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Fetuin-A、Fetuin-B及胰岛素抵抗指数对非酒精性脂肪性肝病的预测价值

杨素莲 施荣杰 李利华

引用本文:
Citation:

Fetuin-A、Fetuin-B及胰岛素抵抗指数对非酒精性脂肪性肝病的预测价值

DOI: 10.12449/JCH240409
基金项目: 

云南省地方本科高校基础研究联合专项项目 (202001BA070001-103)

伦理学声明:本研究方案于2019年6月28日经由大理大学医学伦理委员会审批,批号:DFY20190628001。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:杨素莲负责查阅文献,数据分析和撰写论文;施荣杰负责收集和分析患者临床数据;李利华负责文章选题和指导论文修改。
详细信息
    通信作者:

    李利华, lilihuayncn@163.com (ORCID: 0000-0003-3987-5851)

Value of Fetuin-A, Fetuin-B, and insulin resistance index in predicting nonalcoholic fatty liver disease

Research funding: 

Yunnan Provincial Joint Basic Research Project for Local Undergraduate Colleges and Universities (202001BA070001-103)

More Information
  • 摘要:   目的  探讨血清Fetuin-A、Fetuin-B联合胰岛素抵抗指数(HOMA-IR)对非酒精性脂肪性肝病(NAFLD)的预测价值。  方法  连续选取2020年6月—2021年6月大理大学第一附属医院消化内科就诊的120例NAFLD患者和体检中心的120例健康体检人群为研究对象,收集其临床数据资料,并检测血清Fetuin-A、Fetuin-B水平。计量资料两组间比较采用成组t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。多因素Logistic回归分析NAFLD患者的危险因素。构建受试者工作特征曲线(ROC曲线)评估Fetuin-A、Fetuin-B联合HOMA-IR对NAFLD患者的预测效能。  结果  NAFLD组患者的体质量指数、收缩压、舒张压、ALT、AST、空腹血糖、空腹胰岛素、甘油三酯、HOMA-IR、Fetuin-A和Fetuin-B等均高于健康对照组(P值均<0.05)。多因素Logistic回归分析显示Fetuin-A(OR=1.010,95%CI:1.001~1.020,P<0.05)、Fetuin-B(OR=1.113,95%CI:1.021~1.214,P<0.05)和HOMA-IR(OR=24.053,95%CI:2.624~220.470,P<0.05)是NAFLD的独立危险因素。ROC曲线显示,Fetuin-A、Fetuin-B、HOMA-IR、Fetuin-A联合Fetuin-B、Fetuin-A联合HOMA-IR、Fetuin-B联合HOMA-IR以及三者联合预测NAFLD的ROC曲线下面积分别为0.637(95%CI:0.551~0.722)、0.853(95%CI:0.796~0.912)、0.837(95%CI:0.763~0.912)、0.853(95%CI:0.795~0.911)、0.843(95%CI:0.770~0.916)、0.922(95%CI:0.877~0.967)和0.922(95%CI:0.877~0.966)。  结论  Fetuin-A、Fetuin-B对NAFLD有一定的预测价值,Fetuin-B联合HOMA-IR的预测价值更高。

     

  • 图  1  Fetuin-A、Fetuin-B联合HOMA-IR预测NAFLD的ROC曲线

    Figure  1.  ROC curve of Fetuin-A, Fetuin-B combined with HOMA-IR for predicting NAFLD

    表  1  研究对象的一般特征描述

    Table  1.   Description of general characteristics of study subjects

    指标 NAFLD组(n=120) 健康对照组(n=120) 统计值 P
    男性[例(%)] 56(46.67) 50(41.67) χ2=0.608 0.435
    年龄(岁) 51.08±13.07 38.76±10.92 t=-7.926 <0.001
    本科及以上学历[例(%)] 35(29.17) 90(75.00) χ2=48.685 <0.001
    BMI(kg/m2 26.02±3.47 22.39±2.55 t=-9.234 <0.001
    收缩压(mmHg) 129.46±21.71 115.33±15.73 t=-5.772 <0.001
    舒张压(mmHg) 80.90±12.83 74.29±10.79 t=-4.318 <0.001
    FPG(mmol/L) 5.14(4.45~6.82) 4.57(4.23~4.86) Z=-5.978 <0.001
    FINS(μIU/mL) 5.78(4.29~6.72) 4.09(3.60~4.83) Z=-6.015 <0.001
    ALT(U/L) 24.00(17.50~35.50) 16.00(12.00~23.00) Z=-5.526 <0.001
    AST(U/L) 20.00(16.00~26.00) 17.00(15.00~20.25) Z=-2.552 <0.001
    Alb(g/L) 42.60(38.55~46.10) 47.20(45.58~49.15) Z=10.017 <0.001
    LDL-C(mmol/L) 2.65±0.72 2.81±0.74 t=1.690 0.157
    HDL-C(mmol/L) 1.17±0.32 1.60±0.34 t=9.964 <0.001
    TC(mmol/L) 4.80(4.17~5.46) 5.08(4.44~5.52) Z=0.731 0.104
    TBil(mmol/L) 11.70(8.70~15.20) 13.15(10.17~16.52) Z=0.984 0.020
    BUN(mmol/L) 5.21(4.21~6.50) 5.12(4.06~5.94) Z=-1.788 0.182
    TG(mmol/L) 2.13(1.58~3.12) 1.28(0.93~1.77) Z=-5.140 <0.001
    SUA(μmol/L) 352.00(289.00~407.00) 344.00(296.50~404.75) Z=0.103 0.816
    Scr(μmol/L) 68.34±19.81 69.66±15.93 t=-0.170 0.373
    HOMA-IR 1.32(1.06~1.64) 0.85(0.74~0.96) Z=-7.658 <0.001
    Fetuin-A(μg/mL) 685.23(595.80~776.49) 601.36(534.56~668.06) Z=-7.344 <0.001
    Fetuin-B(μg/mL) 81.44(72.41~100.88) 64.19(57.83~71.31) Z=-2.755 <0.001
    下载: 导出CSV

    表  2  多因素Logistic回归分析

    Table  2.   Multivariable Logistic regression analysis

    指标 β 标准误 Wald值 OR 95%CI P
    常数项 -35.518 10.885 10.648
    年龄 0.086 0.038 5.276 1.090 1.013~1.173 0.022
    性别 1.670 1.282 1.696 5.310 0.430~65.511 0.193
    教育程度 -1.208 1.261 0.917 0.299 0.025~3.538 0.338
    BMI 0.886 0.460 3.700 2.424 0.983~5.977 0.054
    收缩压 0.054 0.048 1.276 1.055 0.961~1.158 0.259
    舒张压 -0.088 0.078 1.264 0.916 0.787~1.067 0.261
    ALT 0.156 0.061 6.605 1.169 1.038~1.317 0.010
    AST -0.023 0.058 0.153 0.978 0.872~1.096 0.695
    HDL-C -8.646 4.714 3.365 0.002 0.001~1.809 0.067
    TG -0.293 0.368 0.634 0.746 0.363~1.534 0.426
    HOMA-IR 5.483 2.305 5.657 24.053 2.624~220.470 0.017
    Fetuin-A 0.010 0.005 4.047 1.010 1.001~1.020 0.044
    Fetuin-B 0.107 0.044 5.910 1.113 1.021~1.214 0.015
    下载: 导出CSV

    表  3  Fetuin-A、Fetuin-B联合HOMA-IR对NAFLD患者的预测价值

    Table  3.   Predictive value of Fetuin-A and Fetuin-B combined with HOMA-IR for NAFLD

    预测指标 最佳截断值 敏感度(%) 特异度(%) AUC(95%CI P
    Fetuin-A 569.06 76.5 43.9 0.637(0.551~0.722) 0.003
    Fetuin-B 71.89 73.5 85.7 0.853(0.796~0.912) <0.001
    HOMA-IR 1.025 75.0 89.8 0.837(0.763~0.912) <0.001
    Fetuin-A联合Fetuin-B 0.46 75.0 84.7 0.853(0.795~0.911) <0.001
    Fetuin-A联合HOMA-IR 0.47 70.6 93.9 0.843(0.770~0.916) <0.001
    Fetuin-B联合HOMA-IR 0.40 80.9 91.8 0.922(0.877~0.967) <0.001
    Fetuin-A、Fetuin-B联合HOMA-IR 0.40 80.9 91.8 0.922(0.877~0.966) <0.001
    下载: 导出CSV
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