海口地区体检人群非酒精性脂肪性肝病患病率调查分析
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摘要
目的了解海口地区非酒精性脂肪性肝病(NAFLD)的流行现状,分析NAFLD与代谢综合征及其相关组分的关系。方法选取2016年9月-2017年8月在海口市人民医院进行健康体检者18 771例,测量身高、体质量、血压、空腹血糖、血脂、肝功能等指标,行肝脏B超检查。计算NAFLD的患病率,分析NAFLD与代谢综合征及其相关组分的关系。计量资料2组间比较采用t检验;计数资料组间比较采用χ2检验。结果 18771例体检对象中NAFLD 5715例,患病率为30.45%;男性NAFLD患病率为41.74%,女性NAFLD患病率为17.22%。男性NAFLD患病高峰年龄为45~59岁,女性NAFLD患病高峰年龄为45岁及以上。男性中度NAFLD患病率高于女性(8.10%vs 1.19%,χ2=476.1,P<0.001)。男性人群中肥胖、超重者的NAFLD患病率较高,女性人群中肥胖者NAFLD患病率较高,男性和女性中不同BMI水平组的NAFLD患病率差异均有统计学意义(χ2值分别为2111、1917,P值均<0.001)。NAFLD患者BMI、血压、FPG、TG、ALT、AST、GGT明显高于非NAFLD者,而HDL明显降低,差异均有统计学意义(t值分别为41.276、32.339、31.487、12.185、9.716、38.382、26.350、25.291、15.008,P值均<0.001)。结论海口地区体检人群NAFLD患病率较高,男性患病率高于女性;NAFLD代谢综合征及其相关组分关系密切。
Objective To investigate the prevalence of nonalcoholic fatty liver disease(NAFLD) in Haikou,China and the association of NAFLD with metabolic syndrome(MS) and its components. Methods A total of 18771 persons who underwent physical examination in Haikou People's Hospital from September 2016 to August 2017 were enrolled. Body height,body weight,blood pressure,fasting plasma glucose,blood lipids,and liver function parameters were measured,and ultrasound examination was performed for the liver. The prevalence rate of NAFLD was calculated,and the association of NAFLD with MS and its components was analyzed. The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results Of all18771 persons,5715 had NAFLD,resulting in a prevalence rate of 30. 45%; the prevalence rate of NAFLD was 41. 74% in men and17. 22% in women. Men aged 45-59 years had the highest prevalence rate of NAFLD,and women aged ≥45 years had the highest prevalence rate. Men had a significantly higher prevalence rate of moderate NAFLD than women(8. 10% vs 1. 19%,χ2= 476. 1,P < 0. 001).Men with obesity and overweight had a higher prevalence rate of NAFLD,and women with obesity had a higher prevalence rate; in both men and women,there was a significant difference in the prevalence rate of NAFLD between groups with different levels of body mass index(BMI)(χ2= 2111,1917,all P < 0. 001). NAFLD patients had significantly higher BMI,blood pressure,fasting plasma glucose,triglyceride,alanine aminotransferase,aspartate aminotransferase,and gamma-glutamyl transpeptidase than non-NAFLD patients(t = 41. 276,32. 339,31. 487,12. 185,9. 716,38. 382,26. 350,25. 291,and 15. 008,all P < 0. 001). Conclusion There is a high prevalence rate of NAFLD in people undergoing physical examination in Haikou,and men tend to have a higher prevalence rate than women. NAFLD is closely associated with MS and its components.
Objective To investigate the prevalence of nonalcoholic fatty liver disease(NAFLD) in Haikou,China and the association of NAFLD with metabolic syndrome(MS) and its components. Methods A total of 18771 persons who underwent physical examination in Haikou People's Hospital from September 2016 to August 2017 were enrolled. Body height,body weight,blood pressure,fasting plasma glucose,blood lipids,and liver function parameters were measured,and ultrasound examination was performed for the liver. The prevalence rate of NAFLD was calculated,and the association of NAFLD with MS and its components was analyzed. The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results Of all18771 persons,5715 had NAFLD,resulting in a prevalence rate of 30. 45%; the prevalence rate of NAFLD was 41. 74% in men and17. 22% in women. Men aged 45-59 years had the highest prevalence rate of NAFLD,and women aged ≥45 years had the highest prevalence rate. Men had a significantly higher prevalence rate of moderate NAFLD than women(8. 10% vs 1. 19%,χ2= 476. 1,P < 0. 001).Men with obesity and overweight had a higher prevalence rate of NAFLD,and women with obesity had a higher prevalence rate; in both men and women,there was a significant difference in the prevalence rate of NAFLD between groups with different levels of body mass index(BMI)(χ2= 2111,1917,all P < 0. 001). NAFLD patients had significantly higher BMI,blood pressure,fasting plasma glucose,triglyceride,alanine aminotransferase,aspartate aminotransferase,and gamma-glutamyl transpeptidase than non-NAFLD patients(t = 41. 276,32. 339,31. 487,12. 185,9. 716,38. 382,26. 350,25. 291,and 15. 008,all P < 0. 001). Conclusion There is a high prevalence rate of NAFLD in people undergoing physical examination in Haikou,and men tend to have a higher prevalence rate than women. NAFLD is closely associated with MS and its components.
引文
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[8]GE H,CHEN J,SUN YM,et al.Prevalence of nonalcoholic fatty fiver disease and its correlated risk factors in health population in Guangzhou[J].Natl Med J China,2016,96(46):3706-3709.(in Chinese)葛辉,陈君,孙毅明,等.广州市健康体检人群非酒精性脂肪肝患病情况及相关危险因素分析[J].中华医学杂志,2016,96(46):3706-3709.
[9]HU L,LI Y.The prevalence and metabolic risk factors of nonalcoholic fatty liver disease among middle-aged and aged people[J].J Pract Med,2017,33(4):632-635.(in Chinese)胡玲,李宇.中老年体检人群非酒精性脂肪肝患病率调查及与代谢相关因素的相关性[J].实用医学杂志,2017,33(4):632-635.
[10]DONG ZX,LU LG.An interpretation of the 2015 JSGE Evidencebased clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis[J/CD].Chin J Front Med Sci:Electronic Version,2015,7(4):19-22.(in Chinese)董志霞,陆伦根.2015 JSGE非酒精性脂肪性肝病/非酒精性脂肪性肝炎循证临床实践指南解读[J/CD].中国医学前沿杂志:电子版,2015,7(4):19-22.
[11]ZHAO XY,CHEN WH,LU YG,et al.Prevalence rate of non-alcoholic fatty liver disease among 33843 office workers in Hebei Province,China,and related risk factors[J].Chin J Gerontol,2013,33(20):5079-5081.(in Chinese)赵晓云,陈伟华,路永刚,等.河北省33843机关职员非酒精性脂肪肝患病率及其危险因素[J].中国老年医学杂志,2013,33(20):5079-5081.
[12]CHANG BX,LI BS,ZOU ZS.An excerpt of EASL-EASD-EASO clinical practice guide lines for the management of non-alcoholic fatty live disease(2016)[J].J Clin Hepatol,2016,32(8):1450-1454.(in Chinese)常彬霞,李保森,邹正升.《2016年欧洲肝病学会、欧洲糖尿病学会和欧洲肥胖学会临床实践指南:非酒精性脂肪性肝病》摘译[J].临床肝胆病杂志,2016,32(8):1450-1454.
[13]MOHAMMAD RF,RAMIN N,ALIREZA S,et al.The prevalence of metabolic syndrome in non-alcoholic fatty liver disease;A population based study[J].Middle East J Dig Dis,2016,8(2):131-137.
[14]GU Z,LI D,HE HY,et al.Body mass index,waist circumference,and waist-to-height ratio for prediction of multiple metabolic risk factors in Chinese elderly population[J].Sci Rep,2018,8(1):385.
[15]ZHU CY,ZHOU D,FAN JG.Advances in diagnosis and treatment of nonalcoholic fatty liver disease[J].Chin J Hepatol,2016,24(2):81-84.(in Chinese)朱婵艳,周达,范建高.非酒精性脂肪性肝病的诊断与治疗进展[J].中华肝脏病杂志,2016,24(2):81-84.
[16]LI M,GULINAZI TEX,DUAN BH.Relationship between A-FABP level and insulin resistance in type 2 diabetic patients with nonalcoholic fatty liver disease[J].J Chin Exp Med,2017,16(15):1487-1490.(in Chinese)李敏,古丽娜孜·吐尔逊,段伯焕.2型糖尿病合并非酒精性脂肪性肝病患者A-FABP水平与胰岛素抵抗的相关性研究[J].临床和实验医杂志,2017,16(15):1487-1490.
[17]SUNG KP,MI HS,HO CS,et al.Clinical availability of nonalcoholic fatty liver disease as an early predictor of type 2 diabetes mellitus in Korean men:5-year prospective cohort study[J].Hepatology,2013,57(4):1378-1383.
[18]DING WJ,FAN JG.A brief introduction of the guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease by World Gastroenterology Organization[J].J Pract Hepatol,2014,17(5):1-4.(in Chinese)丁雯瑾,范建高.世界胃肠病组织非酒精性脂肪性肝病诊疗指南简介[J].实用肝脏病杂志,2014,17(5):1-4.
[19]YOUNOSSI ZM,KOENIG AB,ABDELATIF D,et al.Global epidemiology of nonalcoholic fatty liver disease Meta-analytic assessment of prevalence,incidence,and outcomes[J].Hepatology,2016,64(1):73-84.
[20]BYRNE CD,TARGHER G.NAFLD:A multisystem disease[J].JHepatol,2015,62(1 Suppl):s47-s64.
[2]CHANG BX,ZOU ZS,LI BS,et al.2015 The Japanese Society of Gastroenterology of Evidence-based clinical practice guide line for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis[J].JClin Hepatol,2015,31(7):1027-1030.(in Chinese)常彬霞,邹正升,李保森,等.2015年日本胃肠病学会非酒精性脂肪肝病/非酒精性脂肪肝炎的循证医学临床治疗指南[J].临床肝胆病杂志,2015,31(7):1027-1030.
[3]Group of Fatty Liver and Alcoholic Liver Diseases,Society of Hepatology,Chinese Medical Association.Guidelines for management of non-alcoholic fatty liver disease[J].J Clin Hepatol,2010,26(2):120-124.(in Chinese)中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].临床肝胆病杂志,2010,26(2):120-124.
[4]Fatty Liver and Alcohol Liver Disease Study Group of the Chinese Liver Disease Association.Guidelines for diagnosis and treatment of nonalcoholic fatty liver diseases[J].Chin J Hepatol,2006,14(3):161-163.(in Chinese)中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].中华肝脏病杂志,2006,14(3):161-163.
[5]XIN FZ,FAN JG.An interpretation of European guidelines for the diagnosis and treatment of nonalcoho Hc fatty liver diease[J].Chin J Hepatol,2016,24(6):403-405.(in Chinese)信丰智,范建高.欧洲非酒精性脂肪性肝病诊疗指南解读[J].中华肝脏病杂志,2016,24(6):403-405.
[6]CAO Y,WANG C,SHI WQ,et al.Prevalence and metabolic risk factors of nonalcobolic fatty liver disease in a middle-aged and elderly population in Guangzhou[J].Chin J Epidemiol,2015,36(9):958-961.(in Chinese)曹意,王澄,师雯琦,等.广州市中老年人非酒精性脂肪肝患病率及代谢相关因素分析[J].中华流行病学杂志,2015,36(9):958-961.
[7]EUN HJ,DAE WJ,YONG KC,et al.Regional prevalence of non alcoholic fatty liver disease in Seoul and Gyeonggido,Korea[J].Clin Mol Hepatol,2013,19(3):266-272.
[8]GE H,CHEN J,SUN YM,et al.Prevalence of nonalcoholic fatty fiver disease and its correlated risk factors in health population in Guangzhou[J].Natl Med J China,2016,96(46):3706-3709.(in Chinese)葛辉,陈君,孙毅明,等.广州市健康体检人群非酒精性脂肪肝患病情况及相关危险因素分析[J].中华医学杂志,2016,96(46):3706-3709.
[9]HU L,LI Y.The prevalence and metabolic risk factors of nonalcoholic fatty liver disease among middle-aged and aged people[J].J Pract Med,2017,33(4):632-635.(in Chinese)胡玲,李宇.中老年体检人群非酒精性脂肪肝患病率调查及与代谢相关因素的相关性[J].实用医学杂志,2017,33(4):632-635.
[10]DONG ZX,LU LG.An interpretation of the 2015 JSGE Evidencebased clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis[J/CD].Chin J Front Med Sci:Electronic Version,2015,7(4):19-22.(in Chinese)董志霞,陆伦根.2015 JSGE非酒精性脂肪性肝病/非酒精性脂肪性肝炎循证临床实践指南解读[J/CD].中国医学前沿杂志:电子版,2015,7(4):19-22.
[11]ZHAO XY,CHEN WH,LU YG,et al.Prevalence rate of non-alcoholic fatty liver disease among 33843 office workers in Hebei Province,China,and related risk factors[J].Chin J Gerontol,2013,33(20):5079-5081.(in Chinese)赵晓云,陈伟华,路永刚,等.河北省33843机关职员非酒精性脂肪肝患病率及其危险因素[J].中国老年医学杂志,2013,33(20):5079-5081.
[12]CHANG BX,LI BS,ZOU ZS.An excerpt of EASL-EASD-EASO clinical practice guide lines for the management of non-alcoholic fatty live disease(2016)[J].J Clin Hepatol,2016,32(8):1450-1454.(in Chinese)常彬霞,李保森,邹正升.《2016年欧洲肝病学会、欧洲糖尿病学会和欧洲肥胖学会临床实践指南:非酒精性脂肪性肝病》摘译[J].临床肝胆病杂志,2016,32(8):1450-1454.
[13]MOHAMMAD RF,RAMIN N,ALIREZA S,et al.The prevalence of metabolic syndrome in non-alcoholic fatty liver disease;A population based study[J].Middle East J Dig Dis,2016,8(2):131-137.
[14]GU Z,LI D,HE HY,et al.Body mass index,waist circumference,and waist-to-height ratio for prediction of multiple metabolic risk factors in Chinese elderly population[J].Sci Rep,2018,8(1):385.
[15]ZHU CY,ZHOU D,FAN JG.Advances in diagnosis and treatment of nonalcoholic fatty liver disease[J].Chin J Hepatol,2016,24(2):81-84.(in Chinese)朱婵艳,周达,范建高.非酒精性脂肪性肝病的诊断与治疗进展[J].中华肝脏病杂志,2016,24(2):81-84.
[16]LI M,GULINAZI TEX,DUAN BH.Relationship between A-FABP level and insulin resistance in type 2 diabetic patients with nonalcoholic fatty liver disease[J].J Chin Exp Med,2017,16(15):1487-1490.(in Chinese)李敏,古丽娜孜·吐尔逊,段伯焕.2型糖尿病合并非酒精性脂肪性肝病患者A-FABP水平与胰岛素抵抗的相关性研究[J].临床和实验医杂志,2017,16(15):1487-1490.
[17]SUNG KP,MI HS,HO CS,et al.Clinical availability of nonalcoholic fatty liver disease as an early predictor of type 2 diabetes mellitus in Korean men:5-year prospective cohort study[J].Hepatology,2013,57(4):1378-1383.
[18]DING WJ,FAN JG.A brief introduction of the guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease by World Gastroenterology Organization[J].J Pract Hepatol,2014,17(5):1-4.(in Chinese)丁雯瑾,范建高.世界胃肠病组织非酒精性脂肪性肝病诊疗指南简介[J].实用肝脏病杂志,2014,17(5):1-4.
[19]YOUNOSSI ZM,KOENIG AB,ABDELATIF D,et al.Global epidemiology of nonalcoholic fatty liver disease Meta-analytic assessment of prevalence,incidence,and outcomes[J].Hepatology,2016,64(1):73-84.
[20]BYRNE CD,TARGHER G.NAFLD:A multisystem disease[J].JHepatol,2015,62(1 Suppl):s47-s64.