山东医药

目的 分析代谢相关脂肪性肝病(MAFLD)合并结直肠腺瘤性息肉(CAP)的影响因素，并构建预测模型。方法 选取MAFLD患者180例，其中102例经结肠镜检查及病理证实为CAP，记为MAFLD+CAP组；78例经结肠镜检查大致正常，记为MAFLD组。收集并比较两组患者的基本资料，包括性别、年龄、高血压史、吸烟史、饮酒史、粪便隐血试验结果、血红蛋白、血小板分布宽度、空腹血糖、小而密低密度脂蛋白胆固醇(sdLDL-C)等40个指标。采用Logistic回归分析法分析MAFLD合并CAP的影响因素，并构建MAFLD合并CAP的预测模型，采用受试者工作特征(ROC)曲线评估预测模型对MAFLD合并CAP的预测价值。应用R 4.2.0软件，绘制校准曲线评估模型的一致性。采用Bootstrap法重复抽样1 000次进行模型的内部验证，采用Hosmer-Lemeshow检验评估模型的准确度。结果 MAFLD+CAP组年龄、性别、高血压病史、吸烟史、饮酒史、粪便隐血试验结果、血红蛋白水平、血小板分布宽度、空腹血糖水平、sdLDL-C水平等资料，与MAFLD组相比，P均<0.05。性别、年龄、粪便隐血试验结果、sdLDL-C是MAFLD合并CAP的独立影响因素(P均<0.05)。据此构建了MAFLD合并CAP的预测模型P=1/(1+e^-Y)，其中P表示MAFLD合并CAP的概率，e为自然底数，Y=1.104×性别+1.236×粪便隐血试验+0.078×年龄+1.126×sdLDL-8.207，性别变量中男性为1、女性为0，粪便隐血试验(弱)阳性为1、阴性为0。预测模型的AUC为0.780，灵敏度为63.7%，特异度为78.2%。预测模型的校准曲线比较贴近理想曲线。预测模型的实际概率与预测概率比较，差异无统计学意义(P=0.233)。结论 性别、年龄、粪便隐血试验结果、sdLDL-C是MAFLD合并CAP的独立影响因素，基于上述影响因素构建的预测模型对MAFLD患者合并CAP的风险具有较高的预测价值。

Objective To analyze the risk factors for metabolic dysfunction-associated fatty liver disease(MAFLD) complicated with colorectal adenomatous polyps(CAP) and to construct a corresponding risk prediction model. Methods A total of 180 MAFLD patients were enrolled, including 102 cases with CAP(MAFLD+CAP group) and 78 cases without CAP(MAFLD group). We collected and compared the basic data of patients of the two groups, including 40 indicators of gender, age, hypertension, smoking, alcohol consumption, fecal occult blood test results, hemoglobin, platelet distribution width, fasting blood glucose, small dense low-density lipoprotein cholesterol(sdLDL-C), etc. Logistic Regression analysis was used to identify the influencing factors of MAFLD combined with CAP, and a predictive model was subsequently constructed. The predictive value of the model for MAFLD with CAP was evaluated using the receiver operating characteristic(ROC) curve. A calibration curve was plotted by using R 4. 2. 0 software to evaluate the consistency of the model. Internal validation of the model was performed by resampling 1,000 times using the Bootstrap method, and model accuracy was assessed using the Hosmer-Lemeshow test. Results Statistically significant differences were found in the data such as age, sex, history of hypertension, smoking history, drinking history, fecal occult blood test results, hemoglobin, platelet distribution width, fasting blood glucose, sdLDL-C, and others between the MAFLD+CAP group and MAFLD group(all P<0. 05). Sex, age, fecal occult blood test results, and sdLDL-C were identified as the independent risk factors for MAFLD combined with CAP(all P<0. 05). The risk prediction model based on these factors was formulated as P=1/(1 + e^-Y), where Y=1. 104 × sex + 1. 236 × fecal occult blood test + 0. 078 × age + 1. 126 × sdLDL-8. 207, with sex(male=1, female=0) and fecal occult blood test [(weakly) positive=1, negative=0]. The area under the ROC curve(AUC) of the prediction model was 0. 780, with a sensitivity of 63. 7%, and a specificity of 78. 2%. The calibration curve of the predictive model was close to the ideal curve. Hosmer-Lemeshow test analysis showed no statistically significant difference between the predicted and actual probabilities(P=0. 233), indicating good model fit. Conclusions Male sex, age,(weakly) positive fecal occult blood test, and sdLDL-C are risk factors for MAFLD complicated with CAP. The prediction model constructed in this study has a high predictive value.