超重/肥胖人群血清糖醇水平与代谢相关脂肪性肝病的关联

doi:10.3969/j.issn.1674-8115.2026.07.014

摘要/Abstract

摘要：

目的·探讨超重/肥胖人群血清糖醇水平与代谢相关脂肪性肝病（metabolic dysfunction-associated steatotic liver disease，MASLD）之间的相关性。方法·采用横断面研究设计，选取2019年7月至2021年8月于上海交通大学医学院附属仁济医院肥胖门诊就诊，体质量指数（body mass index，BMI）≥25 kg/m²的超重/肥胖患者91例，并将研究人群分为MASLD组（67例）和非MASLD组（24例）。收集患者的一般资料（年龄、性别、BMI、血压）、血生化指标（肝功能、肾功能、血糖、血脂、胰岛素等）及血清糖醇水平（赤藓糖醇、木糖醇、山梨糖醇、麦芽糖醇）。血清糖醇采用气相色谱-质谱联用系统进行分离和定量分析。采用磁共振成像-质子密度脂肪分数测量肝脏脂肪含量、胰腺脂肪含量、腹部皮下脂肪组织和内脏脂肪组织。Spearman相关性检验分析血清糖醇与肝脏脂肪含量的相关性，单因素和多因素Logistic回归分析MASLD的相关因素。结果·共纳入91例超重/肥胖患者，中位年龄34.00（29.00，42.00）岁，中位BMI 33.04（29.60，36.46）kg/m²，其中男性占48.35%。MASLD组丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转肽酶、尿酸、甘油三酯、空腹胰岛素、胰岛素抵抗指数、糖化血红蛋白、胰腺脂肪含量、肝脏脂肪含量、内脏脂肪组织和赤藓糖醇水平均显著高于非MASLD组（均P<0.05）。Spearman相关性分析显示，超重/肥胖人群血清赤藓糖醇水平与肝脏脂肪含量呈正相关（r=0.209，P=0.046），而血清麦芽糖醇、木糖醇以及山梨糖醇与肝脏脂肪含量均无显著相关性。多因素Logistic回归模型校正性别、尿酸、胰岛素抵抗指数、甘油三酯后，血清赤藓糖醇水平升高仍是超重/肥胖患者发生MASLD的独立危险因素（OR=3.02，95%CI 1.15~7.94，P=0.025）。结论·超重/肥胖人群中血清赤藓糖醇水平与MASLD风险独立正相关。

关键词: 代谢相关脂肪性肝病, 赤藓糖醇, 超重, 肥胖, 糖醇

Abstract:

Objective ·To investigate the correlation between serum sugar alcohol levels and metabolic dysfunction-associated steatotic liver disease (MASLD) in the overweight/obese population. Methods ·This cross-sectional study enrolled 91 overweight/obese patients [body mass index (BMI)≥25 kg/m²] who visited the Obesity Clinic of Renji Hospital, Shanghai Jiao Tong University School of Medicine from July 2019 to August 2021. The participants were divided into the MASLD group (n=67) and the non-MASLD group (n=24). General data (age, sex, BMI, and blood pressure), blood biochemical parameters (liver function, renal function, blood glucose, lipid profile, insulin, etc.), and serum sugar alcohol levels (erythritol, xylitol, sorbitol, and maltitol) were collected. Serum sugar alcohol levels were quantified by gas chromatography-mass spectrometry. Magnetic resonance imaging-proton density fat fraction was used to measure liver fat content, pancreatic fat content, subcutaneous adipose tissue, and visceral adipose tissue. Spearman correlation analysis was used to analyze the correlation between serum sugar alcohol levels and liver fat content. Univariate and multivariate Logistic regression analyses were conducted to identify factors related with MASLD. Results ·A total of 91 overweight/obese patients were enrolled, with a median age of 34.00 (29.00, 42.00) years and a median BMI of 33.04 (29.60, 36.46) kg/m². Among them, 48.35% were male. The MASLD group showed significantly higher levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, uric acid, triglycerides, fasting insulin, homeostasis model assessment of insulin resistance, glycated hemoglobin, pancreatic fat content, liver fat content, visceral adipose tissue, and erythritol compared with the non-MASLD group (all P<0.05). Spearman correlation analysis showed that serum erythritol levels were positively correlated with liver fat content in the overweight/obese population (r=0.209, P=0.046), while maltitol, xylitol, and sorbitol showed no significant correlations with liver fat content. After adjustment for sex, uric acid, homeostasis model assessment of insulin resistance, and triglycerides, multivariate Logistic regression analysis revealed that elevated serum erythritol levels remained an independent risk factor for MASLD in overweight/obese patients (OR=3.02, 95%CI 1.15‒7.94, P=0.025). Conclusion ·Serum erythritol level is independently and positively associated with the risk of MASLD in the overweight/obese population.

Key words: metabolic dysfunction-associated steatotic liver disease (MASLD), erythritol, overweight, obesity, sugar alcohol

中图分类号:

R575.5

谈韬, 岳江, 綦一澄, 杨明兰, 麻静. 超重/肥胖人群血清糖醇水平与代谢相关脂肪性肝病的关联[J]. 上海交通大学学报（医学版）, 2026, 46(7): 954-960.

Tan Tao, Yue Jiang, Qi Yicheng, Yang Minglan, Ma Jing. Correlation between serum sugar alcohol concentrations and metabolic dysfunction-associated steatotic liver disease in the overweight/obese population[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(7): 954-960.

图/表 4

参考文献 26

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Index	Total (n=91)	Non-MASLD (n=24)	MASLD (n=67)	Z/χ²	P value
Age/year	34.00 (29.00, 42.00)	32.50 (28.00, 45.50)	35.00 (29.50, 42.00)	-0.57	0.567
Male/n(%)	44 (48.35)	7 (29.17)	37 (55.22)	4.80	0.028
BMI/(kg·m^-2)	33.04 (29.60, 36.46)	34.28 (28.14, 37.11)	32.77 (29.74, 36.26)	-0.26	0.791
Systolic blood pressure/mmHg	130.00 (121.25, 140.00)	124.00 (116.00, 135.50)	131.50 (123.00, 140.00)	-1.43	0.152
Diastolic blood pressure/mmHg	81.50 (77.00, 89.00)	79.50 (76.00, 89.25)	82.00 (77.00, 88.75)	-0.26	0.795
ALT/(U·L^-1)	29.00 (18.00, 54.50)	16.00 (13.75, 17.25)	44.00 (25.00, 69.00)	-5.88	<0.001
AST/(U·L^-1)	22.00 (16.00, 35.00)	16.00 (13.75, 18.25)	24.00 (20.00, 37.00)	-5.05	<0.001
GGT/(U·L^-1)	33.00 (19.50, 46.50)	19.50 (17.00, 26.00)	39.00 (27.00, 53.00)	-4.56	<0.001
Creatinine/(μmol·L^-1)	68.00 (60.00, 79.00)	66.50 (58.00, 74.75)	68.50 (62.00, 79.75)	-1.00	0.316
Uric acid/(μmol·L^-1)	397.00 (347.25, 475.25)	348.50 (305.00, 393.25)	416.00 (363.00, 524.50)	-3.28	0.001
eGFR/[mL·(min·1.73 m²)^-1]	109.50 (97.25, 116.00)	110.00 (96.25, 114.25)	109.50 (98.00, 118.25)	-0.36	0.718
TG/(mmol·L^-1)	1.76 (1.25, 2.35)	1.50 (0.98, 2.03)	1.86 (1.27, 2.47)	-2.22	0.027
TC/(mmol·L^-1)	5.26 (4.47, 5.80)	5.00 (4.34, 5.42)	5.30 (4.52, 5.87)	-1.29	0.198
HDL-C/(mmol·L^-1)	1.03 (0.89, 1.23)	1.08 (0.92, 1.26)	1.02 (0.89, 1.21)	-0.84	0.401
LDL-C/(mmol·L^-1)	3.19 (2.60, 3.62)	3.11 (2.48, 3.44)	3.24 (2.71, 3.80)	-1.34	0.181
FPG/(mmol·L^-1)	5.03 (4.68, 5.39)	4.80 (4.62, 5.17)	5.13 (4.73, 5.39)	-1.43	0.153
2 h PG/(mmol·L^-1)	7.13 (6.31, 8.27)	6.57 (6.00, 7.70)	7.42 (6.42, 8.47)	-1.90	0.057
FINS/(μIU·mL^-1)	14.21 (10.26, 20.57)	12.30 (9.06, 15.36)	15.61 (10.53, 21.88)	-2.47	0.013
HOMA-IR	3.27 (2.17, 4.49)	2.71 (1.97, 3.40)	3.51 (2.24, 5.18)	-2.45	0.014
HbA1c/%	5.40 (5.10, 5.70)	5.20 (5.00, 5.53)	5.40 (5.30, 5.70)	-1.96	0.049
PFC/%	5.32 (4.22, 9.39)	4.50 (2.45, 5.88)	5.95 (4.47, 10.39)	-2.48	0.013
LFC/%	12.58 (5.86, 22.07)	4.26 (2.87, 5.24)	16.79 (11.11, 25.10)	-7.24	<0.001
SAT/cm²	323.22 (264.22, 435.25)	302.27 (223.59, 446.75)	331.00 (268.54, 423.66)	-1.35	0.177
VAT/cm²	122.72 (95.00, 169.00)	85.34 (51.69, 148.15)	132.00 (109.60, 170.00)	-2.66	0.008
Erythritol/(μmol·L^-1)	10.34 (6.15, 18.30)	7.26 (5.11, 11.92)	11.47 (6.76, 23.21)	-2.62	0.009
Maltitol/(μmol·L^-1)	0.52 (0.50, 0.58)	0.52 (0.50, 0.55)	0.52 (0.50, 0.59)	-0.97	0.331
Xylitol/(μmol·L^-1)	9.09 (6.26, 11.95)	9.04 (5.80, 10.87)	9.09 (6.63, 12.20)	-1.02	0.307
Sorbitol/(μmol·L^-1)	2.14 (1.79, 3.04)	2.16 (1.83, 2.63)	2.14 (1.77, 3.04)	-0.06	0.950

Index	Total (n=91)	Non-MASLD (n=24)	MASLD (n=67)	Z/χ²	P value
Age/year	34.00 (29.00, 42.00)	32.50 (28.00, 45.50)	35.00 (29.50, 42.00)	-0.57	0.567
Male/n(%)	44 (48.35)	7 (29.17)	37 (55.22)	4.80	0.028
BMI/(kg·m^-2)	33.04 (29.60, 36.46)	34.28 (28.14, 37.11)	32.77 (29.74, 36.26)	-0.26	0.791
Systolic blood pressure/mmHg	130.00 (121.25, 140.00)	124.00 (116.00, 135.50)	131.50 (123.00, 140.00)	-1.43	0.152
Diastolic blood pressure/mmHg	81.50 (77.00, 89.00)	79.50 (76.00, 89.25)	82.00 (77.00, 88.75)	-0.26	0.795
ALT/(U·L^-1)	29.00 (18.00, 54.50)	16.00 (13.75, 17.25)	44.00 (25.00, 69.00)	-5.88	<0.001
AST/(U·L^-1)	22.00 (16.00, 35.00)	16.00 (13.75, 18.25)	24.00 (20.00, 37.00)	-5.05	<0.001
GGT/(U·L^-1)	33.00 (19.50, 46.50)	19.50 (17.00, 26.00)	39.00 (27.00, 53.00)	-4.56	<0.001
Creatinine/(μmol·L^-1)	68.00 (60.00, 79.00)	66.50 (58.00, 74.75)	68.50 (62.00, 79.75)	-1.00	0.316
Uric acid/(μmol·L^-1)	397.00 (347.25, 475.25)	348.50 (305.00, 393.25)	416.00 (363.00, 524.50)	-3.28	0.001
eGFR/[mL·(min·1.73 m²)^-1]	109.50 (97.25, 116.00)	110.00 (96.25, 114.25)	109.50 (98.00, 118.25)	-0.36	0.718
TG/(mmol·L^-1)	1.76 (1.25, 2.35)	1.50 (0.98, 2.03)	1.86 (1.27, 2.47)	-2.22	0.027
TC/(mmol·L^-1)	5.26 (4.47, 5.80)	5.00 (4.34, 5.42)	5.30 (4.52, 5.87)	-1.29	0.198
HDL-C/(mmol·L^-1)	1.03 (0.89, 1.23)	1.08 (0.92, 1.26)	1.02 (0.89, 1.21)	-0.84	0.401
LDL-C/(mmol·L^-1)	3.19 (2.60, 3.62)	3.11 (2.48, 3.44)	3.24 (2.71, 3.80)	-1.34	0.181
FPG/(mmol·L^-1)	5.03 (4.68, 5.39)	4.80 (4.62, 5.17)	5.13 (4.73, 5.39)	-1.43	0.153
2 h PG/(mmol·L^-1)	7.13 (6.31, 8.27)	6.57 (6.00, 7.70)	7.42 (6.42, 8.47)	-1.90	0.057
FINS/(μIU·mL^-1)	14.21 (10.26, 20.57)	12.30 (9.06, 15.36)	15.61 (10.53, 21.88)	-2.47	0.013
HOMA-IR	3.27 (2.17, 4.49)	2.71 (1.97, 3.40)	3.51 (2.24, 5.18)	-2.45	0.014
HbA1c/%	5.40 (5.10, 5.70)	5.20 (5.00, 5.53)	5.40 (5.30, 5.70)	-1.96	0.049
PFC/%	5.32 (4.22, 9.39)	4.50 (2.45, 5.88)	5.95 (4.47, 10.39)	-2.48	0.013
LFC/%	12.58 (5.86, 22.07)	4.26 (2.87, 5.24)	16.79 (11.11, 25.10)	-7.24	<0.001
SAT/cm²	323.22 (264.22, 435.25)	302.27 (223.59, 446.75)	331.00 (268.54, 423.66)	-1.35	0.177
VAT/cm²	122.72 (95.00, 169.00)	85.34 (51.69, 148.15)	132.00 (109.60, 170.00)	-2.66	0.008
Erythritol/(μmol·L^-1)	10.34 (6.15, 18.30)	7.26 (5.11, 11.92)	11.47 (6.76, 23.21)	-2.62	0.009
Maltitol/(μmol·L^-1)	0.52 (0.50, 0.58)	0.52 (0.50, 0.55)	0.52 (0.50, 0.59)	-0.97	0.331
Xylitol/(μmol·L^-1)	9.09 (6.26, 11.95)	9.04 (5.80, 10.87)	9.09 (6.63, 12.20)	-1.02	0.307
Sorbitol/(μmol·L^-1)	2.14 (1.79, 3.04)	2.16 (1.83, 2.63)	2.14 (1.77, 3.04)	-0.06	0.950

Variable	LFC
Variable	r	P value
Erythritol	0.209	0.046
Maltitol	0.026	0.809
Xylitol	-0.055	0.607
Sorbitol	-0.052	0.623

Variable	LFC
Variable	r	P value
Erythritol	0.209	0.046
Maltitol	0.026	0.809
Xylitol	-0.055	0.607
Sorbitol	-0.052	0.623

Variable	Univariate Logistic regression					Multivariate Logistic regression
Variable	β	SE	Z	OR (95%CI)	P value	β	SE	Z	OR (95%CI)	P value
Age	0.01	0.02	0.24	1.01 (0.96‒1.05)	0.808
Gender (female vs male)	-1.10	0.51	-2.14	0.33 (0.12‒0.91)	0.032	-0.10	0.76	-0.14	0.90 (0.20‒4.00)	0.891
BMI	0.03	0.05	0.69	1.03 (0.94‒1.13)	0.493
Uric acid	0.01	<0.01	2.82	1.01 (1.01‒1.02)	0.005	0.01	<0.01	2.06	1.01 (1.01‒1.02)	0.039
eGFR	0.01	0.02	0.46	1.01 (0.98‒1.04)	0.648
HOMA-IR	0.46	0.18	2.60	1.59 (1.12‒2.25)	0.009	0.43	0.24	1.81	1.53 (0.96‒2.44)	0.071
TG	0.64	0.32	2.02	1.90 (1.02‒3.55)	0.044	0.39	0.41	0.96	1.48 (0.67‒3.27)	0.336
Erythritol	0.92	0.39	2.34	2.50 (1.16‒5.39)	0.019	0.85	0.40	2.15	3.02 (1.15‒7.94)	0.025