北京地区体检人群非酒精性脂肪肝相关危险因素分析

Analysis for risk factors related to non-alcoholic fatty liver in people undergone physical examinations in Beijing

目的探讨非酒精性脂肪肝与体重指数（BMI）、腰围、血脂等的关系，为脂肪肝的防治提供依据。方法对2007年1月至12月我院体检中心13532例北京地区企事业单位体检者的腹部B超检查、血脂、身高、体重、腰围、BMI等结果进行统计分析。结果共检出非酒精性脂肪肝4807例，中位年龄53岁。各年龄组脂肪肝的检出率均随着体型的变化（正常、超重、肥胖）依次增加（X^2=1640．394，P〈0．01）。正常体重组和超重组比较各年龄段脂肪肝检出率差异有统计学意义（x^2=172．618、31．928，P〈0．01），51～60岁组检出率最高；肥胖组各年龄段脂肪肝检出率差异无统计学意义（X^2=6．194，P=0．402）。脂肪肝组的腰围平均值、BMI、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）高于非脂肪肝组，而高密度脂蛋白胆固醇（HDL—C）水平则低于与非脂肪肝组（均P〈0．05）。脂肪肝组各型血脂异常检出率均高于非脂肪肝组（X^2=112．974～895．500，P〈0．01），其中高甘油三酯血症最多见（54．36％）。在正常体重和超重患者中，腰围超过界值者脂肪肝检出率明显高于腰围在界值内者（X^2=120．982、45．327，P〈0．01）。logistic回归分析显示，腰围、BMI、TG、LDL—C是脂肪肝的危险因素，女性、HDL—C是保护因素。结论超重、肥胖、血脂异常与脂肪肝的发病关系密切。控制体重、血脂是降低人群脂肪肝患病率的重要措施。

Objective To explore relationship of body mass index （BMI）, waist circumference （WC）, blood lipid level with non-alcoholic fatty liver （NAFL） to provide evidence for its early intervention. Methods Data of 13 532 people living in Beijing undergone regular physical examinations at Beijing Hospital, including liver-ultrasonic scanning, measurements of blood lipid, height, weight, waist circumference and BMI during January to December 2007 were statistically analyzed. Results Totally, 4 807 people were diagnosed as NAFL by B-type ultrasonic scanning, with a mean age of （54 ± 14） years and median age of 53 years. Prevalence of NAFL significantly increased with changes in body building （ normal weight, overweight and obesity） and age groups （ X^2 = 1640. 394, P 〈 0. 01 ）. There was statistical significance in prevalence of NAFL between groups with normal weight and overweight at varied ages （ X^2 = 172. 618 and 31. 928, respectively, P 〈 0. 01 ）, with the highest at ages of 51 - 60 years. No statistical difference in prevalence of NAFL between varied age groups was found in those with obesity （ X^2 = 6. 194, P=0. 402）. Mean of WC, BMI, serum levels of triglyeeride （TG） and low-density lipoprotein cholesterol （LDL-C） were significantly higher in NAFL group than those in those without NAFL, but mean serum level of high-density lipoprotein cholesterol （HDL-C） was significantly higher in the former than that in the latter （ P 〈 0. 05 ）. Prevalence of dyslipidemia was significantly higher in NAFL group than that in those without NAFL （X^2 = 112. 974 -895. 500, respectively, P 〈 0. 01 ）, with the highest of hypertriglyceridemia, accounting for 54. 36 percent. Prevalence of NAFL was significantly higher in those with larger WC than that in those with normal WC in the normal weight and overweight group （ X^2 = 120. 982 and 45.327, respectively, P〈0. 01）. Results of logistic regression analysis showed that WC, BMI, TG and LDL-C all were risk factors for NAFL both in men and women, and HDL-C was a protective factor for NAFL only in women. Conclusions Overweight, obesity and dyslipidemia closely correlate with occurrence of NAFL. Control of body weight and blood lipid level are essential for decreasing prevalence of NAFL