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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

引用本文:
Citation:

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
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)

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

Research funding: 

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

More Information
  • 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。

     

  • 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

    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
    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
    5 285(49.9) 1 691(63.8) 1 437(52.8) 1 255(47.4) 902(34.1)
    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
    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
    下载: 导出CSV

    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
    HR(95%CI P HR(95%CI P HR(95%CI P
    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。
    下载: 导出CSV

    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
    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
    下载: 导出CSV

    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
    AUC(95%CI P AUC(95%CI P
    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
    下载: 导出CSV
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  • 收稿日期:  2023-02-07
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  • 出版日期:  2023-11-28
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