临床肝胆病杂志2026，Vol.42Issue(5)：1056-1066,11.DOI:10.12449/JCH260510
代谢指标联合人体测量指标对代谢相关脂肪性肝病及其中高危程度的预测价值及列线图模型构建
Value of metabolic markers combined with anthropometric indicators in predicting and risk stratification of metabolic dysfunction-associated fatty liver disease and establishment of a nomogram model
摘要
Abstract
Objective To develop a novel clinical predictive model for metabolic dysfunction-associated fatty liver disease(MAFLD)based on metabolic markers and anthropometric indicators,and to provide a more effective tool for the early screening and intervention of MAFLD.Methods A retrospective analysis was performed for 2 824 individuals who underwent abdominal color Doppler ultrasound at Health Examination Center of The First Hospital of Lanzhou University from January 1,2024 to January 1,2025,and at a ratio of 7∶3,they were randomly divided into training set with 1 976 patients and validation set with 848 patients.Clinical data,serological markers,and abdominal ultrasound results were collected from all patients,and triglyceride-glucose(TyG)index,triglyceride-to-high-density lipoprotein cholesterol(TG/HDL-C)ratio,and anthropometric indicators were calculated.The independent samples t-test was used for comparison of normally distributed or approximately normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.The multivariate logistic regression analysis was used to identify independent predictive factors for MAFLD and intermediate-to high-risk MAFLD.Five risk prediction models were established for MAFLD based on the independent influencing factors,and a nomogram was plotted.The receiver operating characteristic(ROC)curve was plotted to assess model performance,and the area under the ROC curve(AUC)was calculated.The calibration curve was used to evaluate the predictive accuracy of the models,and decision curve analysis was used to assess the clinical practicability of the models.These models were then compared with traditional models.Results Among the 1 976 individuals in the training set,937(47.42%)were diagnosed with MAFLD,and 423(21.41%)were diagnosed with intermediate-to high-risk MAFLD;among the 848 individuals in the validation set,406(47.88%)were diagnosed with MAFLD.The multivariate logistic regression analysis showed that male sex(odds ratio[OR]=0.23,95%confidence interval[CI]:0.13-0.39,P<0.05),waist circumference(OR=1.11,95%CI:1.06-1.17,P<0.05),alanine aminotransferase(ALT)>40 U/L(OR=2.24,95%CI:1.44-3.51,P<0.05),high-density lipoprotein cholesterol(HDL-C)(OR=0.07,95%CI:0.04-0.15,P<0.05),TyG index(OR=8.27,95%CI:5.09-13.44,P<0.05),TG/HDL-C ratio(OR=0.84,95%CI:0.71-0.99,P<0.05),A Body Shape Index(ABSI)(OR=0.45,95%CI:0.39-0.52,P<0.05),and body roundness index(BRI)(OR=2.31,95%CI:1.50-3.55,P<0.05)were independent influencing factors for MAFLD,and male sex(OR=0.17,95%CI:0.10-0.31,P<0.05),age(OR=1.09,95%CI:1.07-1.11,P<0.05),hemoglobin(OR=0.98,95%CI:0.97-0.98,P<0.05),platelet count(OR=0.81,95%CI:0.70-0.93,P<0.05),fasting blood glucose(OR=0.80,95%CI:0.71-0.89,P<0.05),triglycerides(OR=0.14,95%CI:0.07-0.29,P<0.05),TG/HDL-C ratio(OR=0.78,95%CI:0.67-0.91,P<0.05),TyG index(OR=5.26,95%CI:3.32-8.33),waist circumference(OR=2.50,95%CI:1.72-3.61,P<0.05),ABSI(OR=0.58,95%CI:0.51-0.66,P<0.05),and BRI(OR=0.01,95%CI:0.00-0.21,P<0.05)were independent influencing factors for intermediate-to high-risk MAFLD.Among the five models established,model 5(incorporating sex,ALT elevation,HDL-C,TyG index,TG/HDL-C ratio,waist circumference,and ABSI)had the best performance,with an AUC of 0.917(95%CI:0.905-0.929)in the training set and 0.911(95%CI:0.892-0.930)in the validation set.The calibration curve showed that model 5 had good predictive accuracy,and the decision curve analysis confirmed its clinical practicability.Conclusion The predictive model for MAFLD constructed based on metabolic markers and anthropometric indicators has good discriminatory ability and can be used to assess the risk of MAFLD.In addition,this study shows that waist circumference,TyG index,TG/HDL-C ratio,ABSI,and BRI are independently associated with intermediate-to high-risk MAFLD,but further studies are needed to confirm their value in predicting liver fibrosis progression.关键词
代谢相关脂肪性肝病/危险因素/Logistic模型Key words
Metabolic Dysfunction-Associated Fatty Liver Disease/Risk Factors/Logistic Models引用本文复制引用
赵思瑞,李哲宇,何文强,李俊峰,张立婷..代谢指标联合人体测量指标对代谢相关脂肪性肝病及其中高危程度的预测价值及列线图模型构建[J].临床肝胆病杂志,2026,42(5):1056-1066,11.基金项目
国家自然科学基金(82360132) （82360132）
甘肃省重点研发计划(22YF7FA085) （22YF7FA085）
甘肃省联合科研基金(23JRRA1489) （23JRRA1489）
甘肃省中医药课题重点项目(GZKZ-2022-7) （GZKZ-2022-7）
甘肃省重点人才项目(甘组通字[2024]4号) （甘组通字[2024]4号）
兰州大学第一医院院内基金(ldyyyn2020-02,ldyyyn2020-14) （ldyyyn2020-02,ldyyyn2020-14）
北京肝胆相照公益基金会人工肝专项基金(iGandanF-1082024-RGG130) National Natural Science Foundation of China(82360132) （iGandanF-1082024-RGG130）
Gansu Provincial Key R&D Program(22YF7FA085) （22YF7FA085）
Gansu Provincial Joint Research Fund(23JRRA1489) （23JRRA1489）
Gansu Provincial Key Project on Traditional Chinese Medicine(GZKZ-2022-7) （GZKZ-2022-7）
Gansu Provincial Key Talent Program(Gan Zu Tong Zi[2024]No.4) （Gan Zu Tong Zi[2024]No.4）
Lanzhou University The First Hospital Internal Fund(ldyyyn2020-02,ldyyyn2020-14) （ldyyyn2020-02,ldyyyn2020-14）
Beijing iGandan Foundation Artificial Liver Special Fund(iGandanF-1082024-RGG130) （iGandanF-1082024-RGG130）
