2023 年第 4 期 第 18 卷

代谢相关脂肪性肝病的各代谢组分与严重肝纤维化的相关性分析

Analysis of the correlation between metabolic components of metabolic associated fatty liver disease and severe liver fibrosis

作者：张金鑫李亚冬马立萍

英文作者：Zhang Jinxin Li Yadong Ma Liping

单位：首都医科大学附属北京安贞医院全科医疗科，北京100029

英文单位：Department of General Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：代谢相关脂肪性肝病；代谢组分；肝纤维化

英文关键词：

• 摘要：

• 目的 探讨代谢相关脂肪性肝病(MAFLD)的各代谢组分与严重肝纤维化的相关性。方法 选取2020年1月至2021年12月于首都医科大学附属北京安贞医院住院经超声检查诊断为脂肪肝并符合MAFLD诊断标准的426例患者。按非酒精性脂肪性肝病纤维化评分(NFS)将患者分为MAFLD合并严重肝纤维化组（NFS≥0.676分，56例)和 MAFLD未合并严重肝纤维化组(NFS＜0.676分，370例)。比较2组临床指标及合并疾病的差异，分析MAFLD患者合并严重肝纤维化的危险因素。结果 MAFLD合并严重肝纤维化组年龄、体重指数、基线收缩压、空腹血糖、糖化血红蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转肽酶、血尿酸水平及合并冠心病（冠状动脉粥样硬化性心脏病）、高血压病、2型糖尿病、高脂血症比例均大于/高于MAFLD未合并严重肝纤维化组（均P<0.05）。多因素Logistic回归分析发现，基线收缩压（比值比=1.012，95%置信区间：1.001～1.023，P=0.038）、空腹血糖（比值比=1.146，95%置信区间：1.020～1.288，P=0.022）、γ-谷氨酰转肽酶（比值比=1.007，95%置信区间：1.001～1.013，P=0.033）、合并冠心病（比值比=4.027，95%置信区间：2.087～7.770，P<0.001）及合并高脂血症（比值比=9.524，95%置信区间：3.019～30.043，P<0.001）均为MAFLD伴严重肝纤维化的独立危险因素。结论 MAFLD合并严重肝纤维化患者代谢组分异常明显，基线收缩压、空腹血糖、γ-谷氨酰转肽酶、合并冠心病或高脂血症均为MAFLD合并严重肝纤维化的独立危险因素。

• Objective To investigate the correlation between metabolic components of metabolic associated fatty liver disease(MAFLD) and severe liver fibrosis. Methods From January 2020 to December 2021, 426 patients in Beijing Anzhen Hospital, Capital Medical University who were diagnosed as fatty liver by ultrasound and met the diagnostic criteria of MAFLD were selected. According to non-alcoholic fatty liver disease fibrosis score(NFS), patients were divided into MAFLD with severe liver fibrosis group(NFS≥0.676, 56 cases) and MAFLD without severe liver fibrosis group(NFS<0.676, 370 cases). The differences of clinical indicators and concomitant diseases were compared between the two groups, and the risk factors of severe liver fibrosis in MAFLD patients were analyzed. Results Age, body mass index, baseline systolic blood pressure, fasting plasma glucose, glycosylated hemoglobin, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase, blood uric acid levels and the proportion of patients with coronary atherosclerotic heart disease, hypertension, type 2 diabetes mellitus and hyperlipidemia in MAFLD with severe liver fibrosis group were older/higher than those in MAFLD without severe liver fibrosis group(all P<0.05). Multivariate Logistic regression analysis showed that baseline systolic blood pressure(odds ratio=1.012, 95% confidence interval: 1.001-1.023, P=0.038), fasting plasma glucose(odds ratio=1.146, 95% confidence interval: 1.020-1.288, P=0.022), γ-glutamyl transpeptidase(odds ratio=1.007, 95% confidence interval: 1.001-1.013, P=0.033), complication of coronary atherosclerotic heart disease(odds ratio=4.027, 95% confidence interval: 2.087-7.770, P<0.001) and complication of hyperlipidemia(odds ratio=9.524, 95% confidence interval: 3.019-30.043, P<0.001) were all independent risk factors for MAFLD with severe liver fibrosis. Conclusions  The metabolic components of MAFLD patients with severe liver fibrosis are significantly abnormal. Baseline systolic blood pressure, fasting plasma glucose, γ-glutamyl transpeptidase, complication of coronary atherosclerotic heart disease or hyperlipidemia are independent risk factors for MAFLD with severe liver fibrosis.