上海市成人代谢综合征与脂肪肝关系分析

A cross-sectional study on the relationship between metabolic syndrome and fatty liver in Shanghai adults

目的探讨代谢综合征与脂肪肝的关系,并评估脂肪肝预测代谢紊乱危险因素聚集的价值。方法采取随机多级分层整群抽样方法调查3175名上海市16岁以上居民,内容包括问卷调查、体检、葡萄糖耐量试验、血脂全套和肝脏实时超声。代谢综合征的诊断根据美国国家胆固醇教育计划成人治疗组第三次报告(NCEPATPⅢ)标准(中心性肥胖诊断参照世界卫生组织西太平洋区标准)。结果3175名成人中代谢综合征和脂肪肝检出率分别为22.9%和20.8%。无论男性还是女性,与肥胖、中心性肥胖相比,脂肪肝判定危险因素的聚集率、特异度、阳性预测值以及归因度百分比最高。中心性肥胖、糖尿病、血脂异常、高血压病等人群脂肪肝患病风险分别是对照人群的32.8倍(95%CI,14.9～72.4)、31.6倍(95%CI,14.2～70.4)、22.6倍(95%CI,10.3～50.0)、23.3倍(95%CI,10.5～51.3),而代谢综合征人群脂肪肝患病风险是对照人群的39.3倍(95%CI,17.8～87.1)。661例脂肪肝患者根据体重指数(BMI)分层后,仅腹型肥胖患病率随BMI增加而增加;即使是体重正常的脂肪肝患者,其代谢紊乱1项和5项指标检出率分别达86.1%、2.8%。结论上海市成人代谢综合征和脂肪肝同为常见病,两者关系密切;脂肪肝能较好预测代谢紊乱危险因素聚集。

Objective To explore the relationship between fatty liver and metabolic syndrome, and to evaluate the value of fatty liver in predicting the clustering risk factors in metabolic syndrome. Methods A crosssectional survey with multiple-stages and random samplings was performed in 3175 adult residents aged over 16. Questionaire and 75 g oral glucose tolerance test were conducted ; plasma glucose, lipid-profile as well as body mass index （BMI） , and blood pressure were measured. Diagnosis of fatty liver was based on established real-time uhrasonographic criteria. The diagnosis of metabolic syndrome and its components followed the United States National Cholesterol Education Program-Adult Treatment Panel Ⅲ （ NCEP-ATP Ⅲ ） criteria with the exception of waist circumference （WC） and BMI. Results The prevalences of metabolic syndrome and fatty liver were 22.9% （726/3175） and 20.8% （661/3175） respectively. Compared with obesity （ BMI≥25kg/m^2 ） and abdominal obesity （WC≥90 cm for males and 80 cm ibr females）, fatty liver had the highest percentage in clustering risk factor and attributable risk percentage with high specificity and positive predictive value both in males and females. Compared with the normal controls, the risk for fatty liver was increased by 32.8-fold （95% CI 14.9-72.4） in abdominal obesity participants, 31.6-ibld （14.2-70.4 ） in diabetes mellitus, 22.6-fold （ 10.3-50.0 ） in dyslipidemia, 23.3-fold （ 10.5-51.3 ） in hypertension, and 39.3-fold （ 17.8-87.1 ） in patients with metabolic syndrome. After 661 patients with fatty liver were stratified by BMI, the prevalence of central obesity increased with BMI, however, the prevalence of hypertriglyceridemia, impaired fasting glucose, low HDL-C and hypertension showed no significant increase with BMI. Moreover, the prevalences of one and five risk factors in patients with ihtty liver and normal BMI were 86.1% and 2.8%, respectively. Conclusion There is a high prevalence of the metabolic syndrome and fatty liver in Shanghai adults. Metabolic syndrome is closely related with fatty liver. Fatty liver could be used to predict clustering risk iactors in metabolic disorders.