西北地区脂肪性肝病的流行病学调查研究

Epidemiological investigation of fatty liver disease in Northwest China

目的了解西北地区普通人群饮酒及脂肪性肝病的现况，研究脂肪性肝病的患病率并分析相关危险因素。方法采用多级分层整群抽样的方法，随机对西北地区（陕西、甘肃、新疆）18岁以上的部分城市不同职业人群进行现况调查，内容包括填写问卷，测量身高、体质量、腰围，生物化学检查和肝脏B型超声检查。两样本均数比较用t检验，率之间的比较用x^2检验，危险因素用logistic多元回归分析。结果（1）共收集2300人完整资料，习惯性饮酒者1523人，人群总饮酒率为66．2％，饮酒群体主要为男性。（2）检出酒精性肝病201例，患病率为8．7％；轻症酒精性肝病、酒精性脂肪肝、酒精性肝炎、酒精性肝硬化的患病率分别为4．2％、3．8％、0．5％、0．3％；陕西、甘肃、新疆3省的患病率分别为14．0％、8．6％、5．0％。（3）检出非酒精性脂肪性肝病337例，患病率为14．7％；陕西、甘肃、新疆3省的患病率分别为18．5％、10．3％、16．6％。（4）酒精性肝病组年龄、体质量、人体质量指数、腰围、日均酒精乙醇摄入量、AST、ALT均高于对照组（P〈0．05）。（5）非酒精性脂肪性肝病组年龄、身高、体质量、人体质量指数、腰围、AST、ALT以及肥胖、腹型肥胖、高脂血症、糖尿病、高血压的患病率均高于对照组（P〈0．05）。（6）多因素Logistic回归分析结果显示年龄、性别、日均酒精乙醇摄入量为酒精性肝病的危险因素；年龄、高脂血症、糖尿病、人体质量指数为非酒精性脂肪性肝病的危险因素，女性为保护因素。结论西北地区饮酒率、脂肪性肝病的患病率较高，其中非酒精性脂肪性肝病是最主要的类型。年龄、性别、日均酒精乙醇摄人量、高脂血症、糖尿病、人体质量指数为脂肪性肝病的危险因素。

Objective To describe the incidence and related risk factors of fatty liver disease in the general population of Northwest China. Methods The study was a cross-sectional survey with multiplestage stratified cluster and random sampling. All participants were 18 years or older and resided in northwest provinces of China. Demographic and behavioral data was gathered by questionnaire. Clinical data such as height, body weight, waist circumference, biochemical function （standard tests） and liver status （ultrasonographic examination） were also collected. Results Among the 2 300 total study participants, 1 523 were habitual drinkers （total drinking rate： 66.2%）. This population of drinkers was composed almost exclusively of males. There were 201 cases of alcoholic liver disease （total prevalence： 8.7%）, represented by mild alcoholic injury （prevalence： 4.2%）, alcoholic fatty liver （3.8%）, alcoholic hepatitis （0.5%）, and alcoholic cirrhosis （0.3%）. When examined according to provinces of residence, the prevalence of alcoholic liver disease followed this pattern： Shaanxi （14.0%）, Gansu （8.6%）, and Xinjiang autonomous region （5.0%）. Of the total 337 cases of nonalcoholic fatty liver disease （total prevalence： 14.7%）, the prevalence by province was： Shaanxi （18.5%）, Gansu （10.3%）, and Xinjiang autonomous region （16.6%）. Individuals with alcoholic liver disease had significantly higher mean age （years）, body weight, body mass index （BMI）, waist circumference, average daily alcohol intake, and level of aspartate aminotransferase （AST）, and alanine aminotransferase （ALT） （vs. those with no liver disease, P 〈 0.05）. Individuals with nonalcoholic fatty liver disease had significantly higher mean age （years）, height, body weight, BMI, waist circumference, level of AST and ALT, and presence of obesity, abdominal obesity, hyperlipidemia, diabetes mellitus and hypertension （vs. those with no liver disease, P 〈 0.05）. Multiple logistic regression demonstrated that alcoholic liver disease was closely related to age, sex, and average daily alcohol intake. The prevalence of nonalcoholic fatty liver disease was positively correlated to age, female sex, hyperlipidemia, diabetes mellitus, and BMI. Conclusion The drinking-rate and prevalence of fatty liver disease is high in Northwest China, but the most prevalent type is nonalcoholic fatty liver disease. Fatty liver disease is closely related to age, sex, average daily alcohol intake, hyperlipidemia, diabetes mellitus, and BMI.