| ObjectiveThe purpose of this study was to explore the association between apolipoprotein B/A-I ratio(ApoB/ApoA-?)and non-alcoholic fatty liver disease(Nonalcoholic fatty liver disease,NAFLD)from different angles through cross-sectional study and retrospective cohort study,so as to provide new ideas for the identification,prevention and treatment of NAFLD in high-risk population of NAFLD.Materials and Methods1.Cross-sectional study.People who met the inclusion and exclusion criteria in the physical examination database of the health management center of the second hospital of Dalian medical university from January 2015 to December 2015 were selected as the object of the study.Basic information(age,sex,smoking and drinking,past disease and medication history),physical examination indicators such as height,weight,waistline,systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),laboratory indicators such as alanine aminotransferase(ALT),aspartate aminotransferase(AST),?-glutamyltransferase(GGT),fasting blood glucose(FBG),serum uric acid(SUA),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A-I(ApoA-I),apolipoprotein B(ApoB)and abdominal ultrasound were collected.According to the results of abdominal ultrasound,the subjects were divided into NAFLD group and control group,and the differences of general data between the two groups were compared.The subjects were divided into four groups according to the quartile of apolipoprotein A-? ratio(ApoB/ApoA-?),and the difference of NAFLD prevalence among people with different ApoB/ApoA-? levels were analyzed.Logistic regression analysis was used to compare the correlation between TG,TC,HDL-C,LDL-C,ApoA-I,ApoB,ApoB/ApoA-I and NAFLD.2.Retrospective Cohort study.A retrospective cohort study was conducted among people without NAFLD who met the inclusion and exclusion criteria in the cross-sectional study.The basic information,physical examination index,laboratory test index and abdominal ultrasound data of each subject from 2015 to 2017 were reviewed and collected.All subjects were followed up at least once.The end point of follow-up was the time of occurrence of NAFLD,and the follow-up months of all subjects were calculated.According to the baseline ApoB/ApoA-I level,the patients were divided into four groups by quartile method: Q1,Q2,Q3 and Q4.The differences of baseline data among the groups were compared.According to the results of abdominal ultrasound,the subjects were divided into NAFLD group and control group,and the differences of general data between the two groups were compared.The cumulative incidence of NAFLD in Q1-Q4 group with ApoB/ApoA-I level was compared.COX proportional hazard model was used to analyze the risk factors of NAFLD and the risk of NAFLD in different ApoB/ApoA-? groups.Results1.Cross-sectional study.1.1 1641 subjects(1135 males and 506 females)were included.Among them,659 cases met the diagnostic criteria of NAFLD.Compared with the control group,there were more males and older age in the NAFLD group.WC,BMI,SBP,DBP,ALT,AST,GGT,TG,TC,LDL-C,FBG,SUA,ApoB and ApoB/ApoA-? were higher than those in the control group,while HDL-C and ApoA-? were lower than those in the control group(P<0.05).1.2 The subjects were divided into four groups according to the quartile of ApoB/ApoA-I: Q1: ApoB / ApoA-I<0.57,Q2: 0.57 ? ApoB / ApoA-I<0.69,Q3:0.69 ? ApoB / ApoA-I<0.82,Q4 ApoB / ApoA-I ? 0.82.The prevalence rate of ApoA-I among the four groups was observed.The results showed that the total prevalence rate of NAFLD was 40.2%.The prevalence rates of NAFLD in the four groups were 12.9%,33.3%,51.6% and 62.3%,respectively.It is suggested that the prevalence of NAFLD increases with the increase of ApoB/ApoA-? level(trend test,P<0.01).1.3 Logistic regression analysis was used to analyze the correlation between traditional blood lipid indexes,apolipoprotein variables and NAFLD after adjusting age,sex,BMI,WC,SBP,DBP,FBG,SUA and other indexes.The results showed that TG,HDL-C,LDL-C,ApoAI,ApoB and ApoB/ApoA-I were all correlated with NAFLD status(P < 0.05),TC was not related to NAFLD status.Compared with blood lipid indexes such as ApoB/ApoA-I(OR=14.192,95% CI 6.147-32.769)and TG(OR=1.668,95% CI 1.429-1.947),LDL-C(OR=1.287,95% CI 1.075-1.541)and ApoB(OR=11.938,95% CI 5.358-26.598),the correlation with nonalcoholic fatty liver disease was stronger.At the same time,it was found that after adjusting for sex,age,BMI,WC,SBP,DBP,FBG,SUA and other factors,the risk of NAFLD increased 13.19 times for each increase of ApoB/ApoA-I.It is suggested that the increase of ApoB/ApoA-? level is related to the increased risk of NAFLD.2.Retrospective cohort study.2.1 A total of 751 subjects who met the criteria were included.According to the quartile of ApoB/A-I level,751 subjects were divided into 4 groups:.The subjects were divided into 4 groups according to the quartile of ApoB/ApoA-?,Q1 :ApoB/ApoA-?<0.53,Q2:0.53?ApoB/ApoA-?<0.64,Q3:0.64?ApoB/ApoA-?<0.75,Q4:ApoB/ApoA-??0.75?The baseline results showed that the proportion of men in the population,age,SBP,DBP,BMI,WC,ALT,TG,TC,LDL-C,FBG and SUA increased with the increase of ApoB/ApoA-? level,while HDL-C decreased with the increase of ApoB/ApoA-? level.2.2 Among the 751 patients with follow-up data,a total of 177 subjects were newly detected with NAFLD.WC,BMI,SBP,DBP,ALT,AST,GGT,TG,TC,LDL-C,FBG,SUA,ApoB and ApoB/ApoA-? in NAFLD group were higher than those in control group,while HDL-C and ApoA-? were lower than those in control group(P<0.05).The results showed that the indexes of male,BMI,SBP,DBP,ALT,AST,GGT,TG,TC,LDL-C,FBG,SUA,ApoB and ApoB/ApoA-? were higher than those in control group(P<0.05).2.3 The relationship between the cumulative incidence of NAFLD in the four baseline groups with different levels of ApoB/ApoA-? was observed.The results showed that the cumulative incidence of NAFLD was 23.6% in groups Q1,Q2,Q3 and Q4,and the cumulative incidence of NAFLD in groups Q1,Q2,Q3 and Q4 was 12.2%,16.7%,28.8%,37.1% respectively(trend test,P<0.01).The results suggest that the subjects with higher level of ApoB/ApoA-? have a significantly higher probability of new NAFLD during follow-up.2.4.The COX proportional hazard regression model was used for analysis.With or without NAFLD as the dependent variable,13 significant variables of univariate analysis(including age,sex,WC,BMI,SBP,DBP,FBG,SUA,TG,TC,LDL-C,HDL-C and ApoB/ApoA-I)were entered into the original equation.Finally,five variables were retained in the equation,and it was found that waist circumference,systolic blood pressure,triglyceride,total cholesterol and ApoB/ApoA-? were independent risk factors for NAFLD.2.5 The COX proportional hazard model analysis showed that when Q1 was used as the control group,the risk of NAFLD in Q2,Q3 and Q4 was 1.304(0.765-2.222)times,2.592(1.579-4.255)and 3.596(2.248-5.752)times higher than that in Q1,respectively.After adjusting for age and sex,the risk of NAFLD in Q2,Q3 and Q4 groups was 1.287(0.755-2.195)times,2.470(1.501-4.067)times and 2.998(1.868-4.812)times higher than that in Q1 group,respectively.After adjusting BMI,WC,SBP,DBP,FBG and SUA on the basis of the above adjustment model,the risk of NAFLD in Q2,Q3 and Q4 groups was 1.132(0.663-1.934)times,2.211(1.346-3.631)times and 2.312(1.436-3.723)times higher than that in Q1 group,respectively.It is suggested that high level of ApoB/ApoA-? increases the risk of NAFLD.ConclusionWith the increase of baseline ApoB/ApoA-? level,the risk of NAFLD increased gradually,and high ApoB/ApoA-? level was an independent risk factor for NAFLD.At the same time,compared with the traditional blood lipid index,ApoB/ApoA-? has the stronger correlation with NAFLD.Therefore,regularly monitoring the changes of ApoB/ApoA-? index and evaluating the risk of NAFLD in the physical examination population is of great clinical significance to prevent the occurrence of NAFLD. |
PDF Full Text Request