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Establishment and Analysis of Risk Prediction Model for Metabolic Dysfunction-Associated Fatty Liver Disease in Physical Examination Population
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摘要:
目的 分析体检人群患代谢相关脂肪性肝病（metabolic dysfunction-associated fatty liver disease, MAFLD）的危险因素，建立MAFLD的发生风险预测模型，为疾病的预防与发生提供管理策略。 方法 选取2018年1月–2021年12月于四川大学华西医院体检中心进行体检的14664例人员作为研究对象，按是否患有MAFLD分为MAFLD组（n=4013）与非MAFLD组（n=10651），分别比较糖脂代谢水平等生化指标差异，运用logistic回归分析MAFLD发生的危险因素并建立列线图预测模型。通过一致性指数（C指数）和校准曲线对模型的预测效果进行验证及评价。 结果 14664例体检者中，MAFLD患者4013例，总患病率为27.37%，男性患病率高于女性（38.99% vs. 10.06%，P<0.001）。与非MAFLD组相比，MAFLD组血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、γ-谷氨酰基转肽酶及血清尿酸水平均升高（P<0.05），高密度脂蛋白胆固醇水平降低（P<0.05）。logistic回归分析结果显示男性、年龄、体质量指数、血糖、三酰甘油及高血压均是MAFLD的独立危险因素，高密度脂蛋白胆固醇是保护因素。运用危险因素建立列线图预测风险模型，一致性指数（C指数）和校准曲线显示列线图模型预测性能良好，ROC曲线显示列线图模型对预测MAFLD发生的风险具有较好价值。 结论 体检人群中MAFLD患病率较高，通过常规体检筛查建立的列线图模型可提示临床筛选和分析高风险患者，对高风险人群具有预警作用。 Abstract:Objective To analyze the risk factors of metabolic dysfunction-associated fatty liver disease (MAFLD) in the physical examination population, to establish a risk prediction model for the occurrence of MAFLD, and to provide management strategies for the prevention and occurrence of the disease. Methods A total of 14664 people who underwent physical examination at the Physical Examination Center, West China Hospital, Sichuan University between January 2018 and December 2021 were selected as research subjects. The subjects were divided into a MAFLD group (n=4013) and a non-MAFLD group (n=10651) according to whether they had MAFLD. The differences in biochemical indices, for example, glycolipid metabolism levels, were compared and logistic regression was conducted to analyze the risk factors for MAFLD, thereby establishing a nomogram prediction model. The prediction effect of the model was validated and evaluated with the consistency index (C-index) and the calibration curve. Results Among the 14664 subjects who underwent physical examination, 4013 were MAFLD patients, presenting an overall prevalence of 27.37%, with significantly higher prevalence in men than that in women (38.99% vs. 10.06%, P<0.001). Compared with those of the non-MAFLD group, the levels of glucose (GLU), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase (GGT) and uric acid (UA) were increased (P<0.05), while the high density lipoprotein cholesterol (HDL-C) level was decreased (P<0.05) in the MAFLD group. The results of logistic regression analysis showed that male sex, age, body mass index, GLU, TG and hypertension were all independent risk factors of MAFLD, while HDL-C was a protective factor of MAFLD. The risk factors were used to establish a nomogram risk prediction model and the C-index and calibration curve showed that the nomogram model produced good predictive performance. The receiver operating characteristic (ROC) curve showed that the nomogram model had good predictive value for the risk of MAFLD. Conclusion We found a relatively high prevalence of MAFLD in the physical examination population, and the nomogram model established with routine physical examination screening can provide indications for the clinical screening and analysis of high-risk patients, which has an early warning effect on the high-risk population. -
图 1 预测MAFLD的列线图模型
Figure 1. Column chart model for predicting MAFLD
BMI: body mass index; GLU: glucose; TG: triglyceride; HDL-C: high density lipoprotein cholesterol.
图 2 验证集的ROC曲线
Figure 2. ROC curve of the validation set
The best cut-off value (sensitivity and specificity) is 0.232 (0.744,0.861), indicating that the sensitivity and specificity of the model reach the best at this point.
表 1 两组研究对象一般资料比较
Table 1. Comparison of general data of the two groups of subjects
Variable Non-MAFLD
group (n=10651)MAFLD group
(n=4013)P Sex/case (%) <0.001 Male 5351 (50.24) 3420 (85.22) Female 5300 (49.76) 593 (14.78) Age/case (%) <0.001 <30 yr. 1750 (16.43) 292 (7.28) 30-40 yr. 3756 (35.26) 1177 (29.33) 41-50 yr. 2544 (23.89) 1133 (28.23) 51-60 yr. 2008 (18.85) 1119 (27.88) >60 yr. 593 (5.57) 292 (7.28) BMI/(kg/m2), $ \bar x \pm s $ 23.24±3.38 27.33±2.84 <0.001 Hypertension/case (%) 1668 (15.66) 1487 (37.05) <0.001 
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表 2 两组研究对象实验室检测指标比较
Table 2. Comparison of laboratory testing results of the two groups of subjects
Variable Non-MAFLD
group (n=10651)MAFLD group
(n=4013)P GLU/(mmol/L) 4.98±0.72 5.61±1.52 <0.001 TC/(mmol/L) 4.75±0.87 5.04±0.98 <0.001 TG/(mmol/L) 1.27±0.86 2.44±1.79 <0.001 LDL-C/(mmol/L) 2.85±0.78 3.07±0.81 <0.001 HDL-C/(mmol/L) 1.47±0.33 1.13±0.29 <0.001 AST/(U/L) 21.18±7.23 26.47±11.14 <0.001 ALT/(U/L) 20.09±12.67 36.92±25.03 <0.001 GGT/(U/L)* 24 (12, 31) 53 (28, 68) <0.001 UA/(μmol/L) 328.87±80.63 410.26±90.16 <0.001 * Median (P25, P75). GLU: glucose; TC: total cholesterol; TG: triglyceride; LDL-C: low density lipoprotein cholesterol; HDL-C: high density lipoprotein cholesterol; AST: aspartate transaminase; ALT: alanine transaminase; GGT: gamma-glutamyl transpeptidase; UA: uric acid.
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表 3 MAFLD的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of MAFLD
Factor β SE Wald P OR 95% CI Sex −0.246 0.063 15.433 <0.001 0.782 0.691-0.884 Age 0.016 0.002 56.710 <0.001 1.016 1.012-1.021 BMI 0.401 0.011 1449.596 <0.001 1.493 1.462-1.524 GLU 0.232 0.023 100.022 <0.001 1.261 1.205-1.320 TG 0.360 0.025 199.979 <0.001 1.433 1.363-1.506 HDL-C −1.052 0.093 126.917 <0.001 0.349 0.291-0.419 Hypertension 0.208 0.055 14.165 <0.001 1.231 1.105-1.372 β: partial regression coefficient; SE: standard error; OR: odds ratio; CI: confidence interval.
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