中青年群体体脂指标与代谢相关脂肪性肝病的关联性研究-现代医学

中青年群体体脂指标与代谢相关脂肪性肝病的关联性研究

单位：1. 东南大学医院内科, 江苏南京 210018;
2. 东南大学医院中医科, 江苏南京 210018;
3. 东南大学医院超声科, 江苏南京 210018

分类号：R575.5

出版年·卷·期（页码）：2026·54·第三期（465-472）

摘要：

目的：探讨中青年群体脂质蓄积指数(LAP)、腹部容积指数(AVI)和中国内脏脂肪指数(CVAI)与代谢相关脂肪性肝病(MAFLD)的关联性。方法：采用横断面研究，纳入2 613例20～59岁体检者资料。通过LAP、AVI、CVAI四分位数进行分层分组，构建不同条件校正下的Logistic回归模型，分析性别、年龄、体重指数(BMI)等交互作用。采用受试者工作特征曲线(ROC)评估识别效能，利用限制性立方样条模型(RCS)分析剂量-反应关系。结果：MAFLD组(n=851)的LAP、AVI、CVAI水平均显著高于非MAFLD组(n=1 762)(均P<0.001)。多因素调整后，LAP、AVI和CVAI最高四分位数组的MAFLD患病风险分别为最低组的33.45倍(95%CI 22.11～52.13)、12.40倍(95%CI 9.01～17.32)和37.97倍(95%CI 23.92～63.54)。亚组分析显示，LAP、AVI、CVAI与 MAFLD风险关联稳健(P<0.001)，其中LAP在BMI≤23.9 kg·m^-2人群中与MAFLD高度关联，识别效能显著，其OR值为9.21(95%CI 6.52～13.02)。交互作用分析显示，性别、BMI及收缩压均可显著影响LAP与MAFLD的关联，收缩压对AVI与MAFLD的关联也存在交互作用(P<0.05)；而CVAI与MAFLD的关联则不受上述因素影响(交互作用P>0.05)，表现出良好的稳健性。ROC分析显示，LAP、AVI、CVAI的AUC分别为0.846(95%CI 0.830～0.862)、0.785(95%CI 0.767～0.804)、0.820(95%CI 0.804～0.836)，其最佳截断值分别为24.14、14.24和70.505。RCS提示，LAP>23、AVI>14、CVAI>68时MAFLD风险显著增加(P<0.05)。结论：LAP、AVI及CVAI均与中青年人群MAFLD患病风险呈正相关，其中LAP与MAFLD的关联度最高，而CVAI在不同亚组中关联稳健。

Objective: To investigate the associations of lipid accumulation product(LAP), abdominal volume index(AVI), and Chinese visceral adiposity index(CVAI) with metabolic associated fatty liver disease(MAFLD) in a young and middle-aged population. Methods: This cross-sectional study enrolled 2 613 individuals aged 20-59 years who underwent health examinations. Participants were divided into groups based on quartiles of LAP, AVI, and CVAI. Logistic regression models with progressive levels of adjustment were constructed to evaluate these associations, and potential interactions with sex, age, and body mass index(BMI) were examined. The predictive performance of each index was assessed using receiver operating characteristic(ROC) curves, and dose-response relationships were explored using restricted cubic spline(RCS) models. Results: Levels of LAP, AVI, and CVAI were significantly higher in the MAFLD group(n=851) than in the non-MAFLD group(n=1,762)(all P<0.001). After full adjustment, participants in the highest quartile of LAP, AVI, and CVAI had a 33.45 -fold(95%CI 22.11-52.13), 12.40 -fold(95% CI 9.01-17.32) and 37.97 -fold(95% CI 23.92-63.54) higher risk of MAFLD, respectively, compared with those in the lowest quartile. Subgroup analyses confirmed robust associations of LAP, AVI, and CVAI with MAFLD risk(all P<0.001). Notably, LAP showed a particularly strong association with MAFLD among individuals with BMI ≤23.9 kg·m^-2, with substantial predictive power(OR=9.21, 95% CI 6.52-13.02). Interaction analyses revealed that sex, BMI, and systolic blood pressure significantly modified the association between LAP and MAFLD, while systolic blood pressure also modified the association for AVI(P for interaction<0.05). In contrast, CVAI remained stable across subgroups, with no significant interactions with sex, BMI, or blood pressure(P for interaction>0.05). ROC analysis yielded areas under the curve(AUC) of 0.846(95% CI 0.830-0.862) for LAP, 0.785(95% CI 0.767-0.804) for AVI, and 0.820(95%CI 0.804-0.836) for CVAI, with optimal cut-off values of 24.14, 14.24, and 70.51, respectively. RCS analysis indicated that MAFLD risk increased significantly when LAP exceeded 23, AVI exceeded 14, and CVAI exceeded 68(all P<0.05). Conclusion: LAP, AVI, and CVAI are positively and significantly associated with MAFLD risk in young and middle-aged adults,whereas, LAP shows the strongest association with MAFLD, while CVAI demonstrates the most robust relationships across different subgroups.

参考文献：

[1] LOU T W, YANG R X, FAN J G.The global burden of fatty liver disease:the major impact of China[J].Hepatobiliary Surg Nutr, 2024, 13(1):119-123.
[2] QUEK J, NG C H, TANG A S P, et al.Metabolic associated fatty liver disease increases the risk of systemic complications and mortality.a meta-analysis and systematic review of 12 620 736 individuals[J].Endocr Pract, 2022, 28(7):667-672.
[3] GRIES J J, LAZARUS J V, BRENNAN P N, et al.Interdisciplinary perspectives on the co-management of metabolic dysfunction-associated steatotic liver disease and coronary artery disease[J].Lancet Gastroenterol Hepatol, 2025, 10(1):82-94.
[4] 刘靖, 卢新政, 陈鲁原, 等.中国中青年高血压管理专家共识[J].中华高血压杂志, 2020, 28(4):316-324.
[5] 赵晋荣, 张哲, 郑欢伟, 等.运动对非酒精性脂肪性肝病影响的机制及研究进展[J].现代医学, 2023, 51(8):1171-1175.
[6] SCORLETTI E, CARR R M.A new perspective on NAFLD:Focusing on lipid droplets[J].J Hepatol, 2022, 76(4):934-945.
[7] CHEN X, SHI F, XIAO J, et al.Associations between abdominal obesity indices and nonalcoholic fatty liver disease:Chinese visceral adiposity index[J].Front Endocrinol, 2022, 13:831960.
[8] GHONDAGHSAZ E, KHALAJI A, MAHALLEH M, et al.Exploring the association between cognitive decline and triglyceride-glucose index:a systematic review and meta-analysis[J].Brain Behav, 2024, 14(11):e70131.
[9] COSTO-MURIEL C, CALDERÓN-GARCÍA J F, RICO-MARTÍN S, et al.Relationship between the novel and traditional anthropometric indices and subclinical atherosclerosis evaluated by carotid intima-media thickness(c-IMT)[J].Front Nutr, 2023, 10:1170450.
[10] LI H, ZHANG Y, LUO H, et al.The lipid accumulation product is a powerful tool to diagnose metabolic dysfunction-associated fatty liver disease in the United States adults[J].Front Endocrinol, 2022, 13:977625.
[11] 中华医学会肝病学分会.代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J].中华肝脏病杂志, 2024, 32(5):418-434.
[12] ABDELHAMEED F, KITE C, LAGOJDA L, et al.Non-invasive scores and serum biomarkers for fatty liver in the era of metabolic dysfunction-associated steatotic liver disease(MASLD):a comprehensive review from NAFLD to MAFLD and MASLD[J].Curr Obes Rep, 2024, 13(3):510-531.
[13] YANG Z, LI A, JIANG Y, et al.Global burden of metabolic dysfunction-associated steatotic liver disease attributable to high fasting plasma glucose in 204 countries and territories from 1990 to 2021[J].Sci Rep, 2024, 14(1):22232.
[14] SHENG G, LU S, XIE Q, et al.The usefulness of obesity and lipid-related indices to predict the presence of non-alcoholic fatty liver disease[J].Lipids Health Dis, 2021, 20(1):134.
[15] DAI H, WANG W, CHEN R, et al.Lipid accumulation product is a powerful tool to predict non-alcoholic fatty liver disease in Chinese adults[J].Nutr Metab, 2017, 14:49.
[16] EBRAHIMI M, SEYEDI S A, ALI NABIPOORASHRAFI S, et al.Lipid accumulation product(LAP) index for the diagnosis of nonalcoholic fatty liver disease(NAFLD):a systematic review and meta-analysis[J].Lipids Health Dis, 2023, 22(1):41.
[17] SHEN S, HUANG H, WANG J, et al.Positive association between the Chinese visceral adiposity index and nonalcoholic fatty liver disease in lean adults[J].Dig Dis Sci, 2023, 68(2):656-664.
[18] XIE X, LI Q, ZHANG L, et al.Lipid accumulation product, visceral adiposity index, and Chinese visceral adiposity index as markers of cardiometabolic risk in adult growth hormone deficiency patients:a cross-sectional study[J].Endocr Pract, 2018, 24(1):33-39.
[19] WITARTO B S, WITARTO A P, VISUDDHO V, et al.Gender-specific accuracy of lipid accumulation product index for the screening of metabolic syndrome in general adults:a meta-analysis and comparative analysis with other adiposity indicators[J].Lipids Health Dis, 2024, 23:198.
[20] 邹思沫, 王超群, 丁政平.脂肪组织来源的树突状细胞调节肥胖炎症的研究进展[J].东南大学学报(医学版), 2025, 44(1):159-165.
[21] 吴宏伟, 申雪琦, 杲晓兰, 等.LAP和TyG指数对代谢相关脂肪性肝病的预测价值[J].新疆医学, 2025, 55(2):178-186.
[22] CHEN T P, LIN W Y, CHIANG C H, et al.Metabolically healthy obesity and risk of nonalcoholic fatty liver disease severity independent of visceral fat[J].J Gastroenterol Hepatol, 2021, 36(10):2903-2910.
[23] LI R, LIU J, HAN P, et al.Associations between abdominal obesity indices and pathological features of non-alcoholic fatty liver disease:Chinese visceral adiposity index[J].J Gastroenterol Hepatol, 2023, 38(8):1316-1324.
[24] LEE C, KIM J, JUNG Y.Potential therapeutic application of estrogen in gender disparity of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis[J].Cells, 2019, 8(10):1259.
[25] 李婧, 李小凤, 闫妮, 等.评估肥胖相关指标对非酒精性脂肪肝的筛查价值[J].中华全科医学, 2023, 21(2):195-198.

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