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布朗族非酒精性脂肪性肝病筛查模型的构建

梁烨倍 杨春光 曾华东 陶茹娓 胡秋明 唐小英 史华祥 吴伟 侯旭宏 贾伟平

引用本文:
Citation:

布朗族非酒精性脂肪性肝病筛查模型的构建

DOI: 10.3969/j.issn.1001-5256.2021.12.025
基金项目: 

上海市糖尿病重点实验室开放课题资助 (SHKLD-KF-1602)

上海市自然科学基金项目 (18ZR1429000)

详细信息
    通信作者:

    贾伟平, wpjia@jtu.edu.cn

  • 中图分类号: R575.5

Establishment of screening models for nonalcoholic fatty liver disease in the adult Blang population

Research funding: 

Open Research Project of Shanghai Key Laboratory of Diabetes Mellitus (SHKLD-KF-1602);

Natural Science Foundation of Shanghai (18ZR1429000)

  • 摘要:   目的  构建布朗族成人非酒精性脂肪性肝病(NAFLD)简易筛查模型。  方法  基于2017年布朗族18岁及以上居民的代谢性疾病的调查数据, 将2993例调查对象按性别和年龄组分层(5岁1组)后, 随机分为建模组(n=1497)和验模组(n=1496)。收集患者一般人口学、吸烟、饮酒、疾病家族史及个人疾病史, 身高、体质量、腰围和血压等, 测定空腹血浆血糖(FPG)、餐后或糖负荷后2 h血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、ALT、AST和GGT等。计数资料2组间比较采用χ2检验。应用logistic回归分析建立筛查模型, 并构建受试者工作特征曲线(ROC曲线), 采用ROC曲线下面积(AUC)、灵敏度、特异度、阳性似然比、阴性似然比、阳性预测值和阴性预测值评估构建的筛查模型与已有模型在研究人群中的筛查效能, AUC比较采用DeLong法。  结果  基于布朗族成人的体格测量指标及实验室检测指标构建3个NAFLD模型, 分别为简易无创模型1(包括年龄、BMI和腰围); 增加血压指标的无创模型2和联合血液检测指标(糖尿病和ALT/AST)的模型3。3个模型对判别NAFLD的AUC(95%CI)在建模组分别为0.881(0.864~0.897)、0.892(0.875~0.907) 和0.894(0.877~0.909), 模型1与模型2、3比较差异均有统计学意义(P值分别为0.004 0、<0.001); 在验模组分别为0.891(0.874~0.906)、0.892(0.875~0.907)和0.893(0.876~0.908), 3个模型AUC之间无统计学差异(P值均>0.05)。综合考虑模型筛查效能、检查方法有无创伤性和检查费用, 简易无创模型1被认为是该人群的最佳NAFLD筛查模型。当模型1得分为5分时, 该切点的约登指数最大, 选择得分≥5作为NAFLD的判别标准时, 其灵敏度、特异度、阳性预测值和阴性预测值在建模组和验模组中分别为86.5%和85.6%、79.7%和80.6%、50.3%和51.7%、96.1%和95.8%。  结论  基于年龄和肥胖指标构建的布朗族成人NAFLD筛查模型有较高的灵敏度、特异度和阴性预测值, 对该人群NAFLD及其密切相关的其他代谢性疾病的人群干预具有重要的实际意义。

     

  • 表  1  建模组和验模组一般特征描述

    变量 建模组(n=1497) 验模组(n=1496) χ2 P
    NAFLD[例(%)] 0.038 0.846
      无 1209(80.8) 1204(80.5)
      有 288(19.2) 292(19.5)
    性别[例(%)] 0.001 0.981
      男 551(36.8) 550(36.8)
      女 946(63.2) 946(63.2)
    年龄分组[例(%)] 0.000 1 0.991
      18~29岁 312(20.8) 311(20.8)
      30~39岁 344(23.0) 345(23.1)
      40~49岁 369(24.7) 368(24.6)
      50~59岁 277(18.5) 277(18.5)
      ≥60岁 195(13.0) 195(13.0)
    文化程度[例(%)] 4.765 0.029
      文盲 991(66.2) 1046(69.9)
      小学及以上 506(33.8) 450(30.1)
    目前吸烟[例(%)] 359(24.0) 322(21.5) 2.570 0.109
    目前饮酒[例(%)] 447(29.9) 443(29.6) 0.022 0.882
    BMI[例(%)] 0.106 0.745
      <24 kg/m2 974(65.1) 992(66.3)
      24~<28 kg/m2 395(26.4) 369(24.7)
      ≥28 kg/m2 128(8.6) 135(9.0)
    腰围[例(%)] 0.642 0.423
      男: <85 cm/女: <80 cm 1191(79.6) 1183(79.1)
      男: 85 cm~<90 cm/ 164(11.0) 150(10.0)
      女: 80 cm~<85 cm
      男: ≥90 cm/女: ≥85 cm 142(9.5) 163(10.9)
    血压[例(%)] 5.540 0.019
      正常 692(46.2) 710(47.5)
      正常高值血压 491(32.8) 551(36.8)
      高血压 314(21.0) 235(15.7)
    糖尿病[例(%)] 0.227 0.634
      无 1379(92.1) 1385(92.6)
      有 118(7.9) 111(7.4)
    ALT/AST[例(%)]1) 0.539 0.463
      <0.96 1067(71.3) 1048(70.1)
      ≥0.96 430(28.7) 448(29.9)
    高甘油三酯血症[例(%)] 5.417 0.020
    1103(73.7) 1157(77.3)
    394(26.3) 339(22.7)
    注:1)ALT/AST比值分组,根据建模组中筛查NAFLD的AUC的最佳切点(约登指数最大)分为<0.96组和≥0.96组。
    下载: 导出CSV

    表  2  建模组NAFLD和非NAFLD一般特征描述

    变量 非NAFLD组(n=1209) NAFLD组(n=288) χ2 P OR(95%CI)
    性别[例(%)] 1.184 0.277
      男 453(37.5) 98(34.0) 1.00(参照)
      女 756(62.5) 190(66.0) 1.18(0.90~1.55)
    年龄分组[例数(%)] 18.338 <0.001
      18~29岁 284(23.5) 28(9.7) 1.00(参照)
      30~39岁 284(23.5) 60(20.8) 2.15(1.33~3.47)
      40~49岁 269(22.2) 100(34.7) 3.77(2.40~5.92)
      50~59岁 221(18.3) 56(19.4) 2.55(1.57~4.16)
      ≥60岁 151(12.5) 44(15.3) 2.98(1.78~4.99)
    文化程度[例(%)] 0.416 0.519
      文盲 805(66.6) 186(64.6) 1.00(参照)
      小学及以上 404(33.4) 102(35.4) 1.56(1.15~2.13)
    目前吸烟[例(%)] 308(25.5) 51(17.7) 7.697 0.006 0.56(0.39~0.82)
    目前饮酒[例(%)] 355(29.4) 92(31.9) 0.740 0.390 1.98(1.35~2.90)
    BMI[例(%)] 466.650 <0.001
      <24 kg/m2 933(77.2) 41(14.2) 1.00(参照)
      24 kg/m2~<28 kg/m2 239(19.8) 156(54.2) 15.69(10.73~22.93)
      ≥28 kg/m2 37(3.1) 91(31.6) 63.54(38.20~105.68)
    腰围[例(%)] 429.460 <0.001
      男: <85 cm/女: <80 cm 1088(90.0) 103(35.8) 1.00(参照)
      男: 85 cm~<90 cm/ 80(6.6) 84(29.2) 10.91(7.54~15.77)
      女: 80 cm~<85 cm
      男: ≥90 cm/女: ≥85 cm 41(3.4) 101(35.1) 25.20(16.60~38.24)
    血压[例(%)] 85.038 <0.001
      正常 621(51.4) 71(24.7) 1.00(参照)
      正常高值血压 382(31.6) 109(37.8) 2.64(1.88~3.69)
      高血压 206(17.0) 108(37.5) 5.24(3.55~7.73)
    糖尿病[例(%)] 47.417 <0.001
      无 1142(94.5) 237(82.3) 1.00(参照)
      有 67(5.5) 51(17.7) 3.20(2.13~4.81)
    ALT/AST[例(%)] 86.754 <0.001
      <0.96 926(76.6) 141(49.0) 1.00(参照)
      ≥0.96 283(23.4) 147(51.0) 4.23(3.18~5.63)
    高甘油三酯血症[例(%)] 106.170 <0.001
      无 960(79.4) 143(49.7) 1.00(参照)
      有 249(20.6) 145(50.3) 3.79(2.88~4.99)
    注:年龄OR值仅调整性别,性别OR值仅调整年龄,其余变量OR值均调整年龄和性别。
    下载: 导出CSV

    表  3  模型1逻辑回归系数及得分

    变量 OR(95%CI) β 得分
    年龄分组
      18~29岁 1.00(参照) - 0
      30~39岁 1.74(0.97~3.11) 0.553 1
      40~49岁 2.97(1.71~5.16) 1.088 2
      50~59岁 1.99(1.08~3.64) 0.686 2
      ≥60岁 4.11(2.16~7.83) 1.413 3
    BMI
      <24 kg/m2 1.00(参照) - 0
      24 kg/m2~<28 kg/m2 8.80(5.80~13.34) 2.174 4
      ≥28 kg/m2 17.89(9.76~32.81) 2.884 5
    腰围
      男: <85 cm/女: <80 cm 1.00(参照) - 0
      男: 85 cm~<90 cm/ 3.29(2.15~5.01) 1.190 2
      女: 80 cm~<85 cm
      男: ≥90 cm/女: ≥85 cm 5.84(3.50~9.75) 1.765 3
    注:模型1公式=年龄(岁)+BMI(kg/m2)+腰围(cm)。
    下载: 导出CSV

    表  4  模型2逻辑回归系数及得分

    变量 OR(95%CI) β 得分
    年龄分组
      18~29岁 1.00(参照) - 0
      30~39岁 1.60(0.89~2.89) 0.471 1
      40~49岁 2.53(1.43~4.45) 0.927 3
      50~59岁 1.42(0.75~2.69) 0.351 1
      ≥60岁 2.84(1.44~5.60) 1.045 3
    BMI
      <24 kg/m2 1.00(参照) - 0
      24kg/m2~<28 kg/m2 8.57(5.62~13.06) 2.148 6
      ≥28 kg/m2 16.77(9.07~30.99) 2.820 8
    腰围
      男: <85 cm/女: <80 cm 1.00(参照) - 0
      男: 85 cm~<90 cm/ 3.03(1.97~4.65) 1.109 3
      女: 80 cm~<85 cm
      男: ≥90 cm/女: ≥85 cm 5.33(3.16~8.98) 1.673 5
    血压
      正常 1.00(参照) - 0
      正常高值血压 1.72(1.15~2.57) 0.543 2
      高血压 2.57(1.63~4.03) 0.942 3
    注:模型2公式=年龄+BMI(kg/m2)+腰围(cm)+血压。
    下载: 导出CSV

    表  5  模型3逻辑回归系数及得分

    变量 OR(95%CI) β 得分
    年龄分组
      18~29岁 1.00(参照) - 0
      30~39岁 1.62(0.89~2.96) 0.484 1
      40~49岁 2.51(1.41~4.46) 0.918 2
      50~59岁 1.45(0.75~2.80) 0.374 1
      ≥60岁 2.89(1.44~5.83) 1.063 3
    BMI
      <24 kg/m2 1.00(参照) - 0
      24 kg/m2~<28 kg/m2 7.93(5.18~12.15) 2.071 6
      ≥28 kg/m2 16.32(8.78~30.32) 2.792 7
    腰围
      男: <85 cm/女: <80 cm 1.00(参照) - 0
      男: 85 cm~<90 cm/ 2.74(1.77~4.25) 1.008 3
      女: 80 cm~<85 cm
      男: ≥90 cm/女: ≥85 cm 4.69(2.76~7.98) 1.545 4
    血压
      正常 1.00(参照) - 0
      正常高值血压 1.69(1.13~2.54) 0.527 1
      高血压 2.26(1.43~3.60) 0.818 2
    糖尿病
      无 1.00(参照) - 0
      有 2.08(1.21~3.57) 0.732 2
    ALT/AST
      <0.96 1.00(参照) - 0
      ≥0.96 1.67(1.17~2.39) 0.512 1
    注:模型3公式=年龄(岁)+BMI(kg/m2)+腰围(cm)+血压+糖尿病+ALT/AST。
    下载: 导出CSV

    表  6  建模组NAFLD筛查模型效能比较

    模型 AUC(95%CI) 切点 灵敏度(%) 特异度(%) 阳性似然比 阴性似然比 阳性预测值(%) 阴性预测值(%) 约登指数
    1 0.881(0.864~0.897) ≥5 86.5 79.7 4.3 0.2 50.3 96.1 0.661 1
    2 0.892(0.875~0.907) ≥8 84.4 81.8 4.6 0.2 52.5 95.6 0.661 7
    3 0.894(0.877~0.909) ≥7 88.9 77.3 3.9 0.1 48.3 96.7 0.662 3
    下载: 导出CSV

    表  7  验模组不同NAFLD筛查模型效能比较

    模型 危险因素 AUC(95%CI) 切点 灵敏度(%) 特异度(%) 阳性似然比 阴性似然比 阳性预测值(%) 阴性预测值(%) 约登指数
    模型1 年龄、BMI、腰围 0.891(0.874~0.906) ≥5 85.6 80.6 4.4 0.2 51.7 95.8 0.661 8
    模型2 年龄、BMI、腰围、血压 0.892(0.875~0.907) ≥7 87.0 78.7 4.1 0.2 49.8 96.1 0.657 3
    模型3 年龄、BMI、腰围、血压、糖尿病、ALT/AST比值 0.893(0.876~0.908) ≥8 84.6 81.9 4.7 0.2 53.1 95.6 0.664 8
    ZJU模型[15] BMI、TG、ALT/AST比值、FPG 0.894(0.877~0.909) >35.63 86.0 80.0 4.3 0.2 51.0 95.9 0.659 4
    HSI模型[12] BMI、ALT/AST比值、性别、糖尿病 0.871(0.853~0.887) >32.98 82.2 79.2 3.9 0.2 48.9 94.8 0.613 4
    TyG模型[24] TG、FPG 0.694(0.670~0.717) >8.88 66.8 64.6 1.9 0.5 31.4 88.9 0.314 0
    LAP模型[25] TG、腰围 0.850(0.831~0.867) >20.85 88.0 68.4 2.8 0.2 40.3 95.9 0.563 7
    FSI模型[13] 年龄、性别、BMI、TG、高血压、糖尿病、ALT/AST比值 0.846(0.826~0.863) >-2.3 86.3 68.3 2.7 0.2 39.7 95.4 0.545 7
    FLI模型[11] BMI、TG、腰围、GGT 0.846(0.827~0.864) >1.72 81.5 74.3 3.2 0.3 43.4 94.3 0.557 6
    下载: 导出CSV
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  • 收稿日期:  2021-04-10
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