目的 分析脂肪肝指数（fatty liver index，FLI）在代谢功能障碍相关脂肪性肝病（metabolic dysfunction-associated steatotic liver disease，MASLD）筛查中的诊断效能。 方法 前瞻性地选取2023年6月至2025年6月武汉市第四医院收治的109例MASLD患者作为研究对象，根据是否合并T2DM分为T2DM组（n = 42）和非T2DM组（n = 67）；另选取同期109例非MASLD作为对照。比较不同人群基线资料及FLI，采用二元logistics回归分析影响因素，采用受试者工作特征曲线（ROC）评估筛查效能。 结果 MASLD组患者吸烟史、高血压和T2DM占比显著高于非MASLD组（P < 0.05）。MASLD组收缩压、舒张压、腰围（WC）、体质量指数（BMI）、空腹血糖（FPG）、糖化血红蛋白（HbA_1c）、空腹胰岛素（FINS）、总胆固醇（TC）、甘油三酯（TG）、高敏C反应蛋白（hs-CRP）、γ-谷氨酰转移酶（GGT）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）及FLI水平均显著高于非MASLD组，而低密度脂蛋白胆固醇（LDL-C）、白蛋白（ALB）和前白蛋白（PA）水平则显著低于非MASLD组（P < 0.05）。MASLD合并T2DM患者高血压患病率高于非T2DM组（P < 0.05），且年龄、收缩压、WC、BMI、FPG、HbA_1c、FINS、TG、直接胆红素（DBIL）及FLI水平均显著高于非T2DM组（P < 0.05）。多因素分析显示，FLI、T2DM、HbA_1c和hs-CRP是MASLD的独立危险因素（P < 0.05）；而FLI、高血压、HbA_1c和FINS是T2DM患者中MASLD的独立危险因素（P < 0.05）。ROC曲线分析显示：筛查MASLD时，单一指标中FLI效能最佳（AUC = 0.886），其次为hs-CRP（AUC = 0.755）；联合预测模型效能更优（AUC = 0.916），截断值为0.433时，敏感度为88.1%、特异度为81.7%。在T2DM合并MASLD患者中，HbA_1c表现最佳（AUC = 0.802），其次为FLI（AUC = 0.724）；联合模型效能最优（AUC = 0.876），截断值为0.480时，敏感度为95.5%、特异度为77.1%。 结论 FLI是MASLD筛查的最佳单项预测指标，与T2DM、HbA_1c和hs-CRP联合应用效能更优。在T2DM患者中，FLI与高血压、HbA_1c和FINS联合筛查MASLD效果最佳。FLI作为无创指标在MASLD早期筛查中具有重要应用价值。

Objective To analyze the diagnostic efficacy of the fatty liver index （FLI） in the screening of metabolic dysfunction-associated steatotic liver disease （MASLD） Methods Prospectively， 109 patients diagnosed with MASLD who were admitted to our hospital between June 2023 and June 2025 were selected as the research subjects. They were classified into the diabetes group （n = 42） and the non-diabetes group （n = 67） according to the presence or absence of type 2 diabetes. Additionally， 109 patients without MASLD during the same period were chosen as the control group. The baseline data and Fatty Liver Index （FLI） of different groups were compared. Binary logistic regression analysis was conducted to identify the influencing factors， and the receiver operating characteristic curve （ROC） was employed to assess the screening efficacy. Results The proportions of smoking history， hypertension， and type 2 diabetes in the MASLD group were significantly higher compared to those in the non-MASLD group （P < 0.05）. The levels of systolic blood pressure， diastolic blood pressure， waist circumference， BMI， fasting plasma glucose， HbA_1c， fasting insulin， total cholesterol， triglycerides， hs-CRP， GGT， ALT， AST， TBIL， and FLI in the MASLD group were significantly higher than those in the non-MASLD group， whereas the levels of LDL-C， ALB， and PA were significantly lower than those in the non-MASLD group （P < 0.05）. The prevalence of hypertension in MASLD patients with type 2 diabetes was higher than that in the non-diabetic group （P < 0.05）， and the age， systolic blood pressure， waist circumference， BMI， fasting plasma glucose， HbA_1c， fasting insulin， triglycerides， DBIL， and FLI levels were significantly higher than those in the non-diabetic group （P < 0.05）. Multivariate analysis indicated that FLI， type 2 diabetes， HbA_1c， and hs-CRP were independent predictors for MASLD screening （P < 0.05）； in contrast， FLI， hypertension， HbA_1c， and FINS were independent predictors for MASLD screening in type 2 diabetes patients （P < 0.05）. ROC curve analysis demonstrated that in screening for MASLD， FLI had the best efficacy （AUC = 0.886）， followed by hs-CRP （AUC = 0.755）； the combined prediction model had better efficacy （AUC = 0.916）， with a cutoff value of 0.433， a sensitivity of 88.1%， and a specificity of 81.7%. In type 2 diabetes patients with MASLD， HbA_1c performed best （AUC = 0.802）， followed by FLI （AUC = 0.724）； the combined model had the best efficacy （AUC = 0.876）， with a cutoff value of 0.480， a sensitivity of 95.5%， and a specificity of 77.1%. Conclusions FLI stands out as the most effective single predictor for MASLD screening. Moreover， its efficacy is further enhanced when it is combined with type 2 diabetes， HbA_1c， and hs-CRP. Among patients with type 2 diabetes， the combination of FLI， hypertension， HbA_1c， and FINS yields the optimal screening results for MASLD. As a non-invasive indicator， FLI holds significant application value in the early screening of MASLD.