瘦型非酒精性脂肪性肝病患者的代谢特征及肝脂肪变、纤维化程度分析

摘要/Abstract

摘要： 目的探讨瘦型非酒精性脂肪性肝病(NAFLD)患者代谢特征,并分析其肝脂肪变及肝纤维化程度,为瘦型NAFLD的临床识别与风险评估提供依据。方法根据体型及是否合并NAFLD,将2021年1月至2025年6月长沙市中医医院的就诊对象分为瘦型NAFLD组(n=35)、肥胖型NAFLD组(n=42)和健康瘦型对照组(n=28)。比较3组代谢指标、肝脂肪变程度及相关指标、肝纤维化相关指标等差异。结果与健康瘦型对照组相比,瘦型NAFLD组空腹胰岛素、胰岛素抵抗指数、甘油三酯均升高,分别为11.8(8.9,15.2)IU/mL 比7.4(5.6,9.2)IU/mL、2.9(2.1,3.7)比1.6(1.2,2.1)、(1.7±0.6)mmol/L比(1.1±0.4)mmol/L,而高密度脂蛋白胆固醇降低,为(1.1±0.3)mmol/L比(1.4±0.3)mmol/L(均P<0.05)。肝脂肪变相关指标显示,瘦型NAFLD组肝脂肪含量为(11.4±4.6)%,CAP值为(262±38)dB/m,显著高于健康瘦型对照组的(3.2±1.5)%,(208±31)dB/m,但低于肥胖型NAFLD组的(18.9±6.7)%,(302±46)dB/m(P<0.05)。瘦型NAFLD组中轻度脂肪变18例(51.4%),中重度脂肪变17例(48.6%)。肝纤维化评估结果显示,瘦型NAFLD组肝硬度值为(7.9±2.6)kPa、FIB-4指数为1.4(1.0,1.9)及NFS评分为(-0.3±0.1),均明显高于健康瘦型对照组的(4.8±1.3)kPa、0.9(0.6,1.1)、(-1.3±0.6),而血小板计数低于对照组,为(212±46)×10⁹/L比(236±41)×10⁹/L(均P<0.05)。瘦型NAFLD组显著肝纤维化(≥F2期)比例为25.7%(9/35),进展期肝纤维化(≥F3期)比例为11.4%(4/35)。结论瘦型NAFLD患者虽无明显肥胖,但已表现出一定程度的代谢异常,并可伴随显著的肝脂肪变及肝纤维化风险。临床实践中应重视瘦型人群中NAFLD的筛查和评估,避免仅依据体型而低估其疾病严重程度。

关键词: 瘦型非酒精性脂肪性肝病, 代谢特征, 肝脂肪变, 肝纤维化

Abstract: Objective To investigate the metabolic characteristics of patients with lean non-alcoholic fatty liver disease (NAFLD) and to analyze the severity of hepatic steatosis and liver fibrosis, thereby providing evidence for the clinical identification and risk assessment of lean NAFLD. Methods Between January 2021 and June 2025, study participants were classified into three groups according to body habitus and the presence of NAFLD: a lean NAFLD group (n=35), an obese NAFLD group (n=42), and a lean healthy control group (n=28). Differences among the three groups in metabolic parameters, the degree of hepatic steatosis and related indicators, as well as liver fibrosis-related indices were compared. Results Compared with the lean healthy control group, the lean NAFLD group showed significantly higher fasting insulin levels [FINS: 11.8 (8.9, 15.2) IU/mL vs 7.4 (5.6, 9.2) IU/mL] and homeostatic model assessment of insulin resistance (HOMA-IR) values [2.9 (2.1, 3.7) vs. 1.6 (1.2, 2.1)]. Triglyceride levels [TG: (1.7±0.6) mmol/L vs. (1.1±0.4) mmol/L] were increased, whereas high-density lipoprotein cholesterol levels [HDL-C: (1.1±0.3) mmol/L vs. (1.4±0.3) mmol/L] were decreased (all P<0.05). Indicators related to hepatic steatosis showed that liver fat content [(11.4±4.6)%] and controlled attenuation parameter (CAP) values [(262±38) dB/m] in the lean NAFLD group were significantly higher than those in the lean healthy control group [(3.2±1.5)%, (208±31) dB/m], but lower than those in the obese NAFLD group [(18.9±6.7)%, (302±46) dB/m] (P<0.05). In the lean NAFLD group, 18 patients (51.4%) had mild steatosis and 17 patients (48.6%) had moderate-to-severe steatosis. Assessment of liver fibrosis showed that liver stiffness measurement (LSM) [(7.9±2.6) kPa], the FIB-4 index [1.4 (1.0, 1.9)], and the NAFLD fibrosis score (NFS) [(-0.3±0.1)] were all significantly higher in the lean NAFLD group than those in the lean healthy control group [(4.8±1.3) kPa, 0.9 (0.6, 1.1), (-1.3±0.6)], while the platelet count was lower than that in the control group [(212±46)×10⁹/L vs. (236±41)×10⁹/L] (all P<0.05). In the lean NAFLD group, the proportion of patients with significant fibrosis (≥F2) was 25.7% (9/35), and the proportion with advanced fibrosis (≥F3) was 11.4% (4/35). Conclusion Although patients with lean NAFLD do not exhibit overt obesity, they already demonstrate a certain degree of metabolic abnormality and may be accompanied by a substantial risk of hepatic steatosis and liver fibrosis. In clinical practice, greater attention should be paid to screening and evaluation of NAFLD in lean individuals, so as to avoid underestimating disease severity based solely on body habitus.

Key words: Lean non-alcoholic fatty liver disease, Metabolic characteristics, Hepatic steatosis, Liver fibrosis

杨盈, 夏伶俐, 李游, 曹婷. 瘦型非酒精性脂肪性肝病患者的代谢特征及肝脂肪变、纤维化程度分析[J]. 肝脏, 2026, 31(8): 1152-1155.

Yang Ying, Xia Lingli, Li You, Cao Ting. Metabolic characteristics and the severity of hepatic steatosis and fibrosis in patients with lean non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2026, 31(8): 1152-1155.

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