脂肪肝的预后及与预后相关因素分析

A study on prognosis of fatty liver disease and its related factors

目的探讨脂肪肝(fatty liver disease,FLD)的预后,以及与预后相关的因素。方法纳入2003年某单位接受体检的459例受试者,其中诊断为FLD 154例(03FLD组),非脂肪肝(NFLD)305例(03 NFLD组),2009年对同一受试人群再次进行随访。观察6年后该人群再次进行体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、血脂、肝酶学指标、血尿酸(UA)检测及腹部超声检查的变化,比较两组人群的预后,以及与预后相关的危险或保护因素。结果 6年后再次检测该研究人群时,38例FLD患者超声下转为正常肝脏(B组),其余116例仍为FLD(A组);原来无FLD的305例受试者中有91例新发FLD(C组),其余214例受试者仍然保持为无FLD状态(D组)。A、B组相比无论性别、年龄均无明显差异(P>0.05);C组男性受试者所占百分比明显高于D组(P=0.007),C组女性平均年龄明显高于D组(P=0.025)。A组受试者BMI、DBP、丙氨酸氨基转移酶(ALT)、γ谷氨酰氨基转移酶(GGT)、FBG、UA均值水平均高于B组;C组比D组有更多的代谢异常和肝脏生化学异常。尽管B组受试者随访中FLD已经消失,但与不曾发生FLD的D组受试者比较仍有大部分人体测量学和生化学指标异常。结论脂肪肝的出现与性别、年龄有关,而它的消失与性别、年龄无关;脂肪肝的发生或消失与代谢综合征(metabolic syndrome,MS)密切相关,随着FLD病程的延长,MS各组分的患病率就越高;脂肪肝的治疗效果不仅限于超声下脂肪肝的消减,更重要的是MS组分(包括尿酸)同时消失。

Objective To discuss the prognosis of fatty liver disease（FLD） and its related factors.Methods A total of 459 subjects from one company who underwent health check-up in 2003 were enrolled in the study.154 of the 459 subjects were diagnosed with FLD（03FLD group） and 305 without FLD（03NFLD group）.Levels of BMI,SBP,DBP,FBG,serum lipids,liver enzymes and uric acid（UA） and abdominal ultrasonic examination were observed after 6 years for all subjects in 2009.Prognosis and FLD related factors were analyzed.Results After 6 years,116 subjects were still FLD（group A） and 38 subjects with normal ultrasonic examination（group B）,while the other in 03FLD group.In 03NFLD group,91 subjects developed to FLD（group C）,and 214 subjects remained NFLD（group D）.There was no statistical significance（P0.05） neither sex nor age between group A and group B.Subjects in group C had a higher rate of male and higher average age of female than group D（P=0.007,P=0.025）.The levels of BMI,DBP,ALT,GGT,FBG,UA in group A were all higher than those in group B.Subjects in group C had more metabolic and liver enzyme abnormalities than group D.However,the 38 FLD patients even though（B group） were still presented with many biochemical abnormal indexes compared with group D.Conclusion The occurrence of FLD was associated with sex and age,while the disappearance of FLD was not.MS showed a tight link with occurrence and disappearance of FLD.In pace with the prolonged time of FLD,the incidence of MS components would increase;the assessment of FLD treatment should depend on not only improvement in ultrasonic examination but also disappearance of components of MS（including UA）.