代谢相关脂肪性肝病与视网膜动脉硬化的关联性及危险因素分析
Analysis of the Association and Risk Factors Between Metabolic Associated Fatty Liver Disease and Retinal Arteriosclerosis
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摘要:目的 探讨代谢相关脂肪性肝病（metabolic associated fatty liver disease，MAFLD）合并与未合并视网膜动脉硬化（retinal arteriosclerosis，RAS）患者的代谢指标差异，并构建替代模型分析其独立危险因素。方法 回顾性纳入2023年8月—2024年4月在广东省人民医院体检并诊断为MAFLD且完成眼底照相者247例，按是否合并RAS分为两组。比较体质量指数（body mass index，BMI）、内脏脂肪等级、空腹血糖、糖化血红蛋白（hemoglobin A1c，HbA1c）、血脂及尿酸等指标差异。以是否合并RAS为因变量，分别构建Logistic回归基线模型（采用传统血脂指标及收缩压、舒张压）和替代模型以血浆致动脉粥样硬化指数（plasma atherogenic index，AIP）、甘油三酯-葡萄糖指数（triglyceride-glucose index，TyG）、非高密度脂蛋白胆固醇、脉压及平均动脉压（mean arterial pressure，MAP）替代上述指标，分析独立危险因素并比较两模型的受试者工作特征曲线下面积（areas under the receiver operating characteristic curves，ROC-AUC）。结果 合并RAS组的BMI、内脏脂肪等级、收缩压、舒张压、HbA1c和尿酸水平均高于未合并RAS组，而高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）水平更低，差异均具有统计学意义（P＜0.01）。多因素分析显示：在基线模型中，内脏脂肪等级比值比（odds ratio，OR）=1.676，P=0.004和HbA1c（OR= 1.218，P=0.037）为独立相关因素，HDL-C与RAS呈负相关（OR=0.136，P=0.012）。在替代模型中，内脏脂肪等级（OR=1.766，P=0.001），AIP（OR=1.519，P=0.022），TyG（OR=1.607，P=0.025）与MAP（OR=1.046，P=0.005）为独立相关因素。两模型判别力相近（AUC：基线0.886 vs. 替代0.885）。结论 内脏脂肪等级是MAFLD合并RAS的独立危险因素。在替代模型中，AIP、TyG和MAP也被证实为独立相关因素。临床上应优先关注内脏脂肪控制，同时涵盖脂质代谢、胰岛素抵抗与血压（尤其MAP）管理，以降低MAFLD患者的RAS发生风险。Abstract:Purpose To explore the differences in metabolic indicators between patients with metabolic associated fatty liver disease (MAFLD) with and without retinal arteriosclerosis (RAS), and to construct alternative models to analyze the independent risk factors.Methods A total of 247 patients diagnosed with MAFLD and who underwent fundus photography at Guangdong Provincial People’s Hospital from August 2023 to April 2024 were retrospectively included and divided into two groups based on the presence or absence of RAS. Differences in body mass index (BMI),visceral fat grade, fasting blood glucose, hemoglobin A1c (HbA1c), lipid profile, and uric acid were compared. Logistic regression models were constructed with the presence of RAS as the dependent variable, using traditional lipid indicators and blood pressure (systolic and diastolic) in the baseline model, and alternative indicators plasma atherogenic index (AIP), triglyceride-glucose index (TyG), non-high-density lipoprotein cholesterol, pulse pressure, and mean arterial pressure (MAP) in the alternative model. Independent risk factors were analyzed and the areas under the receiver operating characteristic curves (ROC-AUC) of the two models were compared.Results The BMI, visceral fat grade, systolic blood pressure (SBP), diastolic blood pressure (DBP), HbA1c, and uric acid levels were higher in the RAS group than in the non-RAS group, while high-density lipoprotein cholesterol (HDL-C) levels were lower, with statistically significant differences (P < 0.01). Multivariate analysis showed that visceral fat grade (OR=1.676, P=0.004) and HbA1c odds ratio (OR)=1.218, P=0.037 were independent risk factors in the baseline model, and HDL-C was negatively correlated with RAS (OR=0.136, P=0.012). In the alternative model, visceral fat grade (OR=1.766, P=0.001) AIP (OR=1.519, P=0.022), TyG (OR=1.607, P=0.025), and MAP (OR=1.046, P=0.005) were independent risk factors. The discriminatory power of the two models was similar (AUC: baseline 0.886 vs. alternative 0.885).Conclusion Visceral fat grade is an independent risk factor for MAFLD with RAS. In the alternative model, AIP, TyG, and MAP were also confirmed as independent risk factors. Clinically, priority should be given to controlling visceral fat while managing lipid metabolism, insulin resistance, and blood pressure (especially MAP) to reduce the risk of RAS in MAFLD patients.
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