社区人群血脂水平与非酒精性脂肪肝病发病风险队列研究

A prospective cohort study on the association between blood lipid levels and the risk of non-alcoholic fatty liver disease in a community population

目的分析社区成年人群血脂水平与非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)发病风险的关联性,为社区居民NAFLD综合防治提供依据。方法基于上海市自然人群队列下松江子队列进行前瞻性队列研究。收集检测研究对象基线时血清三酰甘油、总胆固醇、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)以及高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)水平,采用Cox比例风险模型和限制性立方样条模型分析研究对象的血脂水平与NAFLD发病风险的关联性及剂量-反应关系。结果7088名队列人员参与研究,经过2.96年(中位时间)的随访,队列人群新发NAFLD病例1512例,累积发病率为21.33%(95%CI:20.38%~22.29%),年均发病率为7.21%,发病密度为78.80/1000人年。发病人群中三酰甘油、总胆固醇及LDL-C水平均高于未发病人群,HDL-C水平低于未发病人群,差异有统计学意义(P<0.05)。多因素Cox回归结果表明,研究人群的基线三酰甘油水平与NAFLD发病风险呈正相关,总胆固醇最高五分位组相较于最低五分位组的NAFLD发病风险比(Hazard ratio,HR)为2.70(95%CI:2.13~3.42);基线HDL-C水平与NAFLD发病风险呈负相关,HDL-C最高五分位组相较于最低五分位组的NAFLD发病HR为0.77(95%CI:0.62~0.96)。限制性立方样条模型结果表明,血脂水平与NAFLD发病风险存在非线性关联,其中总胆固醇、LDL-C水平与NAFLD发病呈“U”型关联,男性NAFLD发病风险均高于女性。结论上海市社区成年人NAFLD发病风险较高,其血脂水平可能为NAFLD发病的独立危险因素。

Objective To assess the relationship between the blood lipid levels of community inhabitants and the risk of developing non-alcoholic fatty liver disease(NAFLD),to provide a basis for the comprehensive prevention and control of NAFLD in community residents.Methods We conducted a prospective cohort study using the Shanghai Natural Population Songjiang sub-cohort.Key parameters measured included baseline triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)levels.We used proportional Cox and restricted cubic spline models to analyze the relationship between blood lipid levels and the risk of NAFLD,including a dose-response analysis.Results A total of 7088 cohort participants were included in the study.Over a median follow-up of 2.96 years,NAFLD was newly diagnosed in 1512 participants.The cumulative incidence rate was 21.33%(95%CI:20.38%-22.29%),with an annual average incidence rate of 7.21%and an incidence density of 78.80 per 1000 person-years.Notably,higher baseline levels of TG,TC,LDL-C,and lower levels of HDL-C were observed in the NAFLD group compared to those without NAFLD,with statistically significant differences(P<0.05).Multivariable Cox regression analysis revealed a positive correlation between baseline TG levels and NAFLD risk.The highest quintile group for TG levels had a 2.70 times higher risk of developing NAFLD compared to the lowest quintile group(95%CI:2.13-3.42).Conversely,higher baseline HDL-C levels were negatively correlated with NAFLD risk;the highest quintile group for HDL-C had a hazard ratio(HR)of 0.77(95%CI:0.62-0.96)compared to the lowest.The restricted cubic spline model indicated a non-linear relationship between blood lipid levels and NAFLD risk,including a"U"-shaped association for TC and LDL-C,a positive correlation for TG,and a negative correlation for HDL-C.Additionally,males had a higher risk of developing NAFLD compared to females.Conclusions The incidence of NAFLD among community residents in Shanghai is relatively high.Blood lipid levels may serve as independent risk factors for the development of NAFLD.