Angiopoietin-like proteins (ANGPTLs) are closely related to insulin resistance and lipid metabolism, and may be a key in metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) (newly named metabolic-associated fatty liver disease (MAFLD)) is based on metabolic dysfunction. There may be some correlation between ANGPTLs and MAFLD, but the specific correlation is unclear. This study aims to explore the predictive role of ANGPTLs in MAFLD and its progression. Seven databases (PubMed, EMBASE, Cochrane Library, CNKI, WANFANG, CBM and Clinicaltrials.gov ) were searched with free terms and MeSH terms. The random-effects model was used to pool the data, and Standardized Mean Difference (SMD) and 95% confidence intervals (CI) were taken as the overall outcome. No language restrictions existed in the article selection. RevMan 5.3, Stata 16 and MetaXL software were applied to analyse the data and the GRADE system was utilized to assess the certainty of evidence. After reviewing 823 related articles, 13 studies (854 cases and 610 controls) met the inclusion criteria, and contributed to this meta-analysis. The results showed that circulating ANGPTL8 level was significantly elevated in the MAFLD group than in the healthy control group (SMD = 0.97 pg/mL, 95%CI: 0.77, 1.18). Conversely, there was no significant difference in the ANGPTL4 (SMD = 0.11 ng/mL, 95%CI: − 0.32, 0.54) and ANGPTL3 (SMD = − 0.95 ng/mL, 95%CI: − 4.38, 2.48) between the two groups. Subgroup analysis showed that: 1) the MAFLD group had significantly higher ANGPTL8 levels than the healthy control group in Asian and other races; 2) the ANGPTL8 levels in Body Mass Index (BMI) > 25 kg/m2 patients with MAFLD were higher than those in the healthy control group; 3) the higher ANGPTL8 levels were observed in moderate to severe MAFLD group than the healthy control group. Meta-regression demonstrated that BMI might effectively explain the high heterogeneity. No significant publication bias existed (P > 0.05). The certainty of evidence was assessed as very low by the GRADE system. The ANGPTLs may be related to MAFLD. The increased ANGPTL8 level may be positively correlated with different situations of MAFLD, which may act as a potential indicator to monitor the development trends.

中文翻译：

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代谢相关脂肪肝中的循环血管生成素样蛋白：系统评价和荟萃分析

血管生成素样蛋白（ANGPTLs）与胰岛素抵抗和脂质代谢密切相关，可能是代谢综合征的关键。非酒精性脂肪肝（NAFLD）（新命名的代谢相关性脂肪肝（MAFLD））是基于代谢功能障碍。ANGPTLs与MAFLD之间可能存在一定的相关性，但具体的相关性尚不清楚。本研究旨在探讨ANGPTLs在MAFLD及其进展中的预测作用。七个数据库（PubMed、EMBASE、Cochrane Library、CNKI、WANFANG、CBM 和Clinicaltrials.gov）使用免费术语和MeSH 术语进行搜索。随机效应模型用于合并数据，并以标准化平均差 (SMD) 和 95% 置信区间 (CI) 作为总体结果。文章选择中不存在语言限制。RevMan 5.3，应用Stata 16和MetaXL软件分析数据，并利用GRADE系统评估证据的确定性。在回顾了 823 篇相关文章后，13 项研究（854 例病例和 610 例对照）符合纳入标准，并对本次荟萃分析做出了贡献。结果显示，MAFLD组的循环ANGPTL8水平显着高于健康对照组（SMD = 0.97 pg/mL，95%CI：0.77、1.18）。相反，ANGPTL4 (SMD = 0.11 ng/mL, 95%CI: − 0.32, 0.54) 和 ANGPTL3 (SMD = − 0.95 ng/mL, 95%CI: − 4.38, 2.48) 在两者之间没有显着差异组。亚组分析表明：1）亚洲及其他种族MAFLD组ANGPTL8水平明显高于健康对照组；2) 体重指数 (BMI) 中的 ANGPTL8 水平 > 25 kg/m2 MAFLD患者高于健康对照组；3）中重度MAFLD组ANGPTL8水平高于健康对照组。元回归表明 BMI 可能有效地解释了高异质性。不存在显着的发表偏倚（P > 0.05）。GRADE 系统评估证据的质量非常低。ANGPTL 可能与 MAFLD 相关。ANGPTL8水平升高可能与MAFLD的不同情况呈正相关，可作为监测发展趋势的潜在指标。不存在显着的发表偏倚（P > 0.05）。GRADE 系统评估证据的质量非常低。ANGPTL 可能与 MAFLD 相关。ANGPTL8水平升高可能与MAFLD的不同情况呈正相关，可作为监测发展趋势的潜在指标。不存在显着的发表偏倚（P > 0.05）。GRADE 系统评估证据的质量非常低。ANGPTL 可能与 MAFLD 相关。ANGPTL8水平升高可能与MAFLD的不同情况呈正相关，可作为监测发展趋势的潜在指标。