心脏代谢指数与代谢相关脂肪性肝病的相关性分析

武云霞; 李程亮; 李晓磊; 罗钊晓; 任天顺

doi:10.3969/j.issn.1001-5256.2022.10.010

心脏代谢指数与代谢相关脂肪性肝病的相关性分析

DOI: 10.3969/j.issn.1001-5256.2022.10.010

武云霞^{1a, 2, , ,},
李程亮^1a,
李晓磊²,
罗钊晓²,
任天顺^1b, , ,

1a.
西安医学院第一附属医院全科医学科，西安 710000
1b.
西安医学院第一附属医院普通外科，西安 710000
2.
西安医学院研究生院，西安 710000

基金项目:

陕西省科技成果重点推广计划 (2022SF-132)

伦理学声明：本研究方案于2022年3月7日经由西安医学院第一附属医院伦理委员会审批，批号：XYYFY2022LSKY-008。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：武云霞、任天顺、李程亮负责文章的构思与设计；武云霞、李晓磊、罗钊晓负责数据收集整理、统计学分析并撰写论文；任天顺、李程亮负责论文修改、质量控制及审校和最终定稿。

详细信息

通信作者:
武云霞, 1445778990@qq.com

任天顺, rentianshun101@sohu.com

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出版历程
- 收稿日期: 2022-03-30
- 录用日期: 2022-04-30
- 出版日期: 2022-10-20

Correlation between cardiometabolic index and metabolic-associated fatty liver disease

Yunxia WU^{1a, 2
, ,
,},
Chengliang LI^1a,
Xiaolei LI²,
Zhaoxiao LUO²,
Tianshun REN^{1b
, ,
,}

1a.
Department of General Practice, The First Affiliated Hospital of Xi'an Medical College, Xi'an 710000, China
1b.
Department of General Surgery, The First Affiliated Hospital of Xi'an Medical College, Xi'an 710000, China
2.
Graduate School of Xi'an Medical College, Xi'an 710000, China

Research funding:

Shaanxi Provincial Key Promotion Project for Scientific and Technological Achievements (2022SF-132)

More Information

Corresponding author: WU Yunxia, 1445778990@qq.com(ORCID: 0000-0001-6553-364X); REN Tianshun, rentianshun101@sohu.com(ORCID: 0000-0002-5631-6421)

摘要

摘要: 目的研究心脏代谢指数(CMI)与代谢相关脂肪性肝病(MAFLD)的相关性。方法随机纳入2018年1月—2020年12月西安医学院第一附属医院消化内科收治的480例受试者，分为MAFLD组(n=202)和非MAFLD组(n=278)，比较两组CMI及相关生化指标、瞬时弹性成像技术(FibroScan)检测指标差异。计量资料符合正态分布的两组间比较采用t检验，不符合正态分布的两组间比较用Mann-Whitney U检验；计数资料两组间比较采用χ²检验。将CMI按四分位数水平分为4组(Q1 ~ Q4)，采用Kruskal- Wallis H检验比较各组间脂肪衰减程度(CAP)和肝脏硬度(LSM)分布情况；采用Logistic回归分析计算不同CMI水平MAFLD发生风险。结果 MAFLD组CMI、CAP、LSM、体质量、腰围、BMI、收缩压、舒张压、TG、TC、LDL-C、ALT、AST、GGT、尿酸(UA)、空腹血糖(FBG)水平均显著高于非MAFLD组，而高密度脂蛋白胆固醇(HDL-C)水平显著低于非MAFLD组(P值均＜0.01)。不同CMI四分位水平分组中CAP程度差异有统计学意义(χ²=15.220，P=0.002)。多因素logistic回归显示，调整相关危险因素后，Q4组MAFLD发生风险为Q1组的3.521(95%CI：1.415~8.764)倍(P＜0.01)。结论较高的CMI与MAFLD发生风险呈显著正相关，随着CMI四分位数水平的增加，MAFLD患者逐渐增多且发生纤维化的风险显著增加。此外，定期检查和评价CMI可能有助于控制MAFLD的发生。
- 代谢相关脂肪性肝病 /
- 非酒精性脂肪性肝病 /
- 心脏代谢指数 /
- 弹性成像技术
Abstract: Objective To analyze association of the cardiometabolic index (CMI) with risk of metabolism-associated fatty liver disease (MAFLD). Methods This study recruited 480 individuals from Inpatient Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical College from January 2018 to December 2020 and divided into MAFLD (n=202) and non-MAFLD groups (n=278) for comparison of the CMI and related biochemical and FibroScan parameters. The independent samples t-test was performed for comparison of normally distributed continuous data, while the Mann-Whitney U test was performed for comparison of non-normally distributed continuous data and the chi-square test was used for comparison of categorical data between these two groups of individuals. These individuals were then divided into Q1-Q4 subgroups based on their CMI and then subjected to the Kruskal-Wallis H test to compare the distribution of the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) between these two groups of patients. Finally, a Logistic regression analysis was performed to calculate MAFLD risk at different CMI scores (Q1-Q4). Results Compared with the non-MAFLD individuals, the MAFLD group had significantly higher levels of CMI, CAP, LSM, body weight, waist circumference, body mass index, systolic and diastolic blood pressure, triglyceride, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, serum uric acid, and fasting blood glucose, but significantly lower high-density lipoprotein cholesterol level (all P < 0.01). Moreover, there was significant difference in the CAP among different CMI quartile levels in these individuals (χ²=15.220, P=0.002). The multivariate logistic regression analytic data revealed that the CMI in the Q4 was an independent predictor for MAFLD risk vs. the CMI in the Q1 quantile ones (95% confidence interval, 1.415-8.764, OR=3.521; P < 0.01) after adjustment for related risk factors. Conclusion A higher CMI score (Q4) was associated with a MAFLD risk and a gradual increase in the CMI score was with the increased number of MAFLD patients and fibrosis risk, indicating that a routine health check-up and measurement of CMI could help to identify and control MAFLD early.
- Metabolism-Associated Fatty Liver Disease /
- Non-alcoholic Fatty Liver Disease /
- Cardiometabolic Index /
- Elasticity Imaging Techniques

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表 1 受试者基线资料分析

Table 1. Analysis of baseline data of subjects

指标	MAFLD组(n=202)	非MAFLD组(n=278)	统计值	P值
年龄(岁)	51.21±11.13	52.19±12.81	t=0.876	0.381
性别[例(%)]			χ²=2.335	0.127
男	108(45.6)	129(54.4)
女	94(38.7)	149(61.3)
身高(cm)	167.00(160.00~172.00)	165.00(159.75~170.00)	Z=-1.944	0.052
体质量(kg)	70.00(62.00~77.00)	59.50(52.00~66.00)	Z=-9.612	＜0.001
WC(cm)	90.45±8.90	82.87±8.74	t=-9.303	＜0.001
BMI(kg/m²)	25.26±2.73	21.94±2.64	t=-13.414	＜0.001
SBP(mmHg)	118.45±10.86	115.11±12.76	t=-3.010	0.003
DBP(mmHg)	74.42±7.50	71.51±7.17	t=-4.294	＜0.001
吸烟[例(%)]	65(47.8)	71(52.2)	χ²=2.539	0.111
饮酒[例(%)]	42(45.7)	50(54.3)	χ²=0.595	0.441
TG(mmol/L)	1.72(1.22~2.40)	1.18(0.88~1.56)	Z=-8.151	＜0.001
TC(mmol/L)	4.37±0.83	4.12±0.83	t=-3.213	0.001
HDL-C(mmol/L)	1.13(0.96~1.29)	1.24(1.05~1.45)	Z=-4.616	＜0.001
LDL-C(mmol/L)	2.92±0.64	2.70±0.62	t=-3.846	＜0.001
LP(a)(mg/L)	109.00(69.00~276.50)	116.50(71.75~262.75)	Z=-1.414	0.888
ALT(U/L)	18.50(14.00~30.00)	14.00(11.00~20.00)	Z=-5.770	＜0.001
AST(U/L)	21.00(18.00~26.00)	19.00(17.00~23.00)	Z=-3.690	＜0.001
GGT(U/L)	24.00(16.00~40.00)	16.00(12.00~22.00)	Z=-7.619	＜0.001
Alb(g/L)	41.56±3.77	40.97±3.87	t=-1.666	0.096
TBA(μmol/L)	3.45(1.90~6.08)	3.15(1.60~5.20)	Z=-1.429	0.153
Cr(μmol/L)	63.00(52.28~73.23)	61.35(53.00~71.00)	Z=-0.901	0.368
UA(μmol/L)	319.00(276.75~395.00)	281.00(230.50~331.00)	Z=-5.635	＜0.001
FBG(mmol/L)	4.99(4.72~5.43)	4.85(4.50~5.21)	Z=-3.986	＜0.001
WBC(×10⁹/L)	5.42(4.51~6.71)	5.17(4.27~6.37)	Z=-2.058	0.040
NE(×10⁹/L)	3.02(2.46~3.78)	2.93(2.24~3.83)	Z=-0.869	0.385
PLT(×10⁹/L)	206.78±58.40	198.64±53.51	t=-1.582	0.114
CMI	0.81(0.53~1.30)	0.48(0.30~0.69)	Z=-9.216	＜0.001
CAP(dB/m)	292.43±36.57	210.63±45.58	t=-21.052	＜0.001
LSM(kPa)	4.40(3.70~5.30)	3.90(3.40~4.70)	Z=-4.406	＜0.001

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表 2 MAFLD受试者不同CMI水平与CAP、LSM的分布情况

Table 2. CAP and LSM distribution of different CMI levels in MAFLD

组别	CAP[例(%)]			LSM[例(%)]
组别	轻度(n=55)	中度(n=56)	重度(n=91)	低风险(n=194)	高风险(n=8)
Q1组	8(14.5)	8(14.3)	2(2.2)	18(9.3)	0
Q2组	14(25.5)	11(19.6)	15(16.5)	40(20.6)	0
Q3组	18(32.7)	17(30.4)	25(27.5)	57(29.4)	3(37.5)
Q4组	15(27.3)	20(35.7)	49(53.8)	79(40.7)	5(62.5)
χ²值	15.220			3.422
P值	0.002			0.331

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表 3 不同CMI水平MAFLD发生风险的Logistic回归分析

Table 3. Logistic regression analysis of MAFLD risk at different CMI levels

CMI水平分组	模型1		模型2		模型3
CMI水平分组	OR(95%CI)	P值	OR(95%CI)	P值	OR(95%CI)	P值
Q1组	1.000		1.000		1.000
Q2组	2.953(1.571~5.550)	0.001	1.804(0.902~3.608)	0.095	1.622(0.770~3.420)	0.204
Q3组	5.260(2.850~9.708)	＜0.001	2.468(1.237~4.921)	0.010	2.177(0.984~4.817)	0.055
Q4组	12.739(6.763~23.996)	＜0.001	4.725(2.295~9.730)	＜0.001	3.521(1.415~8.764)	0.007

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