PO.PS01.09 · 人群科学
脂肪肝指数及AST/ALT比值用于预测低危韩国男性肝细胞癌：HEXA-G队列研究结果
Fatty liver index and AST/ALT ratio for hepatocellular carcinoma prediction in low-risk Korean men: Results from the HEXA-G cohort
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摘要 Abstract
中文摘要
背景：脂肪肝指数（FLI，一种源自BMI、腰围、甘油三酯及GGT的脂肪变性指数）及AST/ALT（De Ritis）比值在低危亚洲人群中对肝细胞癌（HCC）风险的预后效用尚未明确界定。我们在一个大型韩国队列中评估了它们的独立及增量预测价值。
方法：我们分析了来自Health Examinees-Gem（HEXA-G）队列（2004-2013年）的43,981例韩国男性（376例HCC病例）。通过排除糖尿病或慢性肝炎个体，定义了一个低危亚队列（n = 39,033）。多变量Cox模型在校正人口学、生活方式、社会经济及代谢因素后，评估了与对数转换后的FLI及AST/ALT比值的关联。增量预测价值采用似然比检验（LRT）、C统计量变化及贝叶斯信息准则（BIC）进行评估。使用惩罚回归的敏感性分析得出了相似的结果。
结果：在单变量分析中，AST/ALT比值与HCC存在粗关联，而FLI则无。校正后，这一模式发生逆转：AST/ALT比值变得无预测性——这与年龄、饮酒、吸烟及代谢因素的混杂效应一致——而log(FLI)在低危亚队列中成为一个适度的独立预测因子（校正HR 1.08；95% CI，1.01-1.16；p = 0.04）。区分度改善甚微（C统计量从0.715升至0.719），且传统FLI分类未能对风险进行分层。在完整队列中，log(FLI)仍与HCC独立相关（校正HR 1.11；95% CI，1.03-1.20；p = 0.009），并适度改善了模型拟合（LRT p = 0.011），但未能有意义地改善区分度（C统计量从0.795升至0.797）。De Ritis比值在任何模型中均未增加独立或增量价值。
结论：在低危及混合风险的韩国男性中，FLI在校正后仍是HCC的独立预测因子，尽管效应量适度。相反，AST/ALT比值在考虑人口学、生活方式及代谢混杂因素后丧失了所有预后价值。粗关联与校正关联之间的逆转凸显了AST/ALT存在显著混杂，以及FLI存在一个微小的、与代谢相关的信号。总体而言，这些发现表明FLI在低危环境中提供了一定的独立信息，但HCC风险预测的实质性改善将需要更稳健的生物标志物。
查看英文原文 English abstract
Background: The prognostic utility of the fatty liver index (FLI, a steatosis index derived from BMI, waist circumference, triglycerides, and GGT) and AST/ALT (De Ritis) ratio for hepatocellular carcinoma (HCC) risk in low-risk Asian populations is not well defined. We evaluated their independent and incremental predictive value in a large Korean cohort.
Methods: We analyzed 43,981 Korean men (376 HCC cases) from the Health Examinees-Gem (HEXA-G) cohort (2004-2013). A low-risk subcohort (n = 39,033) was defined by excluding individuals with diabetes or chronic hepatitis. Multivariable Cox models assessed associations with log-transformed FLI and the AST/ALT ratio after adjusting for demographic, lifestyle, socioeconomic, and metabolic factors. Incremental predictive value was evaluated using likelihood ratio tests (LRTs), changes in C-statistics, and Bayesian Information Criterion (BIC). Sensitivity analyses using penalized regression produced similar results.
Results: In univariable analyses, the AST/ALT ratio showed crude associations with HCC, whereas FLI did not. After adjustment, this pattern reversed: the AST/ALT ratio became non-predictive-consistent with confounding by age, alcohol consumption, smoking, and metabolic factors-while log(FLI) emerged as a modest independent predictor in the low-risk subcohort (adjusted HR 1.08; 95% CI, 1.01-1.16; p = 0.04). Discrimination improved minimally (C-statistic 0.715 to 0.719), and conventional FLI categories failed to stratify risk. In the full cohort, log(FLI) remained independently associated with HCC (adjusted HR 1.11; 95% CI, 1.03-1.20; p = 0.009) and modestly improved model fit (LRT p = 0.011) without meaningfully improving discrimination (C-statistic 0.795 to 0.797). The De Ritis ratio added no independent or incremental value in any model.
Conclusions: Across low-risk and mixed-risk Korean men, FLI remained an independent predictor of HCC after adjustment, although the effect size was modest. In contrast, the AST/ALT ratio lost all prognostic value after accounting for demographic, lifestyle, and metabolic confounding. The reversal of crude versus adjusted associations underscores substantial confounding for AST/ALT and a small, metabolically related signal for FLI. Overall, these findings highlight that FLI provides some independent information in low-risk settings, but substantial improvement in HCC risk prediction will require more robust biomarkers.
利益披露 Disclosure
S. Lee, None..
J. Kim, None.