目的 探讨空腹血糖水平与非酒精性脂肪性肝病（NAFLD）在不同性别之间的关系是否存在差异。 方法 回顾性分析2020年1月至2021年11月期间在武汉协和医院进行健康筛查的1 584例年龄≥ 40岁参与者，男1 143例，女441例。收集参与者健康筛查指标，包括一般人口学信息和常规生化检测资料，根据常规腹部B型超声扫描结果将参与者分为NAFLD组和非NAFLD组。采用基于平滑曲线拟合的广义相加模型描述不同性别空腹血糖与NAFLD风险之间的剂量-反应关系，两阶段logistic模型揭示潜在的非线性关系，并采用阈值效应分析确定非线性拐点。 结果 男性和女性NAFLD组的空腹血糖均显著高于非NAFLD组。调整年龄、BMI、抽烟、饮酒、高血压、ALT、AST、TC、TG、HDL-C和LDL-C等协变量后，女性空腹血糖与NAFLD呈正相关，空腹血糖与NAFLD的风险增加有关（OR = 1.29，95% CI：1.02 ~ 1.64）。男性空腹血糖与NAFLD呈非线性相关，当空腹血糖≤ 5.61 mmol/L时，空腹血糖与NAFLD的风险增加有关（OR = 1.58，95% CI：1.17 ~ 2.13），空腹血糖> 5.61 mmol/L时， NAFLD风险趋于稳定。 结论 女性空腹血糖与NAFLD均存在正向关系，而男性空腹血糖≤ 5.61 mmol/L时，NAFLD风险逐渐增加，当空腹血糖> 5.61 mmol/L时，NAFLD风险存在饱和效应。

Objective To investigate whether there are gender differences in the relationship between fasting blood glucose levels and non-alcoholic fatty liver disease （NAFLD）. Methods A retrospective analysis was conducted on 1，584 participants aged ≥ 40 who underwent health screening at Wuhan Union Hospital between January 2020 and November 2021. The cohort included 1，143 men and 441 women. Health screening indicators， including general demographic information and routine biochemical test data， were collected. Based on routine abdominal B-ultrasound scan results， participants were classified into NAFLD and non-NAFLD groups. The generalized additive model based on smooth curve fitting was used to describe the dose-response relationship between fasting blood glucose （FBG） and the risk of NAFLD in different genders. A two-stage logistic model was employed to reveal potential non-linear relationships， and threshold effect analysis was performed to determine the non-linear inflection point. Results FBG levels were significantly higher in the NAFLD group compared to the non-NAFLD group for both men and women. After adjusting for covariates such as age， BMI， smoking， alcohol consumption， hypertension， ALT， AST， TC， TG， HDL-C， and LDL-C， a positive linear correlation between FBG and NAFLD was observed in women， indicating that increased FBG was associated with a higher risk of NAFLD （OR = 1.29， 95% CI： 1.02 ~ 1.64）. In men， the relationship between FBG and NAFLD was non-linear. When FBG was ≤ 5.61 mmol/L， increased FBG was associated with a higher risk of NAFLD （OR = 1.58， 95% CI： 1.17 ~ 2.13）. However， when FBG exceeded 5.61 mmol/L， the risk of NAFLD plateaued. Conclusion There is a positive association between FBG and NAFLD in women. In men， NAFLD risk increases with FBG levels up to 5.61 mmol/L， beyond which the risk stabilizes， indicating a saturation effect.