目的 探究臂围(AC)、臂围身高比(AHtR)、臂腿比(ATR)及臂肌肉占比(AMR)与非超重/肥胖人群非酒精性脂肪肝病(NAFLD)的相关性及其诊断效能。方法 纳入2018-01至2024-09在中国中医科学院西苑医院健康体检的非超重/肥胖的成年人,以是否患有NAFLD作为分组依据,比较两组基线水平;运用EmpowerRCH 4.1分析AC、AHtR、ATR、AMR与非超重/肥胖人群NAFLD的患病率及肝脂肪变性指数(HSI)水平的相关性;为判断研究结果的稳健性,依据性别、年龄、是否吸烟、是否患有高血压及糖尿病进行了亚组分析;运用受试者工作特征(ROC)曲线评估并比较AC、AHtR、ATR、AMR对于非超重/肥胖人群NAFLD的诊断效能。结果 本研究共纳入非超重/肥胖体检数据1472例,logistic回归校正年龄、性别、糖尿病史、高血压病史等混杂因素后,非超重/肥胖个体的AC、ATR、AHtR分别每上升1个单位,诊断为NAFLD的可能性分别增加91%、24%、72%,HSI分别升高1.08个单位、0.33个单位、1.47个单位;AMR每上升1单位,诊断为NAFLD的可能性降低49%,HSI降低0.56个单位。ROC曲线显示,AMR、AHtR、AC、ATR曲线下面积(AUC)分别为0.793、0.688、0.656及0.636,两两比较差异有统计学意义(P＜0.05)。结论 在非超重肥胖人群中,AC、ATR、AHtR与NAFLD的患病率和HSI的水平呈显著的非线性正相关,AMR与NAFLD的患病率和HSI的水平呈显著的非线性负相关。AC、AHtR、ATR、AMR均可用于非超重/肥胖人群NAFLD早期判断,其中AMR具有最优的诊断效能。
Abstract
Objective To explore the correlation between arm circumference (AC), arm -to-height ratio (AHtR), arm-to-thigh ratio(ATR), and arm--muscle ratio (AMR) and non-overweight/obese individuals with non-alcoholic fatty liver disease (NAFLD), as well as their predictive value. Methods A total of 1,472 non-overweight/obese adults who underwent health check-ups at Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 2018 to September 2024 were included. Baseline levels were compared based on whether they had NAFLD. EmpowerRCH 4.1, was used to analyze the relationships between AC, AHtR, ATR, AMR and the prevalence and the hepatic steatosis index (HSI) of NAFLD in non-overweight/obese individuals. To assess the robustness of the research results, subgroup analyses were conducted based on gender, age, smoking status, and presence of hypertension and diabetes. Receiver-operating-characteristic (ROC) curve was used to evaluate the diagnostic efficacy of AC, AHtR, ATR, and AMR for NAFLD in non-overweight/obese individuals. Results A total of 1472 eligible check-up records were included in this study. After adjustment for age, sex, diabetes and hypertension, each 1-unit increase in AC, ATR and AHtR was associated with 91%, 24% and 72% higher odds of NAFLD, respectively, and with increments of 1.08, 0.33 and 1.47 units in HSI. Conversely, every 1-unit increase in AMR reduced the odds of NAFLD by 49% and lowered HSI by 0.56 units. The areas under the ROC curve (AUC) for AC, AHtR, ATR, and AMR were 0.793, 0.688, 0.656 and 0.636, respectively, and there were statistically significant differences between them (P<0.05). Conclusions In non-overweight/obese individuals, AC, ATR, AHtR and AMR exhibit significant nonlinear positive associations, whereas AMR shows a significant non-linear inverse association with both NAFLD prevalence and HSI level, while AMR shows significant nonlinear negative correlations with the prevalence and HSI levels of NAFLD. AC, AHtR, ATR and AMR can all serve as early diagnosis of NAFLD in non-overweight/obese individuals, and AMR has better diagnostic efficacy.
关键词
非酒精性脂肪肝 /
肝脂肪变性指数 /
臂围 /
相关性研究 /
诊断效能
Key words
nonalcoholic fatty liver disease /
hepatic steatosis index /
arm circumference /
association study /
diagnostic efficiency
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基金
北京薪火传承3+3项目(2023-SZ-A51);国家重点研发计划子课题(2018YFC2000600);中国中医科学院科技创新工程(CI2021A03005)
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