人体质量指数及其变化与非酒精性脂肪性肝病发病的关系

Effect of body weight mass and its change on the incidence of nonalcoholic fatty liver disease

目的 探讨健康成人基线体质量及其变化与非酒精性脂肪性肝病（NAFLD）发病的关系.方法 回顾性分析1999年和2001年上海宝山钢铁责任有限公司的普通员工健康体检资料,主要包括个人嗜好、既往病史、人体学指标、动脉血压,空腹血清甘油三酯（TG）、总胆固醇、葡萄糖、ALT以及肝脏实时超声的检查结果.选择研究期间无习惯性饮酒史[每月饮酒小于2次和（或）每周饮用乙醇量小于140 g]以及基线时血清ALT正常（小于40 U/L）和实时超声检查未发现脂肪肝者为研究对象.血清生物化学指标用Bayer 1650全自动生物化学分析仪测定,由同一名资深影像学医师利用同一台1400型Aloka实时超声显像仪（探头频率3.5MHz）作肝脏检查.应用SPSS12.0统计软件进行数据分析,计量资料用均数±标准差表示,采用t检验、方差分析、非参数检验.计数资料用率表示,采用x2检验.结果 有5402例研究对象2年后再次体检时影像学诊断脂肪肝327例（6.05%）,每1000人每年发生NAFLD 30例.年龄＜50岁发生脂肪肝者占5.7%（281/4624）,≥50岁发生脂肪肝者占9.3%（46/451）,x2=9.87,P＜0.01.人体质量指数（BMI）差值在无脂肪肝组为0.50±1.29,脂肪肝组为0.95±1.25,t-6.11,P＜0.01.TG差值在无脂肪肝组为（0.11±1.06）mmol/L,脂肪肝组为（0.35±1.71）mmol/L,t=2.48,P＜0.05.TC差值无脂肪肝组为（0.52±0.63）mmol/L,脂肪肝组为（0.62±0.70）mmol/L,t=2.40,P＜0.05.NAFLD的发病率随基线BMI增加而显著增高,趋势分析显示x2=389.01,P=0.000.体质量正常、超重、肥胖症和重度肥胖症患者NAFLD发病率分别为1.4%、6.4%、16.8%和24.5%.多元回归分析显示基线年龄、BMI和血清TG水平以及随访期间BMI和TG增加幅度与NAFLD的发病密切相关.结论 普通职工NAFLD发病率高,基线时肥胖和代谢紊乱以及随访中体质量和TG增加是发生NAFLD的重要预测因素.

Objective To determine the effect of body mass index （BMI） at baseline and its change during follow-up on the incidence of non-alcoholic fatty liver diseases （NAFLD） in apparently healthy adults.Methods Subjects free of previous liver injury, alcohol consumption of more than 140 g/week and hepatitis B virus infection were identified from employees of Shanghai BaoSteel Group who underwent voluntary medical checkups at a 2-year interval. Results The analyzed population consisted of 5402 non-drinking subjects （4633 men） of age 36.5 ± 9.3 years （18-65 years）, who had normal livers at baseline. Among them 327 subjects （6.05%） developed fatty liver in 2 years. Those who developed NAFLD showed advanced age （especially in females）, elevated BMI, high levels of serum triglyceride and total cholesterol, high prevalence rates of obesity, hyperlipidemia, hypertension and hyperglyceridemia at baseline, more weight gain and increase of serum triglycerides during the 2-year period. The incidence of NAFLD increased significantly with the changes of BMI at baseline, from 1.4% in subjects with normal weight, 6.4% in overweight, 16.8% in obese patients to 24.5% in severe obesity （ x 2 = 389.01, P = 0.000 in trend analysis）. Logistic regression analysis showed a significant interaction occurred between NAFLD age, BMI and serum triglyceride at baseline, and subtle gain of BMI and triglyceride during follow-up. Conclusions There is a high incidence of NAFLD in a Chinese workplace. Obesity and related metabolic disorders at baseline, and more weight gain and increased serum triglyceride during follow-up are important predictors for the development of NAFLD.