脂肪肝检出率及影响因素分析

Analysis of Fatty Liver Prevalence and Related Influencing Factors

目的探讨体检人群脂肪肝检出率情况,以期寻找脂肪肝患病的影响因素及关联,为脂肪肝的预防提供科学依据。方法选取2022年1—12月山西省汾阳医院体检中心的9666名健康体检人群为研究对象,收集体检人群的性别、年龄等一般资料;采用实验室检测总胆固醇(total cholesterol,TC)、总胆红素(total bilirubin,TBil)、总蛋白(total protein,TP)、γ-谷氨酰转肽酶(γ-glutamyl transpeptidase,γ-GT)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、谷丙转氨酶(glutamic pyruvic transaminase,ALT)、谷草转氨酶(glutamic oxaloacetic transaminase,AST)、直接胆红素(direct bilirubin,DBIL)、间接胆红素(indirect bilirubin,IBIL)、碱性磷酸酶(alkaline phosphatase,ACP)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、肌酐(creatinine,CRE)、极低密度脂蛋白胆固醇(very low density lipoprotein cholesterol,VLDL)、尿素(urea,UREA)、葡萄糖(glucose,GLU)和尿酸(uric acid,UA)的指标水平;采用B超法进行肝、胆、脾和肾脏等腹部检查。将流行病学调查资料、体格检查资料和实验室检查的资料采用Epi Data 3.1软件进行双录入,建立数据库文件,经一致性检验无误后将数据转为SPSS 22.0数据文件,采用SPSS 22.0统计软件的t检验、χ^(2)检验和logistic回归模型进行数据分析。结果体检人群的脂肪肝检出率为44.7%,男性为55.7%,女性为32.1%,男性的检出率高于女性(P<0.001),同时脂肪肝的检出率随着年龄的增加而升高。多因素logistic回归分析显示:性别、年龄、TP、γ-GT、ALT、AST、TC、TG、VLDL、LDL-C、HDL-C、GLU和UA与脂肪肝的发病情况密切相关,OR值(95%CI)分别为1.006(0.081~1.148)、1.220(1.168~1.275)、1.028(1.017~1.039)、1.008(1.006~1.010)、1.007(1.001~1.012)、0.989(0.980~0.998)、1.003(1.000~1.005)、0.650(0.345~1.227)、1.634(1.524~1.751)、1.086(0.576~2.047)、2.300(1.213~4.363)、0.546(0.287~1.035)、1.246(1.187~1.308)、1.005(1.004~1.006)。年龄、TC、TP、γ-GT、ALT、AST、TG、LDL-C、VLDL、GLU和UA指标的升高是脂肪肝发病的危险因素,性别和HDL-C指标的升高是脂肪肝发病的保护因素。AST/ALT、TBil、DBIL、IBIL、ACP、UREA、CRE与脂肪肝的发病没有关联,OR值(95%CI)分别为0.492(0.413~0.585)、0.944(0.790~1.129)、1.009(0.842~1.209)、1.060(0.886~1.268)、1.003(1.000~1.005)和1.006(0.967~1.047)、0.989(0.985~0.993)。结论该地区中老年男性脂肪肝的检出率较高,女性脂肪肝的检出率随着年龄的增加而升高。年龄、TC、TP、γ-GT、ALT、AST、TG、LDL-C、VLDL、GLU和UA指标的升高均是脂肪肝发病的危险因素,性别和HDL-C指标的升高均是脂肪肝发病的保护因素。

Objective To explore the prevalence of fatty liver,to find the influencing factors and associations of fatty liver and provide scientific basis for the prevention of fatty liver.Methods A total of 9666 healthy individuals who underwent physical examinations at physical examination center Physical Examination Center,Shanxi Province Fenyang Hospital from January to December 2022 were selected as the research subjects,general data such as gender and age of the physical examination population.Using the laboratory testing of total cholesterol(TC),total bilirubin(TBil),total protein(TP),γ-glutamyl transpeptidase(γ-GT),high-density lipoproteincholesterol(HDL-C),glutamic pyruvic transaminase(ALT),glutamic oxaloacetic transaminase(AST),direct bilirubin(DBIL),indirect bilirubin(IBIL),alkaline phosphatase(ACP),triacylglycerol(TG),low density lipoprotein cholesterol(LDL-C),creatinine(CRE),very low density lipoprotein cholesterol(VLDL),urea(UREA),glucose(GLU)and uric acid(UA)of the indicators.Bultrasound was used for abdominal examination of liver,bile,spleen and kidney.The epidemiological investigation data,physical examination data and laboratory examination data were double entered using EpiData3.1 software,and the database file was established.The data were converted 2 into SPSS 22.0 data file by the t-test,χtest and logistic regression model of SPSS 22.0 statistical software.Results The prevalence of fatty liver was 44.7%,55.7%and 32.1%in men,which was higher than women(P<0.001),and the prevalence of fatty liver increased with age.Multivariate logistic regression analysis showed that:Gender,age,TP,γ-GT,ALT,AST,TC,TG,VLDL,LDL-C,HDL-C,GLU,and UA are closely related to the incidence of fatty liver,withORvalues(95%CI)of 1.006(0.081-1.148),1.220(1.168-1.275),1.028(1.017-1.039),1.008(1.006-1.010),1.007(1.001-1.012),0.989(0.980-0.998),1.003(1.000-1.005),0.650(0.345-1.227),1.634(1.524-1.751),1.086(0.576-2.047),respectively.2.300(1.213-4.363),0.546(0.287-1.035),1.246(1.187-1.308),1.005(1.004-1.006).The elevation of age,TC,TP,γ-GT,ALT,AST,TG,LDL-C,VLDL,GLU,and UA indicators is a risk factor for the development of fatty liver,while the elevation of gender and HDL-C indicators is a protective factor for the development of fatty liver.AST/ALT,TBil,DBIL,IBIL,ACP,UREA,CRE are not associated with the onset of fatty liver,with OR values(95%CI)of 0.492(0.413-0.585),0.944(0.790-1.129),1.009(0.842-1.209),1.060(0.886-1.268),1.003(1.000-1.005),1.006(0.967-1.047),and 0.989(0.985-0.993),respectively.Conclusion The prevalence of fatty liver in this region,and the prevalence of fatty liver in women increased with the increase of age.In addition,elevations in age,TC,TP,γ-GT,ALT,AST,TG,LDL-C,VLDL,GLU and UA indicators were risk factors for the onset of fatty liver;gender and elevated HDL-C indicators were protective factors for the onset of fatty liver disease.