical and anthropometric parameters. Inclusion criteria were age >18 years, BMI ≥ 25 kg/m, no ongoing supplemental or drug therapy, including oral contraceptives or osteoporosis medications; exclusion criteria were pregnancy, endocrinological diseases, cardiovascular diseases, neoplasia, renal or hepatic failure, hereditary thrombocytopenia, hepatitis B (HBV) or hepatitis C virus (HCV) infection, and excess alcohol consumption.

RESULTS

The study sample featured a female predominance (67%, = 60), age range 18-64 years, and 40% prevalence of NAFLD, in accordance with the fibroscan-measured controlled attenuation parameter (CAP) threshold value above 302 dB/m. Males were slightly more frequently affected by NAFLD (51.4% vs. 48.6%, = 0.01). Insulin levels, insulin resistance (quantified by HOMA-IR), diastolic blood pressure, BMI, visceral adipose tissue (VAT), and waist circumference were significantly higher in the NAFLD subset compared to their counterparts ( < 0.01, < 0.01, = 0.05, < 0.01, < 0.01, < 0.01, respectively). Uric acid ( < 0.01) also showed a positive trend in the NAFLD group. Other liver steatosis parameters, measured by stiffness ( < 0.01), fatty liver index (FLI) ( < 0.01) and FibroScan-AST (FAST) ( < 0.01), were also significantly greater in the NAFLD group. In three nested linear regression models built to assess associations between CAP values and serum uric acid levels, a single unit increase in uricemia indicated a CAP increase by 14 dB/m, after adjusting for confounders (coefficient: 14.07, 95% CI 0.6-27.54).

CONCLUSIONS

Clinical-metabolic screening for NAFLD cannot ignore uricemia, especially in patients with obesity.

摘要

背景

瞬时弹性成像术是一种基于超声检测非酒精性脂肪性肝病（NAFLD）的方法。尽管脂肪肝和代谢性疾病的患病率同时上升，但仍需要更多关于脂肪肝代谢风险指标的信息。

方法

对意大利南部87名肥胖人群样本进行横断面研究，以探讨通过FibroScan评估的NAFLD与临床、生化和人体测量参数之间的关联。纳入标准为年龄>18岁，BMI≥25kg/m²，无正在进行的补充治疗或药物治疗，包括口服避孕药或骨质疏松症药物；排除标准为妊娠、内分泌疾病、心血管疾病、肿瘤、肾衰竭或肝功能衰竭、遗传性血小板减少症、乙型肝炎（HBV）或丙型肝炎病毒（HCV）感染以及过量饮酒。

结果

研究样本以女性为主（67%，n = 60），年龄范围为18 - 64岁，NAFLD患病率为40%，符合FibroScan测量的受控衰减参数（CAP）阈值高于302dB/m。男性受NAFLD影响的频率略高（51.4%对48.6%，P = 0.01）。与非NAFLD组相比，NAFLD组的胰岛素水平、胰岛素抵抗（通过HOMA-IR量化）、舒张压、BMI、内脏脂肪组织（VAT）和腰围显著更高（分别为P < 0.01、P < 0.01、P = 0.05、P < 0.01、P < 0.01、P < 0.01）。尿酸（P < 0.01）在NAFLD组中也呈上升趋势。通过硬度（P < 0.01）、脂肪肝指数（FLI）（P < 0.01）和FibroScan - AST（FAST）（P < 0.01）测量的其他肝脂肪变性参数在NAFLD组中也显著更高。在建立的三个嵌套线性回归模型中，用于评估CAP值与血清尿酸水平之间的关联，在校正混杂因素后，尿酸血症每增加一个单位表明CAP增加14dB/m（系数：14.07，95%CI 0.6 - 27.54）。