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目的探讨天津市体检人群腰围、体质指数(BMI)、内脏脂肪面积、皮下脂肪体积与非酒精性脂肪肝(NAFLD)的关联性和诊断价值。方法选取364例体检者为研究对象,根据2010年中华医学会非酒精性脂肪肝诊断标准及B超结果,分为NAFLD组182例和对照组182例。对所有研究对象均进行一般检查、腹部B超检查、人体成分分析和生化指标测定,内科医生询问饮酒史、既往病史、用药史等情况,采用4项体脂测量指标(腰围、BMI、内脏脂肪面积和皮下脂肪体积)反映肥胖者脂肪堆积情况,并比较各指标与NAFLD间的关联。结果无论男女,NAFLD组腰围、BMI、内脏脂肪面积和皮下脂肪体积平均水平均高于对照组,差异均有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析发现,男性BMI、女性腰围对NAFLD具有最高诊断效能,且男性内脏脂肪面积诊断效能高于女性,而皮下脂肪体积低于女性。ROC曲线确定各体脂测量指标诊断发生NAFLD的最佳切点值,男女性腰围分别为91.50和86.50 cm;男女性BMI分别为26.07和25.68 kg/m2;男性内脏脂肪面积为112.40 cm2,女性为95.60 cm2;男性皮下脂肪体积为193.70 cm3,女性为226.37cm3。非条件logistic回归分析发现,内脏脂肪面积更易增加NAFLD发生风险[男性OR=7.240(95%CI:3.099~16.913),女性OR=9.360(95%CI:3.563~24.487),增加1标准差]。结论 4项体脂测量指标(腰围、BMI、内脏脂肪面积和皮下脂肪体积)与NAFLD之间存在关联,其中女性腰围、男性BMI对NAFLD具有最高诊断效能,同时确定了各体质指标诊断NAFLD发生的最佳切点值,内脏脂肪面积比其他指标更易增加NAFLD的发病风险。
Objective To investigate the correlation and diagnostic value of waist circumference, body mass index (BMI), visceral fat area, subcutaneous fat volume and non-alcoholic fatty liver disease (NAFLD) in physical examination population in Tianjin. Methods 364 subjects were selected as subjects. According to the diagnostic criteria of non-alcoholic fatty liver and the results of B-ultrasound in 2010 by Chinese Medical Association, 182 cases were divided into NAFLD group and 182 cases of control group. General examination of all subjects, abdominal B-ultrasound, body composition analysis and biochemical determination, physician asked drinking history, past medical history, medication history, using four body fat measurements (waist circumference, BMI, visceral fat Area and subcutaneous fat volume) reflect the fat accumulation in obese people, and compare the correlation between each index and NAFLD. Results The average waist circumference, BMI, visceral fat area and subcutaneous fat volume in NAFLD group were significantly higher than those in control group (P <0.05). The receiver operating characteristic (ROC) curve analysis found that male BMI and female waist circumference had the highest diagnostic efficacy for NAFLD, and the diagnostic efficiency of visceral fat area of male was higher than that of female, while the volume of subcutaneous fat was lower than that of female. ROC curves were used to determine the optimal cut-off point for the diagnosis of NAFLD. The waist circumference of men and women were 91.50 and 86.50 cm respectively; the male and female BMI were 26.07 and 25.68 kg / m2; the male visceral fat area was 112.40 cm2; the female was 95.60 cm2; the male subcutaneous fat volume was 193.70 cm3 and the female was 226.37 cm3. Non-conditional logistic regression analysis showed that visceral fat area was more likely to increase the risk of NAFLD [male OR = 7.240 (95% CI: 3.099-16.913), female OR = 9.360 (95% CI 3.563-24.487) with 1 standard deviation]. Conclusions There is a correlation between four body fat measurements (waist circumference, BMI, visceral fat area and subcutaneous fat volume) and NAFLD. Female waist circumference and male BMI have the highest diagnostic efficacy for NAFLD. At the same time, the determination of body mass index for the diagnosis of NAFLD The best cut-point value, visceral fat area more likely than other indicators to increase the risk of NAFLD.