Predictive value of FIB-4 in patients with metabolic-associated fatty liver disease complicated with colorectal adenomatous polyps

doi:10.3969/j.issn.1004-583X.2022.04.009

Abstract

Abstract:

Objective To study the predictive value of FIB-4 index in patients with metabolic-associated fatty liver disease(MAFLD) complicated with colorectal adenomatous polyps. Methods Eligible 183 patients from Department of Gastroenterology, Jinzhou Central Hospital during May 2020 to June 2021 were enrolled. In accordance with pathological type, those with of hyperplastic or inflammatory polyps were included in the control group (44 cases), and those with adenomatous polyps in the adenoma group (139 cases), aiming to compare the interclass differences involving baseline information, FIB-4 index, the risk factors of MAFLD complicated with colorectal adenomatous polyps was analyzed by Multivariate logistic regression, and the predictive value of FIB-4 index for that were assessed by drawing receiver operating characteristic (ROC) curve. Results The adenoma group had older age, longer smoking history and diabetes history, elevated body mass index (BMI), low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and FIB-4 (vs control group); while High-density lipoprotein cholesterol (HDL-C) and Platelet count (PLT) in adenoma group were lower than those in control group, with statistical significance differences (P<0.05). The difference in drinking history, hypertension history, Fasting blood glucose(FBG), total cholesterol (TC), triglyceride (TG), and uric acid (UA) between groups was no significant (P>0.05). Multivariate logistic regression analysis indicated that age, gender, BMI, AST and FIB-4 index were independent risk factors for MAFLD complicated with colorectal adenomatous polyps (P<0.05). The AUC of FIB-4 index risk assessment was 0.868, and the sensitivity and specificity were 67.6% and 90.9% respectively.Conclusion FIB-4 index should be attention due to its predictive value for MAFLD complicated with colorectal adenomatous polyps, which can help to identify the high-risk population of adenomatous polyps, early diagnosis and early treatment.

Key words: metabolic fatty liver disease, colorectal adenomatous polyp, FIB-4

CLC Number:

Zhang Limin, Sun Jun. Predictive value of FIB-4 in patients with metabolic-associated fatty liver disease complicated with colorectal adenomatous polyps[J]. Clinical Focus, 2022, 37(4): 334-338.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.04.009

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I4/334

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References 27

[1]	Dekker E, Tanis PJ, Vleugels JLA. et al. Colorectal cancer[J]. Lancet, 2019, 394(10207):1467-1480. doi: 10.1016/S0140-6736(19)32319-0 URL
[2]	Wilkins T, McMechan D, Talukder A. Colorectal cancer screening and prevention[J]. Am Fam Physician, 2018, 97(10):658-665. pmid: 29763272
[3]	Vavra P, Dostalik J, Martinek L. et al. Familial adenomatous polyposis as a precancerosis of colon cancer[J]. Bratisl Lek Listy, 2002, 103(11):418-21.
[4]	Suchanek S, Grega T, Ngo O. et al. How significant is the association between metabolic syndrome and prevalence of colorectal neoplasia?[J]. World J Gastroenterol, 2016, 22(36):8103-8111. doi: 10.3748/wjg.v22.i36.8103 URL
[5]	Fliss-Isakov N, Zelber-Sagi S, Webb M. et al. Distinct metabolic profiles are associated with colorectal adenomas and serrated polyps[J]. Obesity (Silver Spring), 2017, 25(Suppl 2): S72-S80.
[6]	郭美霞, 张晓华, 朱人敏, 等. 代谢综合征与中老年人结直肠腺瘤型息肉的关系[J]. 世界华人消化杂志, 2011, 19(9):969-971.
[7]	Kuchay MS, Choudhary NS, Mishra SK. Pathophysiological mechanisms underlying MAFLD[J]. Diabetes Metab Syndr, 2020, 14(6):1875-1887. doi: 10.1016/j.dsx.2020.09.026 URL
[8]	Sumida Y, Yoneda M, Tokushige K. et al. FIB-4 first in the diagnostic algorithm of metabolic-dysfunction-associated fatty liver disease in the era of the global metabodemic[J]. Life (Basel), 2021, 11(2):143.
[9]	施漪雯, 肖倩倩, 范建高. 亚太肝脏研究协会代谢相关脂肪性肝病临床诊疗指南简介[J]. 中华肝脏病杂志, 2020, 28(11):915-917.
[10]	Holme O, Bretthauer M, Eide T. et al. Long-term risk of colorectal cancerin individuals with serrated polyps[J]. Gut, 2015, 64(6):929-936. doi: 10.1136/gutjnl-2014-307793 URL
[11]	Arnold M, Sierra MS, Laversanne M. et al. Global patterns and trends in colorectal cancer incidence and mortality[J]. Gut, 2017, 66(4):683-691. doi: 10.1136/gutjnl-2015-310912 URL
[12]	Mikolasevic I, Orlic L, Stimac D. et al. Non-alcoholic fatty liver disease and colorectal cancer[J]. Postgrad Med J, 2017, 93(1097):153-158. doi: 10.1136/postgradmedj-2016-134383 pmid: 27852946
[13]	李文洁, 商春雨, 桑慧, 等. 结直肠息肉发病相关危险因素分析[J]. 胃肠病学和肝病学杂志, 2020, 29(9):1037-1041.
[14]	Bhatt BD, Lukose T, Siegel AB. et al. Increased risk of colorectal polyps in patients with non-alcoholic fatty liver disease undergoing liver transplant evaluation[J]. J Gastrointest Oncol, 2015, 6(5):459-468.
[15]	张鹏, 李斌, 韩怡. 老年结直肠息肉的危险因素及其与脂肪肝的相关性分析[J]. 实用老年医学, 2019, 33(7):697-700.
[16]	林晓晓, 胡思思, 余颖聪, 等. 非酒精性脂肪肝与结直肠腺瘤性息肉发病相关性分析[J]. 数理医药学杂志, 2019, 32(9):1278-1280.
[17]	陈亲芬. 非酒精性脂肪肝与结直肠息肉的相关性研究[D]. 温州医科大学, 2018.
[18]	Gunn NT, Shiffman ML. The use of liver biopsy in nonalcoholic fatty liver disease: When to biopsy and in whom[J]. Clin Liver Dis, 2018, 22(1):109-119. doi: 10.1016/j.cld.2017.08.006 URL
[19]	Vilar-Gomez E, Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers[J]. J Hepatol, 2018, 68(2):305-315. doi: S0168-8278(17)32436-4 pmid: 29154965
[20]	钏莉雪, 常江, 赵锦涵, 等. 非酒精性脂肪性肝病与结直肠腺瘤性息肉的相关性分析[J]. 临床肝胆病杂志, 2020, 36(6):1299-1303.
[21]	刘晓, 李文丽, 孙建莉, 等. 非酒精性脂肪性肝病与结直肠腺瘤性息肉的关系研究[J]. 浙江医学, 2019, 41(5):453-456.
[22]	杨秋瑾, 郑杰, 杨婧, 等. 幽门螺杆菌感染对非酒精性脂肪性肝病及其相关结直肠息肉的影响研究[J]. 中国全科医学, 2021, 24(30):3855-3862. doi: 10.12114/j.issn.1007-9572.2021.00.549
[23]	Grivennikov SI. Inflammation and colorectal cancer: Colitis-associated neoplasia[J]. Semin Immunopathol, 2013, 35(2):229-244. doi: 10.1007/s00281-012-0352-6 pmid: 23161445
[24]	Armstrong MJ, Adams LA, Canbay A. et al. Extrahepatic complications of nonalcoholic fatty liver disease[J]. Hepatology, 2014, 59(3):1174-1197. doi: 10.1002/hep.26717 pmid: 24002776
[25]	郝婕, 王媛, 张倩, 等. 非酒精性脂肪肝病与结直肠肿瘤相关性研究进展[J]. 中国实用内科杂志, 2020, 40(7):595-598.
[26]	Angulo P. NAFLD, obesity, and bariatric surgery[J]. Gastroenterology, 2006, 130(6): 1848-1852. pmid: 16697746
[27]	费欢欢, 张宝, 管石侠, 等. 男性脂肪性肝病患者肠道机械屏障功能变化的研究[J]. 安徽医科大学学报, 2020, 55(11):1783-1787.

项目	对照组(n=44)	腺瘤组(n=139)	统计值	P值
年龄(岁)	48.32±12.33	54.21±10.48	t=-3.110	0.002
性别(男/女,例)	22/22	108/31	χ²=12.462	0.000
吸烟史(有/无,例)	22/22	103 /36	χ²=8.967	0.003
饮酒史(有/无,例)	26/18	101/38	χ²=2.898	0.089
高血压(有/无,例)	15/29	55/84	χ²=0.045	0.515
糖尿病(有/无,例)	5/39	46/93	χ²=7.430	0.006
BMI(kg/m²)	25.37±2.03	26.74±2.45	t=-3.361	0.001
FBG(mmol/L)	5.57±0.79	5.68±1.00	t=-0.629	0.530
TC(mmol/L)	5.13±0.77	5.28±0.91	t=-1.032	0.304
TG(mmol/L)	1.88(1.48-2.25)	1.93(1.54-2.47)	Z=1.445	0.148
LDL-C(mmol/L)	2.53±0.84	2.93±1.097	t=-2.217	0.028
HDL-C(mmol/L)	1.18±0.47	0.99±0.37	t=2.415	0.019
ALT(U/L)	26.32±9.42	31.12±12.67	t=-2.318	0.022
AST(U/L)	26.98±9.33	38.25±8.07	t=-7.770	0.000
UA(μmol/L)	290.50(234.00-323.50)	297.00(245.00-367.50)	Z=1.081	0.280
PLT(×10⁹/L)	233.59±59.02	200.22±48.33	t=3.777	0.000
FIB-4	1.103(0.743-1.538)	1.908(1.528-2.357)	Z=7.344	0.000

项目	对照组(n=44)	腺瘤组(n=139)	统计值	P值
年龄(岁)	48.32±12.33	54.21±10.48	t=-3.110	0.002
性别(男/女,例)	22/22	108/31	χ²=12.462	0.000
吸烟史(有/无,例)	22/22	103 /36	χ²=8.967	0.003
饮酒史(有/无,例)	26/18	101/38	χ²=2.898	0.089
高血压(有/无,例)	15/29	55/84	χ²=0.045	0.515
糖尿病(有/无,例)	5/39	46/93	χ²=7.430	0.006
BMI(kg/m²)	25.37±2.03	26.74±2.45	t=-3.361	0.001
FBG(mmol/L)	5.57±0.79	5.68±1.00	t=-0.629	0.530
TC(mmol/L)	5.13±0.77	5.28±0.91	t=-1.032	0.304
TG(mmol/L)	1.88(1.48-2.25)	1.93(1.54-2.47)	Z=1.445	0.148
LDL-C(mmol/L)	2.53±0.84	2.93±1.097	t=-2.217	0.028
HDL-C(mmol/L)	1.18±0.47	0.99±0.37	t=2.415	0.019
ALT(U/L)	26.32±9.42	31.12±12.67	t=-2.318	0.022
AST(U/L)	26.98±9.33	38.25±8.07	t=-7.770	0.000
UA(μmol/L)	290.50(234.00-323.50)	297.00(245.00-367.50)	Z=1.081	0.280
PLT(×10⁹/L)	233.59±59.02	200.22±48.33	t=3.777	0.000
FIB-4	1.103(0.743-1.538)	1.908(1.528-2.357)	Z=7.344	0.000

影响因素	B	SE	Wald χ²值	P值	OR值	95%CI
影响因素	B	SE	Wald χ²值	P值	OR值	下限	上限
年龄	0.087	0.039	5.077	0.024	1.091	1.011	1.177
性别	1.298	0.644	4.059	0.044	3.660	1.036	12.933
吸烟史	0.390	0.593	0.431	0.512	1.476	0.461	4.724
糖尿病史	0.582	0.782	0.554	0.457	1.790	0.386	8.297
BMI	0.294	0.149	3.911	0.048	1.342	1.003	1.796
LDL-C	0.104	0.312	0.110	0.740	1.109	0.061	2.046
HDL-C	-1.389	0.701	3.929	0.047	0.249	0.063	0.985
AST	0.186	0.049	14.435	0.000	1.205	1.094	1.327
FIB-4	1.425	0.689	4.280	0.039	4.157	1.078	16.031

影响因素	B	SE	Wald χ²值	P值	OR值	95%CI
影响因素	B	SE	Wald χ²值	P值	OR值	下限	上限
年龄	0.087	0.039	5.077	0.024	1.091	1.011	1.177
性别	1.298	0.644	4.059	0.044	3.660	1.036	12.933
吸烟史	0.390	0.593	0.431	0.512	1.476	0.461	4.724
糖尿病史	0.582	0.782	0.554	0.457	1.790	0.386	8.297
BMI	0.294	0.149	3.911	0.048	1.342	1.003	1.796
LDL-C	0.104	0.312	0.110	0.740	1.109	0.061	2.046
HDL-C	-1.389	0.701	3.929	0.047	0.249	0.063	0.985
AST	0.186	0.049	14.435	0.000	1.205	1.094	1.327
FIB-4	1.425	0.689	4.280	0.039	4.157	1.078	16.031