三酰甘油葡萄糖-体质指数对瘦型非酒精性脂肪性肝病的预测价值

肝脏 ›› 2025, Vol. 30 ›› Issue (6): 808-812.

三酰甘油葡萄糖-体质指数对瘦型非酒精性脂肪性肝病的预测价值

巩红, 张岩, 张春艳, 邓捷, 吴皓宇, 韩拓

710004 陕西西安西安交通大学第二附属医院健康管理部(巩红),心血管内科(张岩,张春艳,邓捷,韩拓);陕西省人民医院心血管内科(吴皓宇)

收稿日期:2024-04-05 出版日期:2025-06-30 发布日期:2025-08-08
通讯作者: 韩拓,Email:heart0228@xjtu.edu.cn
基金资助:
国家自然科学基金青年项目(82100359);陕西省自然科学基金一般项目(2023-JC-YB-709);西安交通大学第二附属医院院基金青年项目(YJ(QN)202325)

Predictive value of triglyceride-glucose-body mass index in nonalcoholic fatty liver disease among lean populations

GONG Hong¹, ZHANG Yan², ZHANG Chun-yan², DENG Jie², WU Hao-yu³, HAN Tuo²

1. Department of Health Management, the Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi 710004, China;
2. Department of Cardiology, the Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi 710004, China;
3. Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China

Received:2024-04-05 Online:2025-06-30 Published:2025-08-08
Contact: HAN Tuo,Email:heart0228@xjtu.edu.cn

摘要/Abstract

摘要： 目的探究三酰甘油葡萄糖-体质指数(triglyceride-glucose-body mass index, TyG-BMI)与瘦型非酒精性脂肪性肝病(NAFLD)的相关性及其预测价值。方法纳入2020年6月至2021年5月西安交通大学第二附属医院2553名健康体检者,根据TyG-BMI四分位数由低到高分为Q1~Q4组。限制性立方样条(RCS)分析TyG-BMI与瘦型NAFLD之间关系,logistic回归与ROC曲线分析TyG-BMI对于瘦型NAFLD的相关性和预测价值。结果瘦型NAFLD患者共209例(8.2%),其中Q1~Q4组NAFLD患病率分别为0.3%、1.1%、7.1%与24.3%,呈显著递增趋势(P<0.001)。RCS显示,随着TyG-BMI的增加,瘦型NAFLD的患病风险显著增加(P<0.001),两者之间存在非线性相关性(for nonlinear P<0.001)。logistic回归显示,在调整各混杂因素后,TyG-BMI增加与瘦型NAFLD发病风险升高显著相关(OR=1.076, 95% CI: 1.066~1.086),其中TyG-BMI较高四分位数Q3(177.85, 194.28)、Q4(194.28, 269.07)组中瘦型NAFLD的患病风险分别为Q1(115.92, 162.43)组的5.545倍(95% CI: 1.137~27.039)与9.853倍(95% CI: 1.788~54.279)。ROC曲线显示,TyG-BMI对于瘦型NAFLD具有较好预测价值,曲线下面积为0.858,临界值为187.95,敏感度和特异度分别为89.5%与70.8%,优于TyG指数及BMI、WC。结论瘦型体检人群中TyG-BMI指数升高与NAFLD发病风险增加显著相关,TyG-BMI对于瘦型NAFLD具有良好的预测价值,可用于NAFLD早期筛查诊断。

关键词: 非酒精性脂肪性肝病, 瘦型人群, TyG-BMI指数, 胰岛素抵抗

Abstract: Objective To explore the association between triglyceride-glucose-body mass index (TyG-BMI) and nonalcoholic fatty liver disease (NAFLD) in lean population and its predictive value. Methods 2553 healthy subjects from the Second Affiliated Hospital of Xi′an Jiaotong University from June 2020 to May 2021 were randomly included and divided into Q1-Q4 groups according to the TyG-BMI quartiles. The correlation between TyG-BMI and lean NAFLD was analyzed with restricted cubic spline (RCS), and its predictive value was explored by logistic regression and receiver operating characteristic (ROC) curve. Results There were 209 patients with lean NAFLD (8.2%), and the prevalence of NAFLD in Q1-Q4 groups were 0.3%, 1.1%, 7.1% and 24.3%, respectively (P<0.001). RCS showed that the risk of NAFLD in lean population upraised significantly with the increase of TyG-BMI (P<0.001), and there was a nonlinear relationship between them (P for nonlinear < 0.001). Logistic regression showed that after adjusting confounding factors, increased TyG-BMI was significantly associated with the increased risk of lean NAFLD (odds ratio [OR] 1.076, 95% CI: 1.066~1.086), and the risk of lean NAFLD in Q3 (177.85, 194.28) and Q4 (194.28, 269.07) groups was still 5.545 times (95% CI: 1.137~27.039) and 9.853 times (95% CI: 1.788~54.279) than Q1 (115.92, 162.43) group. ROC curve showed that TyG-BMI had a good predictive value for lean NAFLD, with area under the curve of 0.858, critical value of 187.95, the sensitivity and specificity were 89.5% and 70.8%, respectively, which were better than TyG, BMI and waist circumference (WC). Conclusion The TyG-BMI is significantly associated with the risk of NAFLD in lean population, and has a good predictive value, which can be used for early screening and diagnosis of lean NAFLD.

Key words: Nonalcoholic fatty liver disease, Lean population, Triglyceride-glucose-body mass index, Insulin resistance

巩红, 张岩, 张春艳, 邓捷, 吴皓宇, 韩拓. 三酰甘油葡萄糖-体质指数对瘦型非酒精性脂肪性肝病的预测价值[J]. 肝脏, 2025, 30(6): 808-812.

GONG Hong, ZHANG Yan, ZHANG Chun-yan, DENG Jie, WU Hao-yu, HAN Tuo. Predictive value of triglyceride-glucose-body mass index in nonalcoholic fatty liver disease among lean populations[J]. Chinese Hepatolgy, 2025, 30(6): 808-812.

/ 推荐

参考文献

[1] Younossi Z M, Koenig A B, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes [J]. Hepatology, 2016, 64(1):73-84.
[2] Ye Q, Zou B, Yeo Y H, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis [J]. Lancet Gastroenterol Hepatol, 2020, 5(8):739-752.
[3] Long M T, Noureddin M, Lim J K. AGA clinical practice update: diagnosis and management of nonalcoholic fatty liver disease in lean individuals: expert review [J]. Gastroenterology, 2022, 163(3):764-774.e761.
[4] Younossi Z, Anstee Q M, Marietti M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention [J]. Nat Rev Gastroenterol Hepatol, 2018, 15(1):11-20.
[5] Lu F B, Zheng K I, Rios R S, et al. Global epidemiology of lean non-alcoholic fatty liver disease: a systematic review and meta-analysis [J]. J Gastroenterol Hepatol, 2020, 35(12):2041-2050.
[6] Tang A, Ng C H, Phang P H, et al. Comparative burden of metabolic dysfunction in lean NAFLD vs non-lean NAFLD-a systematic review and meta-analysis [J]. Clin Gastroenterol Hepatol, 2023, 21(7):1750-1760.e1712.
[7] Xu R, Pan J, Zhou W, et al. Recent advances in lean NAFLD [J]. Biomed Pharmacother, 2022, 153:113331.
[8] Ito T, Ishigami M, Zou B, et al. The epidemiology of NAFLD and lean NAFLD in Japan: a meta-analysis with individual and forecasting analysis, 1995-2040 [J]. Hepatol Int, 2021, 15(2):366-379.
[9] Bilic-Curcic I, Cigrovski Berkovic M, Virovic-Jukic L, et al. Shifting perspectives - interplay between non-alcoholic fatty liver disease and insulin resistance in lean individuals [J]. World J Hepatol, 2021, 13(1):80-93.
[10] 康娟, 刘文徽, 常青, 等. 三酰甘油-葡萄糖指数及其衍生指数与老年男性代谢相关脂肪性肝病的相关性分析 [J]. 解放军医学杂志, 2023, 48(11):1344-1352.
[11] Yu R, Xie W, Peng H, et al. Diagnostic value of triglyceride-glucose index and related parameters in metabolism-associated fatty liver disease in a Chinese population: a cross-sectional study [J]. BMJ Open, 2023, 13(9):e075413.
[12] 卢蓉, 李慧, 张超, 等. 甘油三酯/葡萄糖指数预测非酒精性脂肪性肝病严重程度效能研究 [J]. 实用肝脏病杂志, 2023, 26(06):805-810.
[13] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版) [J]. 临床肝胆病杂志, 2018, 34(05):947-957.
[14] Eslam M, Sarin S K, Wong V W, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease [J]. Hepatol Int, 2020, 14(6):889-919.
[15] Eslam M, Sanyal A J, George J. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease [J]. Gastroenterology, 2020, 158(7):1999-2014.e1991.
[16] 张沥, 陈海滨, 宋俊华. TyG-BMI对非酒精性脂肪性肝病的预测价值分析 [J]. 中华保健医学杂志, 2023, 25(02):151-154.
[17] Er L K, Wu S, Chou H H, et al. Triglyceride glucose-body mass index is a simple and clinically useful surrogate marker for insulin resistance in nondiabetic individuals [J]. PLoS One, 2016, 11(3):e0149731.