代谢相关脂肪性肝病患者心肺运动能力与肝脏脂肪变严重程度关系的横断面研究

作者：袁文春1 2  陈金军1  白红莲2  周玲1

单位：1. 南方医科大学南方医院 感染内科肝病中心 广东 广州 510515 2. 佛山市第一人民医院 感染科 广东 佛山 528000

关键词：代谢相关脂肪性肝病 心肺运动能力 血脂 高密度脂蛋白 总胆固醇

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出版年,卷(期):页码：2024,16(3):52-58

摘要：

摘要：目的 探讨代谢相关脂肪性肝病（metabolic associated fatty liver disease， MAFLD）患者肝脏脂肪变严重程度与心肺运动能力的相关性。方法 采用横断面研 究，以2018年3月至2022年7月在佛山市第一人民医院感染科脂肪肝中心就诊的400例 经超声诊断为MAFLD的患者为研究对象，根据脂肪衰减参数（controlled attenuation parameter，CAP）将患者分为轻度组（240 dB/m ＜ CAP ≤ 265 dB/m）、中度组 （265 dB/m ＜ CAP ≤ 295 dB/m）和重度组（CAP ＞ 295 dB/m），收集患者体重指数 （body mass index，BMI）、肝功能 [包括总胆红素、直接胆红素、间接胆红素、丙氨 酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、γ-谷氨酰转移酶（γ-glutamyl transferase，GGT）] 及代谢 指标 [包括甘油三酯、总胆固醇、胰岛素、空腹血糖、高密度脂蛋白（high-density lipoprotein，HDL）、低密度脂蛋白（low density lipoprotein，LDL）] 等临床资料， 并进行心肺运动试验。采用有序多分类Logistic回归分析MAFLD严重程度的影响因 素。采用Pearson相关分析血脂水平和峰值公斤摄氧量的相关性。结果 轻度组、中 度组、重度组患者的BMI [（20.68 ± 1.50）kg/m2比（21.56 ± 1.19）kg/m2比（23.13 ± 1.91）kg/m2]、LSM [（8.07 ± 0.93）kPa比（10.18 ± 1.13）kPa比（13.96 ± 1.61）kPa]、 HDL [（1.16 ± 0.08）mmol/L比（1.13 ± 0.09）mmol/L比（1.02 ± 0.09）mmol/L]、LDL [（3.28 ± 0.14）mmol/L比（3.34 ± 0.17）mmol/L比（3.51 ± 0.14）mmol/L]、甘油三 酯 [（1.59 ± 0.08）mmol/L比（1.62 ± 0.06）mmol/L比（1.90 ± 0.20）mmol/L]、总胆固 醇 [（4.43 ± 0.43）mmol/L比（4.74 ± 0.46）mmol/L比（5.06 ± 0.21）mmol/L]、体脂肪 [（31.79 ± 9.47）g/cm2比（33.83 ± 7.67）g/cm2比（34.76 ± 6.95）g/cm2] 和体脂肪百分比 [（26.20 ± 3.56）%比（28.55 ± 5.73）%比（31.08 ± 4.46）%] 差异均有统计学意义（P 均＜ 0.05）。有序多分类Logistic回归分析表明BMI（OR = 1.16，95%CI：1.05～1.27， P = 0.003）、甘油三酯（OR = 1.15，95%CI：1.00～1.32，P = 0.043）、LDL（OR = 1.73，95%CI：1.12～2.67，P = 0.013）、LSM（OR = 1.36，95%CI：1.19～1.54，P ＜ 0.001）、体脂肪（OR = 1.04，95%CI：0.84～1.25，P ＜ 0.001）和体脂肪百分比（OR = 1.07，95%CI：1.03～1.12，P = 0.001）为影响MAFLD患者肝脏脂肪变严重程度的危险 因素，HDL是保护因素（OR = 0.07，95%CI：0.03～0.18，P ＜ 0.001）。心肺运动结 果表明，峰值公斤摄氧量 [轻度组比中度组比重度组：（21.39 ± 1.04）ml/（min·kg）比 （20.93 ± 1.11）ml/（min·kg）比（19.51 ± 1.26）ml/（min·kg）]、峰值氧脉搏 [轻度组 比中度组比重度组：（6.18 ± 0.31）ml/次比（5.97 ± 0.33）ml/次比（5.68 ± 0.19）ml/次] 和峰值代谢当量（轻度组比中度组比重度组：6.05 ± 0.25比5.82 ± 0.33比5.57 ± 0.25）随 着肝脏脂肪变程度增加而进一步降低（P均＜ 0.05）。峰值公斤摄氧量与HDL水平呈正 相关（r = 0.40，P ＜ 0.0001），与LDL、总胆固醇和甘油三脂水平呈负相关（r值分别 为－0.44、－0.40、－0.47，P ＜ 0.001）。结论 MAFLD患者血脂水平和肝脏脂肪变严 重程度与患者的心肺运动能力密切相关。

Abstract: Objective To investigate the correlation between cardiopulmonary exercise ability and the severity of hepatic steatosis in patients with metabolic related fatty liver disease (MAFLD). Methods A cross-sectional study was conducted on 400 patients diagnosed as MAFLD by ultrasound at the Fatty Liver Center of the Infectious Disease Department of the First People’s Hospital of Foshan from March 2018 to July 2022. The patients were divided into mild group (240 dB/m ＜ CAP ≤ 265 dB/m), moderate group (265 dB/m ＜ CAP ≤ 295 dB/m) and severe group (CAP ＞ 295 dB/m) based on the controlled attenuation parameter (CAP) value. Clinical data including body mass index (BMI), liver function [total bilirubin, direct bilirubin, indirect bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transferase (GGT)] and metabolic indicators [triglycerides, total cholesterol, insulin, fasting blood glucose, high-density lipoprotein (HDL) and low-density lipoprotein (LDL)] were collected, and cardiopulmonary exercise testing was performed. Ordered multiclassification Logistic regression was used to analyze the factors influencing the severity of MAFLD. Pearson correlation analysis was conducted to assess the relationship between lipid levels and peak oxygen consumption. Results The differences of BMI [(20.68 ± 1.50) kg/m2 vs. (21.56 ± 1.19) kg/m2 vs. (23.13 ± 1.91) kg/m2], LSM [(8.07 ± 0.93) kPa vs. (10.18 ± 1.13) kPa vs. (13.96 ± 1.61) kPa], HDL [(1.16 ± 0.08) mmol/L vs. (1.13 ± 0.09) mmol/L vs. (1.02 ± 0.09) mmol/L], LDL [(3.28 ± 0.14) mmol/L vs. (3.34 ± 0.17) mmol/L vs. (3.51 ± 0.14) mmol/L], triglycerides [(1.59 ± 0.08) mmol/L vs. (1.62 ± 0.06) mmol/L vs. (1.90 ± 0.20) mmol/L], total cholesterol [(4.43 ± 0.43) mmol/L vs. (4.74 ± 0.46) mmol/L vs. (5.06 ± 0.21) mmol/L], body fat [(31.79 ± 9.47) g/cm2 vs. (33.83 ± 7.67) g/cm2 vs. (34.76 ± 6.95) g/cm2] and body fat percentage [(26.20 ± 3.56)% vs. (28.55 ± 5.73)% vs. (31.08 ± 4.46)%] of patients in mild group, moderate group and severe group were statistically significant (all P ＜ 0.05). Ordered multiclassification Logistic regression showed that BMI (OR = 1.16, 95%CI: 1.05～1.27, P = 0.003), triglycerides (OR = 1.15, 95%CI: 1.00～1.32, P = 0.043), LDL (OR = 1.73, 95%CI: 1.12～2.67, P = 0.013), LSM (OR = 1.36, 95%CI: 1.19～1.54, P ＜ 0.001), body fat (OR = 1.04, 95%CI: 0.84～1.25, P ＜ 0.001) and body fat percentage (OR = 1.07, 95%CI: 1.03～1.12, P = 0.001) were independent factors influencing the severity of liver steatosis in patients with MAFLD, while HDL was a protective factor (OR = 0.07, 95%CI: 0.03～0.18, P ＜ 0.001). Cardiopulmonary exercise results showed that peak kilogram oxygen uptake [mild group vs. moderate group vs. severe group: (21.39 ± 1.04) ml/(min·kg) vs. (20.93 ± 1.11) ml/(min·kg) vs. (19.51 ± 1.26) ml/(min·kg)], peak oxygen pulse [mild group vs. moderate group vs. severe group: (6.18 ± 0.31) ml/beat vs. (5.97 ± 0.33) ml/beat vs. (5.68 ± 0.19) ml/beat] and peak metabolic equivalent (mild group vs. moderate group vs. severe group: 6.05 ± 0.25 vs. 5.82 ± 0.33 vs. 5.57 ± 0.25) further decreased as the degree of hepatic steatosis increased (all P ＜ 0.05). Conclusions The level of blood lipids and the severity of hepatic steatosis in patients with MAFLD were closely related to their cardiopulmonary exercise ability.

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