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[中国内脏脂肪素指数对代谢相关脂肪性肝病的预测价值]

[Predictive value of a Chinese visceral adiposity index for metabolic associated fatty liver disease].

作者信息

Zhang M X, Wang L, Zhang X, Dong Y C, Wang Y C

机构信息

Second Department of Gastroenterology, Zhongshan Hospital Affiliated to Dalian University, Dalian 116001, China.

Department of Radiology, Zhongshan Hospital Affiliated to Dalian University, Dalian 116001, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2025 Aug 20;33(8):781-789. doi: 10.3760/cma.j.cn501113-20240910-00486.

Abstract

To explore the correlation between Chinese visceral adiposity index (CVAI) and metabolic associated fatty liver disease (MAFLD) so as to evaluate its predictive value for MAFLD. Six hundred and thirteen cases admitted to the Department of Gastroenterology, Zhongshan Hospital Affiliated to Dalian University from June 2022 to August 2023 were selected and divided into the MAFLD group (=312) and the non-MAFLD group (=301) according to the diagnostic criteria of MAFLD. The clinical data differences between the two groups were compared. The MAFLD group was divided into a mild MAFLD group (=243) and a moderate to severe MAFLD group (=69) according to the liver/spleen CT value. The differences in body fat indices such as CVAI, visceral fat index (VAI), and visceral fat area (VFA) were compared between subjects with different degrees of MAFLD. The Spearman test was used to analyze the correlation between CVAI, VAI, and various clinical indicators. The subjects were divided into groups (Q1-Q4) according to the quartile levels of CVAI and VAI, and the distribution of MAFLD conditions among the groups was compared. Logistic regression analysis was used to determine the occurrence risk of MAFLD at different CVAI and VAI levels. The receiver operating characteristic curve was drawn. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the predictive value of CVAI, VAI, VFA, waist circumference, and body mass index for MAFLD. The DeLong test was used to compare the differences in the AUC of each predictive index. The prevalence of hypertension and type 2 diabetes mellitus, and the levels of systolic blood pressure, diastolic blood pressure, CVAI, VAI, VFA, subcutaneous fat area, waist circumference, body mass index, total cholesterol, triglycerides, low-density lipoprotein cholesterol, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, and serum uric acid were higher in the MAFLD group than the non-MAFLD group (<0.05), while the level of high-density lipoprotein cholesterol was lower than the non-MAFLD group (<0.001). The levels of CVAI, VAI, VFA, waist circumference, and body mass index were higher in the mild and the moderate to severe MAFLD group than those in the non-MAFLD group (<0.001). The detection rate of MAFLD gradually increased(=176.953, 133.659, <0.001) with the increase of CVAI and VAI levels. Correlation analysis showed that CVAI was positively correlated with VFA (=0.755, <0.001) and the homeostasis model assessment of insulin resistance (=0.579, <0.001). Multivariate logistic regression analysis showed that after adjusting for various risk factors, the risk of MAFLD in the Q4 group of the CVAI subgroup was still 7.159 times that of the Q1 group (95%:3.126-16.392, <0.001), and the risk of MAFLD in the Q4 group of the VAI subgroup was still 4.667 times that of the Q1 group (95%: 2.187-9.962, <0.001). The receiver operating characteristic curve results showed that the AUC of CVAI for predicting MAFLD was similar to that of VFA (0.822 . 0.826), and higher than that of VAI (AUC 0.772), waist circumference (AUC 0.796), and body mass index (AUC 0.755). The optimal critical value of CVAI for predicting the risk of MAFLD was 125.50, with sensitivity and specificity at 70.5% and 79.1%, respectively. The patient's risk of MAFLD increases with the rise of CVAI level, and CVAI has a favorable predictive value for the occurrence of MAFLD.

摘要

探讨中国内脏脂肪指数(CVAI)与代谢相关脂肪性肝病(MAFLD)之间的相关性,以评估其对MAFLD的预测价值。选取2022年6月至2023年8月大连大学附属中山医院消化内科收治的613例患者,根据MAFLD诊断标准分为MAFLD组(=312)和非MAFLD组(=301)。比较两组临床资料差异。MAFLD组根据肝脏/脾脏CT值分为轻度MAFLD组(=243)和中重度MAFLD组(=69)。比较不同程度MAFLD患者的CVAI、内脏脂肪指数(VAI)和内脏脂肪面积(VFA)等体脂指标差异。采用Spearman检验分析CVAI、VAI与各项临床指标的相关性。根据CVAI和VAI的四分位数水平将研究对象分组(Q1-Q4),比较各组MAFLD患病情况分布。采用Logistic回归分析确定不同CVAI和VAI水平下MAFLD的发生风险。绘制受试者工作特征曲线。计算受试者工作特征曲线下面积(AUC),评估CVAI、VAI、VFA、腰围和体重指数对MAFLD的预测价值。采用DeLong检验比较各预测指标AUC的差异。MAFLD组高血压、2型糖尿病患病率及收缩压、舒张压、CVAI、VAI、VFA、皮下脂肪面积、腰围、体重指数、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、空腹血糖、空腹胰岛素、胰岛素抵抗稳态模型评估、高敏C反应蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、γ-谷氨酰转移酶及血尿酸水平均高于非MAFLD组(<0.05),而高密度脂蛋白胆固醇水平低于非MAFLD组(<0.001)。轻度和中重度MAFLD组的CVAI、VAI、VFA、腰围和体重指数水平均高于非MAFLD组(<0.001)。随着CVAI和VAI水平升高,MAFLD检出率逐渐升高(=176.953,133.659,<0.001)。相关性分析显示,CVAI与VFA(=0.755,<0.001)及胰岛素抵抗稳态模型评估(=0.579,<0.001)呈正相关。多因素Logistic回归分析显示,校正各种危险因素后,CVAI亚组Q4组MAFLD发生风险仍为Q1组的7.159倍(95%:3.126-16.392,<0.001),VAI亚组Q4组MAFLD发生风险仍为Q1组的4.667倍(95%:2.187-9.962,<0.001)。受试者工作特征曲线结果显示,CVAI预测MAFLD的AUC与VFA相似(0.822 . 0.826),高于VAI(AUC 0.772)、腰围(AUC 0.796)和体重指数(AUC 0.755)。CVAI预测MAFLD风险的最佳临界值为125.50,敏感度和特异度分别为70.5%和79.1%。MAFLD患者发生风险随CVAI水平升高而增加,CVAI对MAFLD发生具有较好的预测价值。

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