ZJU指数、TyG指数及其衍生指数在代谢相关脂肪性肝病筛查及严重程度预测中的价值

摘要/Abstract

摘要： 目的探索浙江大学(ZJU)指数、甘油三酯葡萄糖(TyG)指数及其衍生指数对代谢相关脂肪性肝病(MAFLD)及其严重程度的预测价值。方法将2023年11月至2025年4月郑州市第一人民医院健康体检中心及消化内科就诊的522例患者设为研究对象,根据肝脏瞬时弹性成像结果将参与者分为MAFLD组(295例)与非MAFLD组(227例),根据受控衰减参数将MAFLD组分为轻度组、中度组、重度组。应用logistic回归分析与ROC曲线分析ZJU指数、TyG指数及TyG-BMI指数对MAFLD发生及严重程度的预测价值。结果 MAFLD组的ZJU指数(39.2±5.5)、TyG指数(9.1±0.6)及TyG-BMI指数(243.2±37.3)均高于非MAFLD组(31.8±3.7、8.3±0.5、186.6±28.9),差异有统计学意义(P<0.05)。轻度组、中度组和重度组间ZJU指数、TyG指数、TyG-BMI指数呈上升趋势(P<0.05)。多因素logistic回归分析结果显示,ZJU指数、TyG指数、TyG-BMI指数升高是MAFLD发生的独立危险因素(OR=1.058、20.815、1.485, P<0.05),也是中重度MAFLD发生的危险因素(OR=1.517、11.702、1.061, P<0.05)。TyG指数、ZJU指数、TyG-BMI指数预测MAFLD的AUC分别为0.839(95%CI 0.805~0.873)、0.876(95%CI 0.847~0.905)、0.891(95%CI 0.864~0.919),截断值分别为8.72、34.41、212.84。预测中重度MAFLD的AUC分别为0.832(95%CI 0.796~0.867)、0.916(95%CI 0.893~0.939)、0.916(95%CI 0.892~0.940),截断值分别为8.79、36.19、224.47。结论 TyG指数、ZJU指数、TyG-BMI指数均是MAFLD及中重度MAFLD的独立危险因素,对MAFLD及中重度MAFLD有预测价值,其中,TyG-BMI指数对MAFLD的预测价值更高,ZJU指数和TyG-BMI指数对中重度MAFLD的预测价值更高。

Abstract: Objective To explore the predictive value of the Zhejiang University index (ZJU index), triglyceride-glucose index (TyG index), and their derived indices for metabolic associated fatty liver disease (MAFLD) and its severity. Methods A total of 522 patients in the health examination center and gastroenterology department of Zhengzhou First People′s Hospital from November 2023 to April 2025 were enrolled. According to the diagnosis of MAFLD by liver transient elastography, the participants were divided into MAFLD group (295 cases) and non-MAFLD group (227 cases). According to the controlled attenuation parameters detected by transient elastography, the MAFLD group was divided into mild group, moderate group, and severe group. Logistic regression and ROC curve analysis were conducted to explore the correlation and predictive value of the ZJU index, TyG index, and TyG-BMI index with the occurrence and severity of MAFLD. Results The MAFLD group exhibited significantly higher metabolic indices than the non-MAFLD group (ZJU: 39.2 ± 5.5 vs. 31.8 ± 3.7; TyG: 9.1 ± 0.6 vs. 8.3 ± 0.5; TyG-BMI: 243.2 ± 37.3 vs. 186.6 ± 28.9; all P<0.05). Furthermore, ZJU, TyG, and TyG-BMI progressively increased across mild, moderate, and severe MAFLD subgroups, and the differences were statistically significant (P< 0.05). Multivariate logistic regression identified elevated ZJU (OR=1.058), TyG (OR=20.815), and TyG-BMI (OR=1.485) as independent risk factors for MAFLD occurrence (all P<0.05), and for moderate-to-severe MAFLD development (OR=1.517, 11.702, and 1.061; all P<0.05). For predicting MAFLD, AUC values were: TyG, 0.839 (95% CI 0.805~0.873; cut-off 8.72); ZJU, 0.876 (95% CI 0.847~0.905; cut-off 34.41); TyG-BMI, 0.891 (95% CI 0.864~0.919; cut-off 212.84). Corresponding AUCs for moderate-to-severe MAFLD prediction were: TyG, 0.832 (95% CI 0.796~0.867; cut-off 8.79); ZJU, 0.916 (95% CI 0.893~0.939; cut-off 36.19); TyG-BMI, 0.916 (95% CI 0.892~0.940; cut-off 224.47). Conclusion The TyG, ZJU and TyG-BMI are all independent risk factors for MAFLD and moderate to severe MAFLD, and have predictive value for MAFLD and moderate to severe MAFLD, among which TyG-BMI has a higher predictive value for MAFLD. The ZJU and TyG-BMI have higher predictive value for moderate to severe MAFLD.

Key words: Metabolically associated fatty liver disease, Zhejiang University index, Triglyceride glucose index, Triglyceride-glucose-body mass index, Transient elastography

刘晓桐, 张保静, 王满, 吴凤霞, 宋晨源, 王树俊. ZJU指数、TyG指数及其衍生指数在代谢相关脂肪性肝病筛查及严重程度预测中的价值[J]. 肝脏, 2026, 31(5): 697-703.

LIU Xiao-tong, ZHANG Bao-jing, WANG Man, WU Feng-xia, SONG Chen-yuan, WANG Shu-jun. The value of the ZJU index, TyG index, and their derivative index in screening and predicting the severity of metabolic dysfunction-associated fatty liver disease[J]. Chinese Hepatolgy, 2026, 31(5): 697-703.

/ 推荐

参考文献

[1] Nassir F. NAFLD:mechanisms, treatments, and biomarkers[J]. Biomolecules, 2022, 12(6):824.
[2] Eslam M, Newsome P N, Sarin S K, et al. A new definition for metabolic dysfunction-associated fatty liver disease:an international expert consensus statement[J]. J Hepatol, 2020, 73(1):202-209.
[3] Zhou J, Zhou F, Wang W, et al. Epidemiological features of NAFLD from 1999 to 2018 in China[J]. Hepatology, 2020, 71(5):1851-1864.
[4] Estes C, Anstee Q M, Arias-Loste M T, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016~2030[J]. Hepatol, 2018, 69(4):896-904.
[5] Pipitone R M, Ciccioli C, Infantino G, et al. MAFLD:a multisystem disease[J]. Ther Adv Endocrinol Metab, 2023, 14:20420188221145549.
[6] Pan Z, Derbala M, AlNaamani K, et al. MAFLD criteria are better than MASLD criteria at predicting the risk of chronic kidney disease[J]. Ann Hepatol, 2024, 29:101512.
[7] Bae S D W, George J, Qiao L. From MAFLD to hepatocellular carcinoma and everything in between[J]. Chin Med J (Engl), 2022, 135(5):547-556.
[8] Sakurai Y, Kubota N, Yamauchi T, et al. Role of insulin resistance in MAFLD[J]. Int J Mol Sci, 2021, 22(8):4156.
[9] Ramdas Nayak V K, Satheesh P, Shenoy M T, et al. Triglyceride glucose (TyG) index:a surrogate biomarker of insulin resistance[J]. J Pak Med Assoc, 2022, 72(5):986-988.
[10] Wang J, Yan S, Cui Y, et al. The Diagnostic and prognostic value of the triglyceride-glucose index in metabolic dysfunction-associated fatty liver disease (MAFLD):a systematic review and meta-analysis[J]. Nutrients, 2022, 14(23):4969.
[11] Otsubo N, Fukuda T, Cho G, et al. Utility of indices obtained during medical checkups for predicting fatty liver disease in non-obese people[J]. Intern Med, 2023, 62(16):2307-2319.
[12] Badmus O O, Hillhouse S A, Anderson C D, et al. Molecular mechanisms of metabolic associated fatty liver disease (MAFLD):functional analysis of lipid metabolism pathways[J]. Clin Sci (Lond), 2022, 136(18):1347-1366.
[13] Mehta M, Shah J, Joshi U. Understanding insulin resistance in NAFLD:a systematic review and meta-analysis focused on HOMA-IR in South Asians[J]. Cureus, 2024, 16(10):e70768.
[14] Kitae A, Hashimoto Y, Hamaguchi M, et al. The triglyceride and glucose index is a predictor of incident nonalcoholic fatty liver disease:a population-based cohort study[J]. Can J Gastroenterol Hepatol, 2019, 2019:5121574.
[15] 武艳, 董奥奇, 张先翠,等. 甘油三酯葡萄糖指数及其衍生指数与代谢相关性脂肪肝的相关性研究[J]. 齐齐哈尔医学院学报, 2024, 45(24):2313-2320.
[16] 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.
[17] Xue Y, Xu J, Li M, et al. Potential screening indicators for early diagnosis of NAFLD/MAFLD and liver fibrosis:triglyceride glucose index-related parameters[J]. Front Endocrinol (Lausanne), 2022, 13:951689.
[18] Ji B, Qu H, Wang H, et al. The ZJU index:a useful indicator for recognizing insulin resistance in the Chinese general population[J]. Acta Diabetol, 2016, 53(5):817-823.
[19] 武艳, 董奥奇, 张先翠,等. ZJU指数、METS-IR指数及TyG-BMI指数预测代谢相关脂肪性肝病价值的比较[J]. 皖南医学院学报, 2025, 44(2):133-137.