血浆致动脉粥样硬化指数轨迹与新发非酒精性脂肪性肝病的关联：基于中青年体检人群的回顾性队列研究

Association between trajectories of the atherogenic index of plasma and new-onset non-alcoholic fatty liver disease: a retrospective cohort study in young and middle-aged health check-up participants

摘要

目的 通过识别中青年人群血浆致动脉粥样硬化指数(atherogenic index of plasma, AIP)动态变化轨迹及其与新发非酒精性脂肪性肝病(non-alcoholic fatty liver disease, NAFLD)的关联,探索NAFLD的潜在危险因素和方便可测量的生物标志物。方法 基于回顾性研究设计,纳入4836名基线无NAFLD、2021—2024年于西安交通大学第二附属医院完成连续年度健康体检的中青年(18～60岁)体检者,收集其AIP、NAFLD及相关混杂因素等数据。采用基于组的轨迹模型(group-based trajectory modeling, GBTM)探索轨迹期(2021—2023年)入组者AIP的轨迹变化特征；通过多因素Logistic回归分析不同轨迹组与NAFLD的关联,并开展性别、年龄及身体质量指数(BMI)亚组分析。结果 通过GBTM方法将研究人群AIP分为低轨迹组、中轨迹组和高轨迹组(-0.85±0.29 vs. -0.26±0.31 vs. 0.46±0.41),分别占比29.34%、46.34%、24.32%；结局观察期(2024年)研究人群总体NAFLD发生率为7.44%,其在高中轨迹组的发生率显著高于中、低轨迹组(16.24% vs. 6.56% vs. 1.55%)(趋势性χ²=196.69,P＜0.001)。调整混杂因素后,中轨迹组(OR=3.30,95% CI:2.10～5.43)和高轨迹组(OR=5.90,95% CI:3.65～9.91)的NAFLD风险仍显著升高(均P＜0.001)。亚组分析显示,在各性别、年龄及BMI亚组中,AIP中、高轨迹组的NAFLD发生风险均呈显著升高趋势。结论 AIP动态轨迹或可作为NAFLD发病风险的潜在预测指标,为NAFLD的早期识别和精准干预提供初步的理论参考。

Abstract

Objective To identify the dynamic trajectories of the atherogenic index of plasma (AIP) in young and middle-aged health check-up participants and their association with incident non-alcoholic fatty liver disease (NAFLD), so as to explore potential risk factors and easily measurable biomarkers for NAFLD. Methods A retrospective cohort study design was adopted, enrolling 4836 young and middle-aged health check-up participants (18-60 years) free of NAFLD at baseline who underwent consecutive annual health check-ups at The Second Affiliated Hospital of Xi'an Jiaotong University from 2021 to 2024. Data on AIP, incident NAFLD, and related confounding factors were collected. Group-based trajectory modeling (GBTM) was used to characterize AIP trajectory changes during the trajectory period (2021-2023). Multivariate Logistic regression analysis was performed to examine the association between different AIP trajectory groups and incident NAFLD; subgroup analyses by gender, age, and body mass index (BMI) were conducted. Results Using the GBTM approach, we stratified the participants into three AIP trajectory groups: low trajectory group, moderate trajectory group, and high trajectory group (-0.85±0.29 vs. -0.26±0.31 vs. 0.46±0.41), accounting for 29.34%, 46.34%, and 24.32% of the total study population, respectively. The overall incidence of NAFLD during the outcome follow-up period (2024) was 7.44%, with the incidence rate significantly higher in the high AIP trajectory group than in the moderate and low groups (16.24% vs. 6.56% vs. 1.55%, χ ² for trend=196.69, P＜0.001). After adjusting for confounding factors, the risk of incident NAFLD remained significantly elevated in the moderate trajectory group (OR=3.30, 95% CI: 2.10-5.43) and high trajectory group (OR=5.90, 95% CI: 3.65-9.91) (both P＜0.001). Subgroup analyses revealed that the risk of incident NAFLD was significantly increased in the moderate and high AIP trajectory groups across all subgroups stratified by gender, age, and BMI. Conclusion Dynamic AIP trajectories may serve as a potential predictive indicator for the risk of incident NAFLD, providing a preliminary theoretical basis for the early identification and precise intervention of NAFLD.

关键词

血浆致动脉粥样硬化指数(AIP) / 非酒精性脂肪性肝病(NAFLD) / 基于组的轨迹模型 / 疾病风险 / 轨迹研究

Key words

atherogenic index of plasma (AIP) / non-alcoholic fatty liver disease (NAFLD) / group-based trajectory model / disease risk / trajectory study

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基金资助

陕西省软科学研究计划项目(2016KRM131)