ZJU指数对新疆维吾尔自治区农村地区维吾尔族人群非酒精性脂肪性肝病发生风险的预测价值

程萧; 王甲嘉; 杨婧; 白蓉; 张示杰; 张宏伟; 吴向未; 马儒林; 张向辉; 郭恒; 郭淑霞; 彭心宇

doi:10.3969/j.issn.1001-5256.2023.11.012

ZJU指数对新疆维吾尔自治区农村地区维吾尔族人群非酒精性脂肪性肝病发生风险的预测价值

DOI: 10.3969/j.issn.1001-5256.2023.11.012

程萧^{1, 2},
王甲嘉^{1, 2},
杨婧^{2, 3},
白蓉^{1, 2},
张示杰^{2, 3},
张宏伟^{2, 3},
吴向未^{2, 3},
马儒林¹,
张向辉¹,
郭恒¹,
郭淑霞¹,
彭心宇^{2, 3, , ,}

1.
石河子大学医学院，新疆石河子 832000
2.
国家卫生健康委中亚高发病防治重点实验室，新疆石河子 832000
3.
石河子大学医学院第一附属医院肝胆外科，新疆石河子 832000

基金项目:

新疆生产建设兵团科技重点项目 (2018AB022)

伦理学声明：本研究方案于2010年2月3日经由石河子大学医学院第一附属医院伦理委员会审批，批号：SHZ2010LL01，患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：郭淑霞、彭心宇负责课题设计；程萧负责资料分析，撰写论文；杨婧、白蓉、张示杰、张宏伟、吴向未、马儒林、张向辉、郭恒、王甲嘉参与收集数据，整理数据；彭心宇负责指导撰写文章并最后定稿。

详细信息

通信作者:
彭心宇， pengxinyu2000@sina.com （ORCID： 0000-0003-3249-5178）

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出版历程
- 收稿日期: 2023-02-07
- 录用日期: 2023-03-20
- 出版日期: 2023-11-28

ZJU index and the risk of nonalcoholic fatty liver disease in the Uygur population in the rural area of Xinjiang Uygur Autonomous Region： A cohort study

Xiao CHENG^{1, 2},
Jiajia WANG^{1, 2},
Jing YANG^{2, 3},
Rong BAI^{1, 2},
Shijie ZHANG^{2, 3},
Hongwei ZHANG^{2, 3},
Xiangwei WU^{2, 3},
Rulin MA¹,
Xianghui ZHANG¹,
Heng GUO¹,
Shuxia GUO¹,
Xinyu PENG^{2, 3
, ,
,}

1.
Shihezi University School of Medicine，Shihezi，Xinjiang 832000，China
2.
NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases，Shihezi，Xinjiang 832000，China
3.
Department of Hepatobiliary Surgery，The First Afﬁliated Hospital of Shihezi University School of Medicine，Shihezi，Xinjiang 832000，China

Research funding:

Key Science and Technology Project of Xinjiang Production and Construction Corps (2018AB022)

More Information

Corresponding author: PENG Xinyu， pengxinyu2000@sina.com （ORCID： 0000-0003-3249-5178）

摘要

摘要: 目的探讨ZJU指数与维吾尔族NAFLD发病的关联性及其对NAFLD发生风险的预测价值。方法选择新疆喀什地区兵团第三师51团维吾尔族聚集区为调查现场，研究对象为在当地居住且年龄>18岁的维吾尔族居民。分别在2019、2020和2021年进行随访，2021年6月—8月完成结局调查；最终共纳入研究对象10 597名。连续变量组间比较采用Kruskal-Wallis H检验；分类变量采用χ²检验。根据ZJU指数水平将研究对象分为4组（Q1～Q4组），采用Kaplan-Meier曲线计算NAFLD事件的发生率，采用Cox回归模型分析ZJU指数与NAFLD发病风险的关联；采用受试者工作特征曲线下面积（AUC）评估ZJU指数对NAFLD发生风险的预测价值。结果在4.92年的中位随访期间，研究人群NAFLD发病率为9.4%（992/10 597）。经多因素调整后，随着ZJU指数的升高，NAFLD发生风险HR（95%CI）值分别为2.55（1.60～4.06）、7.32（4.78～11.20）、21.74（14.32～33.00），呈明显上升趋势（P_趋势值<0.001）。ROC曲线结果显示，ZJU指数预测NAFLD效果更好（AUC=0.816），男性亚组ZJU指数AUC（0.829）高于女性AUC（0.809）。结论 ZJU指数是新疆维吾尔自治区农村地区维吾尔族NAFLD发生的预测因子，对NAFLD发病风险具有良好的预测价值。
- 非酒精性脂肪性肝病 /
- 预测 /
- 新疆维吾尔自治区
Abstract: Objective To investigate the association between ZJU index and the onset of nonalcoholic fatty liver disease （NAFLD） in the Uygur population and the value of ZJU index in predicting the risk of NAFLD. Methods The Uighur community of The 51st Regiment of The Third Division of Xinjiang Kashgar Corps was selected as the investigation site， and the Uygur residents who lived in this area and had an age of >18 years were selected as subjects. Follow-up studies were conducted in 2019， 2020， and 2021， and the investigation of outcomes was completed in June to August of 2021. Finally 10 597 subjects were enrolled for analysis. The Kruskal-Wallis H test was used for comparison of continuous variables between groups， and the chi-square test was used for comparison of categorical variables between groups. The subjects were divided into Q1-Q4 groups according to the level of ZJU index. The Kaplan-Meier curve was used to predict the incidence rate of NAFLD， and the Cox regression model was used to analyze the association between ZJU index and the risk of NAFLD； the area under the ROC curve （AUC） was used to evaluate the value of ZJU index in predicting the risk of NAFLD. Results During the median follow-up time of 4.92 years， the incidence rate of NAFLD was 9.4% （992/10 597） among the study population. After adjustment for multiple factors， there was a significant increase in the risk of NAFLD with the increase in ZJU index， with a hazard ratio of 2.55 （95% confidence interval ［CI］： 1.60‍ — ‍4.06）， 7.32 （95%CI： 4.78‍ — ‍11.20）， and 21.74 （95%CI： 14.32‍ — ‍33.00）， respectively （all P_trend<0.001）. The ROC curve showed that ZJU index had a higher value in predicting NAFLD （AUC=0.816）， and the male subgroup had a significantly higher predictive accuracy of ZJU index than the female subgroup （AUC： 0.829 vs 0.809）. Conclusion ZJU index is a predictive factor for the onset of NAFLD in the Uygur population in rural areas of Xinjiang and has a good value in predicting the risk of NAFLD.
- Non-alcoholic Fatty Liver Disease /
- Forecasting /
- Xinjiang

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图 1 不同ZJU四分位数分组的NAFLD事件发生率的Kaplan-Meier曲线

Figure 1. Kaplan-Meier curves for cumulative NAFLD event rates by ZJU quartile grouping

下载: 全尺寸图片幻灯片

表 1 新疆维吾尔族ZJU指数四分位数分组人群基线特征的比较

Table 1. Comparison of baseline characteristics of Xinjiang Uyghur ZJU index quartile group population

特征	总例数（n=10 597）	Q1组（n=2 649）	Q2组（n=2 649）	Q3组（n=2 650）	Q4组（n=2 649）	统计值	P值
年龄（岁）	35.71±13.03	28.65±10.69	34.44±12.17	38.60±12.56	42.82±12.41	H=2 103.149	<0.001
性别［例（%）］						χ²=498.814	<0.001
男	5 285（49.9）	1 691（63.8）	1 437（52.8）	1 255（47.4）	902（34.1）
女	5 312（50.1）	958（36.2）	1 212（45.8）	1 395（52.6）	1 747（65.9）
收缩压（mmHg）	127.02±18.23	120.90±14.74	124.36±16.39	128.93±18.49	135.63±20.14	H=826.487	<0.001
舒张压（mmHg）	75.01±11.70	71.89±10.17	73.43±11.15	75.91±11.43	79.73±12.70	H=624.455	<0.001
血糖（mmol/L）	4.92±1.71	4.43±0.83	4.71±0.89	4.85±0.99	5.85±3.01	H=767.086	<0.001
BMI（kg/m²）	25.49±4.55	20.94±1.94	24.01±1.90	26.90±2.13	31.35±3.83	H=7 850.767	<0.001
AST（U/L）	27.36±15.67	26.91±14.74	26.60±14.34	28.02±16.46	28.10±17.27	H=10.597	0.060
ALT（U/L）	24.13±9.40	22.47±8.70	23.76±8.01	24.60±8.81	26.08±11.67	H=120.604	<0.001
GGT（U/L）	17.33±12.82	14.80±9.96	15.91±11.20	18.35±13.84	21.02±15.39	H=392.526	<0.001
TG（mmol/L）	1.64±1.25	1.12±0.60	1.40±0.79	1.76±1.08	2.45±1.88	H=1 791.191	<0.001
TC（mmol/L）	4.65±1.42	4.25±1.34	4.62±1.45	4.81±1.31	5.02±1.47	H=756.864	<0.001
LDL-C（mmol/L）	2.62±0.71	2.54±0.63	2.57±0.69	2.67±0.74	2.74±0.78	H=115.495	<0.001
HDL-C（mmol/L）	1.66±0.58	1.71±0.52	1.67±0.58	1.63±0.58	1.61±0.64	H=120.755	<0.001
T2DM［例（%）］	525（5.0）	11（0.4）	47（1.8）	87（3.3）	380（14.3）	χ²=684.618	<0.001
吸烟［例（%）］	1 834（17.3）	708（26.7）	487（18.4）	402（15.2）	237（8.9）	χ²=304.225	<0.001
高血压［例（%）］	2 573（24.3）	332（12.5）	498（18.8）	679（25.6）	1 064（40.2）	χ²=675.667	<0.001
NAFLD［例（%）］	992（9.4）	24（0.9）	70（2.6）	220（8.3）	678（25.6）	χ²=1 190.359	<0.001
注：按基线ZJU指数水平分为4组（Q1～Q4组），Q1组（≤32.05），Q2组（32.05～35.33），Q3组（35.33～39.28）和Q4组（≥39.28）。

下载: 导出CSV

表 2 研究人群不同年龄段NAFLD发病率

Table 2. The incidence of NAFLD in different age groups

不同年龄段	男性		女性		总例数
不同年龄段	例数	NAFLD［例（%）］	例数	NAFLD［例（%）］	例数	NAFLD［例（%）］
<35岁	2 983	109（3.7 ）	2 917	112（3.8）	5 900	221（3.7）
35～44岁	1 330	169（12.7）	1 244	194（15.6）	2 574	363（14.1）
>44岁	972	179（18.4）	1 151	229（19.9）	2 123	408（19.2）
χ²_趋势值		239.331		289.636		530.567
P_趋势值		<0.001		<0.001		<0.001

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表 3 新疆维吾尔族ZJU指数与NAFLD发生风险的关联

Table 3. Association of ZJU index with the risk of NAFLD occurrence in Xinjiang Uyghur people

ZJU指数	模型1		模型2		模型3
ZJU指数	HR（95%CI）	P值	HR（95%CI）	P值	HR（95%CI）	P值
Q1组	1		1		1
Q2组	2.94（1.85～4.68）	<0.001	2.66（1.67～4.24）	<0.001	2.55（1.60～4.06）	<0.001
Q3组	9.47（6.21～14.43）	<0.001	7.98（5.22～12.20）	<0.001	7.32（4.78～11.20）	<0.001
Q4组	31.73（21.12～47.67）	<0.001	25.35（16.75～38.38）	<0.001	21.74（14.32～33.00）	<0.001
P_趋势值		<0.001		<0.001		<0.001
注：模型1无调整；模型2调整性别、年龄；模型3在模型2基础上进一步调整高血压、吸烟、GGT、HDL-C、LDL-C、TC。

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表 4 新疆维吾尔族TyG、LAP、HSI、VAI、ZJU指数对NAFLD发病的预测价值

Table 4. Predictive value of TyG， LAP， HSI， VAI， and ZJU indices for the development of NAFLD in Xinjiang Uyghur people

变量	截断值	敏感度	特异度	约登指数	AUC（95%CI）	P值
TyG	2.263	0.494	0.792	0.286	0.689（0.671～0.706）	<0.001
LAP	43.830	0.775	0.631	0.406	0.768（0.754～0.783）	<0.001
WHtR	0.571	0.804	0.650	0.454	0.786（0.772～0.800）	<0.001
HSI	35.854	0.702	0.660	0.362	0.733（0.718～0.749）	<0.001
VAI	75.585	0.749	0.603	0.352	0.733（0.718～0.749）	<0.001
ZJU	37.808	0.786	0.717	0.503	0.816（0.804～0.829）	<0.001

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表 5 TyG、LAP、WHtR、HSI、VAI、ZJU指数对NAFLD预测准确性的性别差异

Table 5. Gender differences in diagnostic accuracy of TyG， LAP， WHtR， HSI， VAI， and ZJU indices for NAFLD

变量	男性		女性
变量	AUC（95%CI）	P值	AUC（95%CI）	P值
TyG	0.734（0.710～0.758）	<0.001	0.659（0.636～0.683）	<0.001
LAP	0.802（0.782～0.822）	<0.001	0.737（0.717～0.758）	<0.001
WHtR	0.806（0.787～0.824）	<0.001	0.772（0.751～0.792）	<0.001
HSI	0.730（0.706～0.754）	<0.001	0.748（0.727～0.769）	<0.001
VAI	0.761（0.738～0.783）	<0.001	0.702（0.681～0.724）	<0.001
ZJU	0.829（0.811～0.848）	<0.001	0.809（0.792～0.826）	<0.001

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