甘油三酯葡萄糖乘积指数联合...酒精性脂肪性肝病的预测价值_蒋绒.pdf

脂肪性肝病DOI:10 3969/j issn1001 5256 2023 03 010甘油三酯葡萄糖乘积指数联合肥胖指标对阻塞性睡眠呼吸暂停患者发生非酒精性脂肪性肝病的预测价值蒋绒，李永霞昆明医科大学第二附属医院 呼吸与危重症医学科，昆明 650101通信作者:李永霞，yongxiali999163 com(OCID:0000 0002 8166 2211)摘要:目的探讨甘油三酯葡萄糖乘积指数(TyG)、TyG 联合 BMI 及 TyG 联合腰围(WC)预测阻塞性睡眠呼吸暂停(OSA)患者发生非酒精性脂肪性肝病(NAFLD)的价值。方法回顾性分析 2020 年 1 月2021 年 12 月在昆明医科大学第二附属医院行睡眠呼吸监测并诊断为 OSA 的患者 190 例，依据超声检查结果分为 OSA 合并 NAFLD 组 107 例及对照组 83 例。计量资料两组间比较采用 t 检验或 Mann Whitney U 检验;计数资料两组间比较采用 2检验。采用二元 Logistic 回归分析探讨 OSA 患者发生 NAFLD 的影响因素。绘制 TyG、TyG 联合 BMI 及 TyG 联合 WC 预测 OSA 患者发生 NAFLD 的受试者工作特征曲线(OC 曲线)，计算曲线下面积(AUC)。AUC 的比较采用 Z 检验。结果与对照组相比，OSA 合并 NAFLD 患者的 BMI、颈围、WC、AHI、ODI、ALT、GGT、TG、FPG、TyG 较高，年龄、Average SpO2、LSaO2、HDL C 较低(P 值均 0.05)。二元 Logistic 分析显示 TyG(O=1 961，95%CI:1 03 3 73，P=0 040)、BMI(O=1 203，95%CI:1 03 1 41，P=0 020)、WC(O=1 074，95%CI:1 01 1 14，P=0 026)为 OSA 患者发生NAFLD 的独立危险因素。TyG、TyG 联合BMI 及TyG 联合WC 预测OSA 患者发生NAFLD 的AUC(95%CI)分别为0696(0625 0760)、0787(0.722 0843)和0803(0739 0857)，最佳截断点分别为 8 72、0 36 和0 60。TyG 联合 BMI对 OSA 患者发生 NAFLD 的预测价值高于 TyG(Z=2 542，P=0 011)，TyG 联合 WC 的预测价值也高于 TyG(Z=2.976，P=0.002 9)。结论TyG、TyG 联合 BMI 及 TyG 联合 WC 对 OSA 发生 NAFLD 具有良好的预测价值，以 TyG 联合 WC 的预测价值最佳，有望成为 OSA 患者发生 NAFLD 风险的预测指标。关键词:睡眠呼吸暂停，阻塞性;非酒精性脂肪性肝病;甘油三酯葡萄糖乘积指数;人体质量指数;腰围基金项目:昆明医科大学研究生创新基金(2022S073)Value of triglyceride glucose index combined with obesity index in predicting nonalcoholic fatty liver diseasein individuals with obstructive sleep apneaJIANG ong，LI Yongxia(Department of espiratory and Critical Care Medicine，The Second Affiliated Hospital of KunmingMedical University，Kunming 650101，China)Corresponding author:LI Yongxia，yongxiali999163 com(OCID:0000 0002 8166 2211)Abstract:ObjectiveTo investigate the value of triglyceride glucose index(TyG)，TyG combined with body mass index(BMI)，and TyG combined with waist circumference(WC)in predicting nonalcoholic fatty liver disease(NAFLD)in pa-tients with obstructive sleep apnea(OSA)MethodsA retrospective analysis was performed for 190 patients who underwentsleep respiratory monitoring and were diagnosed with OSA in The Second Affiliated Hospital of Kunming Medical Universityfrom January 2020 to December 2021，and according to the results of ultrasonography，they were divided into OSA+NAFLDgroup with 107 patients and control group with 83 patients The t test or the Mann Whitney U test was used for comparison ofcontinuous data between two groups，and the chi square test was used for comparison of categorical data between two groups645临床肝胆病杂志第39 卷第3 期2023 年3 月J Clin Hepatol，Vol39 No3，Mar2023The binary logistic regression analysis was used to explore the influencing factors for the development of NAFLD in patients withOSA The receiver operating characteristic(OC)curve was plotted for TyG，TyG combined with BMI，and TyG combinedwith WC in predicting NAFLD in the patients with OSA，and the area under the OC curve(AUC)was calculated The Z testwas used for comparison of AUC esultsCompared with the control group，the OSA+NAFLD group had significantly higherBMI，neck circumference，WC，apnea hypopnea index，oxygen desaturation index，alanine aminotransferase，gamma glu-tamyltransferase，triglyceride，fasting plasma glucose，and TyG and significantly lower age，average SpO2，LSaO2，and high density lipoprotein cholesterol(all P 0.05)The binary logistic regression analysis showed that TyG(odds ratio O=1961，95%confidence interval CI:1 03 3 73，P=0 04)，BMI(O=1 203，95%CI:1 03 1 41，P=0 020)，andWC(O=1 074，95%CI:1 01 1 14，P=0 026)were independent risk factors for NAFLD in patients with OSA TyG，TyG combined with BMI，and TyG combined with WC had an AUC of 0 696(95%CI:0 625 0 760)，0.787(95%CI:0722 0 843)，and 0 803(95%CI:0 739 0 857)，respectively，in predicting NAFLD in OSA patients，with an optimalcut off value of 8 72，0 36，and 0 60，respectively TyG combined with BMI had a significantly higher value than TyG inpredicting NAFLD in OSA patients(Z=2 542，P=0 011)，and TyG combined with WC also had a significantly higher pre-dictive value than TyG(Z=2 976，P=0 002 9)ConclusionTyG，TyG combined with BMI，and TyG combined with WChave a good value in predicting NAFLD in OSA patients，among which TyG combined with WC has the best predictive valueand is thus expected to become a predictor for the risk of NAFLD in OSA patientsKey words:Sleep Apnea，Obstructive;Non alcoholic Fatty Liver Disease;Triglyceride Glucose Index;Body Mass Index;Waist Circumferenceesearch funding:Graduate Student Innovation Fund of Kunming Medical University(2022S073)阻塞性睡眠呼吸暂停(obstructive sleep apnea，OSA)是指患者在睡眠中反复发作的上呼吸道阻塞，全球 30 69 岁的成年人患有 OSA 的近 10 亿1。非酒精性脂肪性肝病(NAFLD)是肝细胞中脂肪的异常堆积，在中国的患病率在 25%以上，成为了中国慢性肝病和肝功能检查异常的主要原因，带来了严重的公共卫生负担2。研究3 发现 OSA 和 NAFLD 密切相关且 OSA 患者中 NAFLD 的患病率较高，其中可能的机制之一为 OSA 所致的慢性间歇性低氧(chronic inter-mittent hypoxia，CIH)所引起的胰岛素抵抗(I)，容易加重 NAFLD 的发生发展。甘油三酯葡萄糖乘积指数(TyG)由空腹血糖(FPG)和甘油三酯(TG)计算得出，是识别 I 的有效指标4，有研究5 表明，TyG 联合肥胖指标 即人体质量指数(BMI)或腰围(WC)比单独的 TyG 指数有更高的敏感度和特异度。但目前探讨TyG 联合肥胖指标对 OSA 患者发生 NAFLD 的预测价值的研究较少，因此，本文旨在探索 TyG、TyG 联合BMI、TyG 联合 WC 对成人 OSA 患者发生 NAFLD 的预测价值。1资料与方法11研究对象收集 2020 年 1 月2021 年 12 月在昆明医科大学第二附属医院行睡眠呼吸监测并