基于血清Betatrophin水平的非酒精性脂肪肝列线图预测模型的建立与分析
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摘要
目的通过分析非酒精性脂肪肝(NAFLD)发生的相关危险因素,建立基于血清Betatrophin水平的列线图评价模型,并评价其预测的准确性。方法选取2017年1月～2018年4月秦皇岛市第一医院收治的NAFLD患者180例作为NAFLD组,另选取同期门诊体检肝脏脂肪含量(LF)正常(LF<9.15%)的体检者72例,作为对照组。单因素分析NAFLD发生的相关因素,并将有统计学意义的指标纳入多因素Logistic回归模型,分析NAFLD发生的危险因素。根据回归分析结果建立列线图预测模型。利用受试者工作特征曲线(ROC)及Hosmer-Lemeshow检验评价模型预测效能。结果多因素分析显示,Betatrophin、三酰甘油(TG)、天冬氨酸氨基转移酶(AST)是NAFLD发生的危险因素,高密度脂蛋白(HDL)是NAFLD发生的保护因素(P <0.05)。利用R软件成功建立了预测NAFLD发生的列线图预测模型。Hosmer-Lemeshow检验结果显示,该模型预测效能为85.71%,模型拟合良好(P <0.05)。预测NAFLD发生的曲线下面积(AUC)为0.877,特异性为88.68%,敏感性为82.98%。结论基于血清Betatrophin水平的NAFLD发生风险的列线图预测模型具有良好的特异性和敏感性,模型拟合良好,临床价值较高。
Objective To establish a nomogram predictive model by analyzing the risk factors of nonalcoholic fatty liver disease(NAFLD), and to establish a nomogram model based on serum Betatrophin level, and evaluate the accuracy of prediction. Methods From January 2017 to April 2018, 180 patients with NAFLD admitted to the First Hospital of Qinhuangdao were selected as the NAFLD group, and 72 patients with normal liver fat content(LF < 9.15%) were selected as control group. Univariate analysis of factors associated with NAFLD, statistically significant indicators were included in the multivariate Logistic regression model, and the risk factors for the NAFLD were analyzed. Based on the results of the regression analysis, a preoperative model was established. The receiver operating characteristic curve(ROC) and the Hosmer-Lemeshow test were used to evaluate the model prediction performance. Results Multivariate analysis showed that Betatrophin, triglyceride(TG) and aspartate aminotransferase(AST) were risk factors for NAFLD,and high-density lipoprotein(HDL) was a protective factor for NAFLD(P < 0.05). The nomogram prediction model for predicting the occurrence of NAFLD was successfully established by using R software. The Hosmer-Lemeshow test showed that the model had a predicted performance of 85.71% and the model fit well(P < 0.05). The area under the curve(AUC) for predicting the occurrence of NAFLD was 0.877, the specificity was 88.68%, and the sensitivity was82.98%. Conclusion The nomogram prediction model based on the serum Betatrophin level of NAFLD has good specificity and sensitivity. The model is well fitted and has high clinical value.
Objective To establish a nomogram predictive model by analyzing the risk factors of nonalcoholic fatty liver disease(NAFLD), and to establish a nomogram model based on serum Betatrophin level, and evaluate the accuracy of prediction. Methods From January 2017 to April 2018, 180 patients with NAFLD admitted to the First Hospital of Qinhuangdao were selected as the NAFLD group, and 72 patients with normal liver fat content(LF < 9.15%) were selected as control group. Univariate analysis of factors associated with NAFLD, statistically significant indicators were included in the multivariate Logistic regression model, and the risk factors for the NAFLD were analyzed. Based on the results of the regression analysis, a preoperative model was established. The receiver operating characteristic curve(ROC) and the Hosmer-Lemeshow test were used to evaluate the model prediction performance. Results Multivariate analysis showed that Betatrophin, triglyceride(TG) and aspartate aminotransferase(AST) were risk factors for NAFLD,and high-density lipoprotein(HDL) was a protective factor for NAFLD(P < 0.05). The nomogram prediction model for predicting the occurrence of NAFLD was successfully established by using R software. The Hosmer-Lemeshow test showed that the model had a predicted performance of 85.71% and the model fit well(P < 0.05). The area under the curve(AUC) for predicting the occurrence of NAFLD was 0.877, the specificity was 88.68%, and the sensitivity was82.98%. Conclusion The nomogram prediction model based on the serum Betatrophin level of NAFLD has good specificity and sensitivity. The model is well fitted and has high clinical value.
引文
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[8]刘捷,王永红,罗蓉,等.ZJU指数筛查对健康体检人群非酒精性脂肪肝患病风险预测的价值评估:一项基于重庆市体检人群的单中心研究[J].重庆医科大学学报,2017,42(2):244-248.
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[14]胡玲,李宇.中老年体检人群非酒精性脂肪肝患病率调查及与代谢相关因素的相关性[J].实用医学杂志,2017,33(4):632-635.
[15]吕霞霞,孙建光.代谢综合征与非酒精性脂肪肝的相关性分析[J].现代预防医学,2015,42(22):4218-4220.
[16]江勇,韩涛,张志广,等.8-羟基脱氧鸟苷酸在非酒精性脂肪性肝炎诊断中的意义[J].中华内科杂志,2017,56(1):34-38.
[17]Torres DM,Harrison SA.NAFLD:Predictive value of ALTlevels for NASH and advanced fibrosis[J].Nat Rev Gastro Hepat,2013,10(9):510-511.
[18]骆善彩,陈晓敏,过晓阳,等.代谢综合征各组分与非酒精性脂肪肝发生的回顾性巢式病例对照研究[J].现代预防医学,2016,43(16):2921-2925.
[19]Ampuero J,Ranchal I,Gallego-Durán R,et al.Oxidized low-density lipoprotein antibodies/high-density lipoprotein cholesterol ratio is linked to advanced non-alcoholic fatty liver disease lean patients[J].J Gastroen Hepatol,2016,31(9):1611-1618.
[20]Fu Z,Berhane F,Fite A,et al.Elevated circulating lipasin/betatrophin in human type 2 diabetes and obesity[J].Sci Rep,2014,4(6186):5013.
[2]Lonardo A,Ballestri S,Marchesini G,et al.Nonalcoholic fatty liver disease:a precursor of the metabolic syndrome[J].Digest Liver Dis,2015,47(3):181-190.
[3]Younossi ZM,Koenig AB,Abdelatif D,et al.Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence,incidence,and outcomes[J].Hepatology,2016,64(1):73-84.
[4]European Association for the Study of the Liver,European Association for the Study of Diabetes(EASD.EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease[J].Obesity Facts,2016,9(2):65-90.
[5]Ballestri S,Romagnoli D,Nascimbeni F,et al.Role of ultrasound in the diagnosis and treatment of nonalcoholic fatty liver disease and its complications[J].Expert Rev Gastroent,2015,9(5):603-627.
[6]Chen X,Lu P,He W,et al.Circulating betatrophin levels are increased in patients with type 2 diabetes and associated with insulin resistance[J].J Clin Endocr Metab,2015,100(1):E96-E100.
[7]Lee Y,Lee SG,Lee CJ,et al.Association between betatrophin/ANGPTL8 and non-alcoholic fatty liver disease:animal and human studies[J].Sci Rep,2016,6(6):24 013.
[8]刘捷,王永红,罗蓉,等.ZJU指数筛查对健康体检人群非酒精性脂肪肝患病风险预测的价值评估:一项基于重庆市体检人群的单中心研究[J].重庆医科大学学报,2017,42(2):244-248.
[9]王景骅,虞朝辉.非酒精性脂肪性肝病的诊断研究进展[J].中华肝脏病杂志,2017,25(2):115-118.
[10]夏明锋,高鑫.无创定量肝脏脂肪含量的新方法[J].中华内分泌代谢杂志,2012,28(8):611-613.
[11]中华医学会肝病学分会脂肪肝和酒精性肝病学组.中国非酒精性脂肪性肝病诊疗指南(2010年修订版)[J].中国医学前沿杂志,2012,4(7):4-10.
[12]Hu W,Shao X,Guo D,et al.Relationship of serum betatrophin with nonalcoholic fatty liver in a Chinese population[J].PLo S One,2017,12(1):e0 170 758.
[13]杨蕊旭,胡春秀,宓余强,等.非酒精性脂肪性肝病患者血清脂质组学研究[J].中华肝脏病杂志,2017,25(2):122-127.
[14]胡玲,李宇.中老年体检人群非酒精性脂肪肝患病率调查及与代谢相关因素的相关性[J].实用医学杂志,2017,33(4):632-635.
[15]吕霞霞,孙建光.代谢综合征与非酒精性脂肪肝的相关性分析[J].现代预防医学,2015,42(22):4218-4220.
[16]江勇,韩涛,张志广,等.8-羟基脱氧鸟苷酸在非酒精性脂肪性肝炎诊断中的意义[J].中华内科杂志,2017,56(1):34-38.
[17]Torres DM,Harrison SA.NAFLD:Predictive value of ALTlevels for NASH and advanced fibrosis[J].Nat Rev Gastro Hepat,2013,10(9):510-511.
[18]骆善彩,陈晓敏,过晓阳,等.代谢综合征各组分与非酒精性脂肪肝发生的回顾性巢式病例对照研究[J].现代预防医学,2016,43(16):2921-2925.
[19]Ampuero J,Ranchal I,Gallego-Durán R,et al.Oxidized low-density lipoprotein antibodies/high-density lipoprotein cholesterol ratio is linked to advanced non-alcoholic fatty liver disease lean patients[J].J Gastroen Hepatol,2016,31(9):1611-1618.
[20]Fu Z,Berhane F,Fite A,et al.Elevated circulating lipasin/betatrophin in human type 2 diabetes and obesity[J].Sci Rep,2014,4(6186):5013.