脂肪肝指数在代谢功能障碍相关脂肪性肝病筛查中的诊断效能分析

doi:10.3969/j.issn.1006-5725.2026.03.008

Abstract

Abstract:

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.

Key words: metabolic dysfunction-associated steatotic liver disease, fatty liver index, metabolic disorder, screening, efficacy

CLC Number:

R575

Lili FAN,Hongmin LI,Kan ZHOU,Bo XU. Analysis of the diagnostic efficacy of fat liver index in the screening of metabolic dysfunction-related fatty liver diseases[J]. The Journal of Practical Medicine, 2026, 42(3): 416-424.

Figures/Tables 10

Tab.1

Comparison of baseline data and FLI between MASLD and Non-MASLD groups"

项目	MASLD组（n = 109）	非MASLD组（n = 109）	t/χ²值	P值
年龄/岁	49.20 ± 9.98	47.15 ± 9.74	1.539	0.125
性别/［例（%）］			3.604	0.058
男	64（58.72）	50（45.87）
女	45（41.28）	59（54.13）
受教育程度/［例（%）］			1.009	0.604
小学及以下	18（16.51）	15（13.76）
高中及初中	52（47.71）	48（44.04）
大专及以上	39（35.78）	46（42.20）
吸烟史/［例（%）］			5.887	0.015
是	38（34.86）	22（20.18）
否	71（65.14）	87（79.82）
饮酒史/［例（%）］			2.755	0.097
是	28（25.69）	18（16.51）
否	81（74.31）	91（83.49）
高血压/［例（%）］			9.920	0.002
是	58（53.21）	35（32.11）
否	51（46.79）	74（67.89）
T2DM/［例（%）］			13.246	0.000
是	42（38.53）	18（16.51）
否	67（61.47）	91（83.49）
高脂血症/［例（%）］			3.328	0.068
是	67（61.47）	51（46.79）
否	42（38.53）	58（53.21）
收缩压/mmHg	134.12 ± 19.4	125.03 ± 18.19	3.568	< 0.001
舒张压/mmHg	83.22 ± 10.05	75.96 ± 10.21	5.289	< 0.001
WC/cm	88.35 ± 10.28	75.00 ± 7.94	10.730	< 0.001
BMI/（kg/m2）	26.8 ± 3.04	23.41 ± 2.53	8.944	< 0.001
FPG/（mmol/L）	6.18 ± 1.90	5.07 ± 0.83	5.602	< 0.001
HbA_1c/%	6.51 ± 1.56	5.57 ± 0.86	5.546	< 0.001
FINS（mU/L）	16.43 ± 8.64	14.16 ± 4.34	2.456	< 0.001
TG/（mg/dL）	191.12 ± 85.72	94.31 ± 43.11	10.535	< 0.001
TC/（mmol/L）	5.27 ± 0.96	4.76 ± 1.00	3.826	< 0.001
HDL-C/（mmol/L）	1.10 ± 0.28	1.04 ± 0.22	1.596	0.112
LDL-C/（mmol/L）	3.24 ± 0.85	3.54 ± 0.82	2.698	0.008
hs-CRP/（mg/L）	3.77 ± 2.27	1.89 ± 1.12	7.789	< 0.001
GGT/（U/L）	53.06 ± 25.26	26.35 ± 15.34	9.439	< 0.001
ALT/（U/L）	43.53 ± 27.38	24.28 ± 9.77	6.913	< 0.001
AST/（U/L）	36.56 ± 17.99	25.95 ± 9.05	5.503	< 0.001
TBIL/（μmol/L）	16.33 ± 6.03	10.84 ± 4.69	7.502	< 0.001
DBIL/（μmol/L）	4.26 ± 1.83	4.58 ± 1.60	1.370	0.172
ALB/（g/L）	42.80 ± 3.74	44.72 ± 3.44	3.949	< 0.001
PA/（mg/L）	265.48 ± 48.20	297.08 ± 29.73	5.827	< 0.001
FLI	65.13 ± 23.61	29.00 ± 16.95	12.977	< 0.001

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Fig.1

Fig.2

Tab.6

Fig.3

Fig.4

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项目	T2DM组（n = 42）	非T2DM组（n = 67）	t/χ²值	P值
年龄/岁	52.33 ± 8.63	47.24 ± 10.32	2.667	0.009
性别/［例（%）］			0.287	0.592
男	26（61.90）	38（56.72）
女	16（38.10）	29（43.28）
受教育程度/［例（%）］			1.201	0.549
小学及以下	9（21.40）	9（13.40）
高中及初中	19（45.20）	33（49.30）
大专及以上	14（33.30）	25（37.30）
吸烟史/［例（%）］			0.314	0.575
是	16（38.10）	22（32.84）
否	26（61.90）	45（67.16）
饮酒史/［例（%）］			0.992	0.319
是	13（30.95）	15（22.39）
否	29（69.05）	52（77.61）
高血压/［例（%）］			4.969	0.026
是	28（66.67）	30（44.78）
否	14（33.33）	37（55.22）
高脂血症/［例（%）］			2.862	0.091
是	30（71.43）	37（55.22）
否	12（28.57）	30（44.78）
收缩压/mmHg	139.01 ± 18.38	131.05 ± 19.52	2.117	0.037
舒张压/mmHg	84.98 ± 10.97	82.11 ± 9.35	1.459	0.147
WC/cm	90.92 ± 10.04	86.74 ± 10.17	2.095	0.039
BMI/（kg/m2）	27.75 ± 3.11	26.20 ± 2.85	2.656	0.009
FPG/（mmol/L）	7.87 ± 1.97	5.12 ± 0.72	10.367	0.000
HbA_1c/%	8.13 ± 1.23	5.49 ± 0.54	15.435	0.000
FINS/（mU/L）	19.50 ± 10.25	14.51 ± 6.87	3.042	0.003
TG/（mg/dL）	212.22 ± 97.19	177.90 ± 75.46	2.065	0.041
TC/（mmol/L）	5.14 ± 1.08	5.34 ± 0.87	1.062	0.291
HDL-C/（mmol/L）	1.05 ± 0.28	1.12 ± 0.29	1.184	0.239
LDL-C/（mmol/L）	3.44 ± 0.79	3.11 ± 0.87	1.979	0.050
hs-CRP/（mg/L）	4.22 ± 2.09	3.5 ± 2.35	1.631	0.106
GGT/（U/L）	56.74 ± 28.82	50.76 ± 22.67	1.205	0.231
ALT/（U/L）	42.60 ± 29.59	44.12 ± 26.11	0.282	0.779
AST/（U/L）	38.64 ± 18.04	35.25 ± 17.97	0.957	0.341
TBIL/（μmol/L）	15.52 ± 6.45	16.83 ± 5.73	1.102	0.273
DBIL/（μmol/L）	5.00 ± 2.02	3.79 ± 1.55	3.500	0.001
ALB/（g/L）	42.52 ± 4.27	42.98 ± 3.39	0.619	0.537
PA/（mg/L）	259.60 ± 53.03	269.16 ± 44.93	1.009	0.315
FLI	76.61 ± 20.94	57.88 ± 22.56	4.335	0.000

指标	β	标准误	Wald χ²	P值	OR（95%CI）
T2DM	0.891	0.342	6.785	0.009	2.437（1.248 ~ 4.761）
HbA_1c	0.367	0.156	5.532	0.019	1.444（1.064 ~ 1.960）
hs-CRP	0.168	0.076	4.879	0.027	1.183（1.019 ~ 1.373）
FLI	0.682	0.089	58.763	< 0.001	1.978（1.661 ~ 2.355）

指标	β	标准误	Wald χ²	P值	OR（95%CI）
高血压	1.134	0.498	5.183	0.023	3.107（1.170 ~ 8.247）
HbA_1c	0.485	0.198	6.014	0.014	1.624（1.101 ~ 2.396）
FINS	0.076	0.032	5.625	0.018	1.079（1.013 ~ 1.149）
FLI	0.523	0.145	13.016	< 0.001	1.687（1.270 ~ 2.240）

指标	AUC	特异度	敏感度	约登指数	最佳截断值	P值	95%CI
FINS	0.589	0.945	0.624	0.569	14.800 mU/L	0.023	0.510 ~ 0.668
hs-CRP	0.755	0.874	0.578	0.452	2.350 mg/L	< 0.001	0.688 ~ 0.822
FLI	0.886	0.946	0.587	0.533	50.200	< 0.001	0.842 ~ 0.930
联合	0.916	0.817	0.881	0.698	0.433	< 0.001	0.878 ~ 0.955

指标	AUC	特异度	敏感度	约登指数	最佳截断值	P值	95%CI
HbA_1c	0.802	1.000	0.762	0.762	6.000%	< 0.001	0.689 ~ 0.916
FINS	0.655	1.000	0.238	0.238	15.000 mU/L	0.007	0.541 ~ 0.768
FLI	0.724	0.970	0.357	0.357	60.000	< 0.001	0.626 ~ 0.822
联合	0.876	0.771	0.955	0.726	0.480	< 0.001	0.794 ~ 0.958

Analysis of the diagnostic efficacy of fat liver index in the screening of metabolic dysfunction-related fatty liver diseases

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