体重指数与非酒精性脂肪肝的相关性研究

The association between body mass index and non-alcoholic fatty liver disease in health checkup examinees

目的调查非酒精性脂肪肝(NAFLD)在不同体重指数(BMI)人群中的流行情况,以探讨BMI与NAFLD的相关性。方法以我院查体中心5175例BMI≥18kg/m2健康体检者为研究对象,测量其身高、体重、血压,空腹取血行肝肾功能、血脂、血糖、肝炎相关检查,同时行心电图、腹部超声、胸部X线等检查。NAFLD和代谢综合征(MS)诊断符合中华医学会肝病学分会脂肪肝和酒精性肝病学组推荐2010年修订版的临床诊断标准,MS诊断符合改良的2005年国际糖尿病联盟标准,统计不同BMI下NAFLD和MS的患病情况。结果健康体检人群MS和NAFLD总检出率分别为20.8%和22.5%,肥胖人群MS和NAFLD总检出率显著高于非肥胖人群(42.8%,40.3%vs.3.8%,9.3%;P均<0.01),无论男性还是女性人群,随着BMI水平的增高,血压增高、FBS增高、高甘油三酯血症以及MS检出率均有显著上升(女性χ2=198.8,79.9,143.6,356.0;男性χ2=323.9,63.9,291.3,659.2;P均<0.01);而低HDL-C检出率显著降低(女性χ2=99.8;男性χ2=33.9;P均<0.01)。进一步对无其他MS相关组分的人群分析发现,随BMI增高NALFD检出率显著上升(χ2=18.2或68.8,P均<0.01)。Logistic回归分析显示,性别、BMI、血压升高、FBS升高、低密度脂蛋白胆固醇(LDL-C)和尿酸分级是NAFLD的高危因素,OR值分别为2.347、3.369、1.378、1.787、1.389、1.264,在其他变量不变情况下,BMI每升高5kg/m2,NAFLD发病风险增加3.369倍。结论超重或肥胖是NAFLD的独立危险因素,BMI作为衡量整体肥胖的公认指标,与NAFLD发病风险呈显著正相关,对NAFLD发病具有预测价值。

Objective To evaluate the relationship between body mass index(BMI)and nonalcoholic fatty liver disease(NAFLD)by observing the prevalence of non-alcoholic fatty liver disease among health checkup examinees with different levels of BMI.Methods The medical checkup data of 5175 persons from medical centers for health examination were analyzed,such as height,weight,blood pressure,blood lipids,blood sugar,hepatitis-related markers,and abdominal color Doppler ultrasound examination were conducted in the fasting state.The diagnosis of NAFLD and MS was in line with diagnostic criteria adopted by China Institute of Liver Disease and Alcoholic Liver Disease Group,and the prevalence of non-alcoholic fatty liver disease were investigated among these health checkup examinees.Results Total detection rate of MS and NAFLD was 20.8% and 22.5% in these healthy check-up crowd,and significantly higher in obese people than non-obese people(42.8%,40.3% vs.3.8%,9.3%;P<0.01).The detection rate of hypertension,hyperglycemia,hypertriglyceridemia,metabolic syndrome and NAFLD were increased with the levels of BMI increased in both males and females(female:χ2=198.8,79.9,143.6,356.0 or male:χ2=323.9,63.9,291.3,659.2;all P<0.01),but the detection rate of serum low HDL-C dencreased with the levels of BMI increased(female:χ2=99.8 or male:χ2=33.9;both P<0.01).In further studies for whom without other components of metabolic syndrome,this relation between BMI and NAFLD also exist(χ2=18.2 or 68.8,both P<0.01).Logistic regression showed that sex,BMI,hypertension,hyperglycemia,LDL-C and uric acid grade were high risk factors of NAFLD(OR value were 2.347,3.369,1.378,1.787,1.389,1.264),and there was a strongly positive association of BMI with NAFLD risk,with each 5 kg/m2 higher in BMI associated with 3.4 times increased risk NAFLD.Conclusions Overweight or obesity is independent risk factor for NAFLD.BMI as obesity index,is significantly positively correlated with the risk of NAFLD and has the predictive value of NAFLD.