人体质量指数与非酒精性脂肪性肝病发生和消退的关系

The association between body mass index and non-alcoholic fatty liver disease

目的：探讨健康成人基线人体质量指数（BMI）及其变化与非酒精性脂肪性肝病（NAFLD）发病及消退的关系。方法：回顾性分析2008年7月浙江省某三甲医院体检中心成人健康体检的体检资料以及相同体检者2011年健康体检资料，主要包括饮酒史、既往史、身高、人体质量、血压、实验室检查和肝脏超声检查结果。以2008年体检时超声检测出有无脂肪肝及根据是否符合《NAFLD诊疗指南》（2010年修订版）诊断，分为NAFLD组和非NAFLD组。对两组NAFLD发病和消退情况进行跟踪并分析危险因素。结杲：共725例体检者纳入研究，其中非NAFLD者563例，NAFLD者162例。随访3年，563例非NAFLD者中132例（23．4％）进展为NAFLD，随访中NAFLD发病率随基线BMI增加而显著升高（χ^2=82．861，P〈0．01）；多因素logistic回归分析显示收缩压、基线BMI及BMI增幅和丙氨酸转氨酶是NAFLD发病的独立危险因素，而高密度脂蛋白一胆固醇是NAFLD发病的保护因素。162例NAFLD患者随访3年后71例（43．8％）转归为非NAFLD，随访中NAFLD消退率随基线BMI增加而显著下降（χ^2=22．425，P〈0．01）；多因素logistic回归分析显示男性、基线BMI和BMI增幅是NAFLD消退的独立危险因素，而年龄是NAFLD消退的保护因素。结论：健康体检人群中NAFLD发病率及消退率高，基线时高BMI以及随访中BMI增加是NAFLD发病及消退的独立危险因素。

Objective： To investigate the association of body mass index （BMI） with alcoholic fatty liver disease （NAFLD）. Methods： A cohort of 725 adult subjects underwent general health check-up at our hospital in July 2008, then were followed up in 2011. The clinical data including body mass index （BMI）, blood pressure, lab testing results and liver ultrasonic findings were retrospectively analyzed. The NAFLD was diagnosed according to the guidelines for management of nonalcoholic fatty liver disease： an updated and revised edition in 2010 based on liver ultrasound results. The risk factors for NAFLD were analyzed with multivariate logistic regression. Results： One hundred and sixty two NAFLD cases and 563 non-NAFLD cases were found in 2008 check-up. Among 563 non-NAFLD subjects, NAFLD was developed in 132 （23.4%） at follow-up in 2011. The incidence of NAFLD was correlated with the baseline BMI （χ^2 = 82. 861, P 〈 0. 01 ）. Multivariate logistic regression analysis showed that baseline BMI, systolic blood pressure, alanine aminotransferase and the increase of BMI were the independent risk factors, while high density lipoprotein-cholesterol （HDL-C） was the protective factor for the development of NAFLD. Among 162 NAFLD cases, 71（43.8% ） had no evidence of NAFLD at the second check-up in 2011. The remission of NAFLD was negatively correlated with baseline BMI （χ^2 = 22. 425, P 〈 0.01 ）. Multivariate logistic regression analysis showed that male sex, baseline BMI and the increase of BMI were negatively associated with remission of NAFLD, while the age was positively associated with the remission of NAFLD. Conclusion： The development and remission of NAFLD are frequently encountered in health check-up subjects, which are closely related to baseline BMI and changes of BMI during the follow-up.