Fetuin-A、Fetuin-B及胰岛素抵抗指数对非酒精性脂肪性肝病的预测价值

杨素莲; 施荣杰; 李利华

doi:10.12449/JCH240409

Fetuin-A、Fetuin-B及胰岛素抵抗指数对非酒精性脂肪性肝病的预测价值

DOI: 10.12449/JCH240409

a.
大理大学第一附属医院预防保健科，云南大理 671000
b.
大理大学第一附属医院消化内科，云南大理 671000
c.
大理大学第一附属医院老年病科，云南大理 671000

基金项目:

云南省地方本科高校基础研究联合专项项目 (202001BA070001-103)

伦理学声明：本研究方案于2019年6月28日经由大理大学医学伦理委员会审批，批号：DFY20190628001。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：杨素莲负责查阅文献，数据分析和撰写论文；施荣杰负责收集和分析患者临床数据；李利华负责文章选题和指导论文修改。

详细信息

通信作者:
李利华， lilihuayncn@163.com （ORCID： 0000-0003-3987-5851）

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出版历程
- 收稿日期: 2023-07-15
- 录用日期: 2023-08-04
- 出版日期: 2024-04-11

Value of Fetuin-A， Fetuin-B， and insulin resistance index in predicting nonalcoholic fatty liver disease

Sulian YANG^a,
Rongjie SHI^b,
Lihua LI^{c
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a.
Preventive Health Care Department, The First Affiliated Hospital of Dali University，Dali，Yunnan 671000，China
b.
Department of Gastroenterology, The First Affiliated Hospital of Dali University，Dali，Yunnan 671000，China
c.
Department of Geriatrics，The First Affiliated Hospital of Dali University，Dali，Yunnan 671000，China

Research funding:

Yunnan Provincial Joint Basic Research Project for Local Undergraduate Colleges and Universities (202001BA070001-103)

More Information

Corresponding author: LI Lihua， lilihuayncn@163.com （ORCID： 0000-0003-3987-5851）

摘要

摘要: 目的探讨血清Fetuin-A、Fetuin-B联合胰岛素抵抗指数（HOMA-IR）对非酒精性脂肪性肝病（NAFLD）的预测价值。方法连续选取2020年6月—2021年6月大理大学第一附属医院消化内科就诊的120例NAFLD患者和体检中心的120例健康体检人群为研究对象，收集其临床数据资料，并检测血清Fetuin-A、Fetuin-B水平。计量资料两组间比较采用成组t检验或Mann-Whitney U检验；计数资料两组间比较采用χ²检验。多因素Logistic回归分析NAFLD患者的危险因素。构建受试者工作特征曲线（ROC曲线）评估Fetuin-A、Fetuin-B联合HOMA-IR对NAFLD患者的预测效能。结果 NAFLD组患者的体质量指数、收缩压、舒张压、ALT、AST、空腹血糖、空腹胰岛素、甘油三酯、HOMA-IR、Fetuin-A和Fetuin-B等均高于健康对照组（P值均<0.05）。多因素Logistic回归分析显示Fetuin-A（OR=1.010，95%CI：1.001～1.020，P<0.05）、Fetuin-B（OR=1.113，95%CI：1.021～1.214，P<0.05）和HOMA-IR（OR=24.053，95%CI：2.624～220.470，P<0.05）是NAFLD的独立危险因素。ROC曲线显示，Fetuin-A、Fetuin-B、HOMA-IR、Fetuin-A联合Fetuin-B、Fetuin-A联合HOMA-IR、Fetuin-B联合HOMA-IR以及三者联合预测NAFLD的ROC曲线下面积分别为0.637（95%CI：0.551～0.722）、0.853（95%CI：0.796～0.912）、0.837（95%CI：0.763～0.912）、0.853（95%CI：0.795～0.911）、0.843（95%CI：0.770～0.916）、0.922（95%CI：0.877～0.967）和0.922（95%CI：0.877～0.966）。结论 Fetuin-A、Fetuin-B对NAFLD有一定的预测价值，Fetuin-B联合HOMA-IR的预测价值更高。
- α-2-HS-糖蛋白 /
- 胎球蛋白B /
- 胰岛素抵抗 /
- 非酒精性脂肪性肝病
Abstract: Objective To investigate the value of serum Fetuin-A and Fetuin-B combined with Homeostasis Model Assessment of Insulin Resistance （HOMA-IR） in predicting nonalcoholic fatty liver disease （NAFLD）. Methods A total of 120 patients with NAFLD who attended Department of Gastroenterology， The First Affiliated Hospital of Dali University， from June 2020 to June 2021， and 120 healthy individuals who underwent physical examination at Physical Examination Center during the same period of time were enrolled as subjects， and clinical data were collected from all subjects. The serum levels of Fetuin-A and Fetuin-B were measured. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups； the multivariate Logistic regression analysis was used to assess the risk factors for NAFLD. The receiver operating characteristic （ROC） curve was plotted to evaluate the predictive efficacy of Fetuin-A and Fetuin-B combined with HOMA-IR in NAFLD patients. Results Compared with the healthy control group， the NAFLD group had significantly higher levels of body mass index， systolic blood pressure， diastolic blood pressure， alanine aminotransferase， aspartate aminotransferase， fasting blood glucose， fasting insulin， triglycerides， HOMA-IR， Fetuin-A， and Fetuin-B （all P<0.05）. The multivariate Logistic regression analysis showed that Fetuin-A （odds ratio ［OR］=1.010， 95% confidence interval ［CI］： 1.001‍‍‍ ‍‍‍—‍‍‍ ‍‍1.020， P<0.05）， Fetuin-B （OR=1.113， 95%CI： 1.021‍ ‍‍—‍‍ ‍1.214， P<0.05）， and HOMA-IR （OR=24.053， 95%CI： 2.624‍ ‍‍—‍‍ ‍220.470， P<0.05） were independent risk factors for NAFLD. The ROC curve analysis showed that Fetuin-A， Fetuin-B or HOMA-IR alone had an area under the ROC curve （AUC） of 0.637 （95%CI： 0.551‍ ‍—‍ ‍0.722）， 0.853 （95%CI： 0.796‍ ‍—‍ ‍0.912）， and 0.837 （95%CI： 0.763‍ ‍—‍ ‍0.912）， respectively， and Fetuin-A combined with Fetuin-B， Fetuin-A combined with HOMA-IR， and Fetuin-B combined with HOMA-IR had an AUC of 0.853 （95%CI： 0.795‍ ‍—‍ ‍0.911）， 0.843 （95%CI： 0.770‍ ‍—‍ ‍0.916）， 0.922 （95%CI： 0.877‍ ‍—‍ ‍0.967）， respectively， while the combination of these three indicators had an AUC of 0.922 （95%CI： 0.877‍ ‍—‍ ‍0.966）. Conclusion Fetuin-A and Fetuin-B have a certain value in predicting NAFLD， and Fetuin-B combined with HOMA-IR tends to have a higher predictive value.
- alpha-2-HS-Glycoprotein /
- Fetuin-B /
- Insulin Resistance /
- Non-alcoholic Fatty Liver Disease

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图 1 Fetuin-A、Fetuin-B联合HOMA-IR预测NAFLD的ROC曲线

Figure 1. ROC curve of Fetuin-A， Fetuin-B combined with HOMA-IR for predicting NAFLD

下载: 全尺寸图片幻灯片

表 1 研究对象的一般特征描述

Table 1. Description of general characteristics of study subjects

指标	NAFLD组（n=120）	健康对照组（n=120）	统计值	P值
男性［例（%）］	56（46.67）	50（41.67）	χ²=0.608	0.435
年龄（岁）	51.08±13.07	38.76±10.92	t=-7.926	<0.001
本科及以上学历［例（%）］	35（29.17）	90（75.00）	χ²=48.685	<0.001
BMI（kg/m²）	26.02±3.47	22.39±2.55	t=-9.234	<0.001
收缩压（mmHg）	129.46±21.71	115.33±15.73	t=-5.772	<0.001
舒张压（mmHg）	80.90±12.83	74.29±10.79	t=-4.318	<0.001
FPG（mmol/L）	5.14（4.45～6.82）	4.57（4.23～4.86）	Z=-5.978	<0.001
FINS（μIU/mL）	5.78（4.29～6.72）	4.09（3.60～4.83）	Z=-6.015	<0.001
ALT（U/L）	24.00（17.50～35.50）	16.00（12.00～23.00）	Z=-5.526	<0.001
AST（U/L）	20.00（16.00～26.00）	17.00（15.00～20.25）	Z=-2.552	<0.001
Alb（g/L）	42.60（38.55～46.10）	47.20（45.58～49.15）	Z=10.017	<0.001
LDL-C（mmol/L）	2.65±0.72	2.81±0.74	t=1.690	0.157
HDL-C（mmol/L）	1.17±0.32	1.60±0.34	t=9.964	<0.001
TC（mmol/L）	4.80（4.17～5.46）	5.08（4.44～5.52）	Z=0.731	0.104
TBil（mmol/L）	11.70（8.70～15.20）	13.15（10.17～16.52）	Z=0.984	0.020
BUN（mmol/L）	5.21（4.21～6.50）	5.12（4.06～5.94）	Z=-1.788	0.182
TG（mmol/L）	2.13（1.58～3.12）	1.28（0.93～1.77）	Z=-5.140	<0.001
SUA（μmol/L）	352.00（289.00～407.00）	344.00（296.50～404.75）	Z=0.103	0.816
Scr（μmol/L）	68.34±19.81	69.66±15.93	t=-0.170	0.373
HOMA-IR	1.32（1.06～1.64）	0.85（0.74～0.96）	Z=-7.658	<0.001
Fetuin-A（μg/mL）	685.23（595.80～776.49）	601.36（534.56～668.06）	Z=-7.344	<0.001
Fetuin-B（μg/mL）	81.44（72.41～100.88）	64.19（57.83～71.31）	Z=-2.755	<0.001

下载: 导出CSV

表 2 多因素Logistic回归分析

Table 2. Multivariable Logistic regression analysis

指标	β值	标准误	Wald值	OR值	95%CI	P值
常数项	-35.518	10.885	10.648
年龄	0.086	0.038	5.276	1.090	1.013～1.173	0.022
性别	1.670	1.282	1.696	5.310	0.430～65.511	0.193
教育程度	-1.208	1.261	0.917	0.299	0.025～3.538	0.338
BMI	0.886	0.460	3.700	2.424	0.983～5.977	0.054
收缩压	0.054	0.048	1.276	1.055	0.961～1.158	0.259
舒张压	-0.088	0.078	1.264	0.916	0.787～1.067	0.261
ALT	0.156	0.061	6.605	1.169	1.038～1.317	0.010
AST	-0.023	0.058	0.153	0.978	0.872～1.096	0.695
HDL-C	-8.646	4.714	3.365	0.002	0.001～1.809	0.067
TG	-0.293	0.368	0.634	0.746	0.363～1.534	0.426
HOMA-IR	5.483	2.305	5.657	24.053	2.624～220.470	0.017
Fetuin-A	0.010	0.005	4.047	1.010	1.001～1.020	0.044
Fetuin-B	0.107	0.044	5.910	1.113	1.021～1.214	0.015

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表 3 Fetuin-A、Fetuin-B联合HOMA-IR对NAFLD患者的预测价值

Table 3. Predictive value of Fetuin-A and Fetuin-B combined with HOMA-IR for NAFLD

预测指标	最佳截断值	敏感度（%）	特异度（%）	AUC（95%CI）	P值
Fetuin-A	569.06	76.5	43.9	0.637（0.551～0.722）	0.003
Fetuin-B	71.89	73.5	85.7	0.853（0.796～0.912）	<0.001
HOMA-IR	1.025	75.0	89.8	0.837（0.763～0.912）	<0.001
Fetuin-A联合Fetuin-B	0.46	75.0	84.7	0.853（0.795～0.911）	<0.001
Fetuin-A联合HOMA-IR	0.47	70.6	93.9	0.843（0.770～0.916）	<0.001
Fetuin-B联合HOMA-IR	0.40	80.9	91.8	0.922（0.877～0.967）	<0.001
Fetuin-A、Fetuin-B联合HOMA-IR	0.40	80.9	91.8	0.922（0.877～0.966）	<0.001

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