广州市中老年人非酒精性脂肪肝患病率及代谢相关因素分析

Prevalence and metabolic risk factors of nonalcoholic fatty liver disease in a middle-aged and elderly population in Guangzhou

目的探讨非酒精性脂肪性肝病（NAFLD）在中老年人群中的患病情况及其代谢相关因素。方法采用横断面调查的方法，通过问卷调查和实验室检测对2935名广州市中老年人进行资料收集、整理。探讨NAFLD在中老年人群中的患病情况，并采用协方差和logistic回归分析代谢因素与NAFLD患病情况之间的关系。NAFLD的诊断标准采用中华医学会肝脏病学分会脂肪肝和酒精性肝病学组的影像学诊断标准，并且按照其严重程度分为轻、中、重三个等级。结果广州市中老年人群中NAFLD的患病率为50．6％。NAFLD患者组中WC、BMI、FPG、TG、SBP、DBP以及MS患病率均明显高于对照组，而体力活动水平和HDL．C明显降低（P〈0．001）。lo-gistic回归分析显示，WC、SBP、DBP、TG、FPG和HDL-C每升高一个标准差其对应NAFLD患病的OR值（95％CI）分别为2．70（2．45—2．98）、1．47（1．35-1．59）、1．48（1．37～1．60）、1．88（1．66～2．12）、1．25（1．15-1．36）和0．51（0．47-0．56）。随着NAFLD严重程度不断增加，WC、BMI、TG、SBP、DBP和FPG水平均呈现上升趋势，而HDL—C呈现减少的趋势（P〈0．001）。结论中老年人NAFLD患病率较高，MS及相关组分与NAFLD关系密切，其中WC增加对NAFLD患病影响最大。

Objective To investigate the prevalence of nonalcoholic fatty liver disease （NAFLD） and understand the relationship between NAFLD and metabolic risk factors in middle-aged and elderly adults. Methods This cross-sectional study recruited 2 935 subjects in Guangzhou, Guangdong province. Face-to-face interviews and laboratory analyses were conducted to collect general information and other covariates. Analysis of covariance and logistic regression analysis were performed to investigate the relationship between metabolic factors and the prevalence of NAFLD. NAFLD was diagnosed based on standard criteria recommend by the Fatty Liver Disease and Alcoholic Liver Disease Branch of Chinese Hepatology Society, and the degree of steatosis was assessed （mild, moderate or severe）. Results Compared with normal subjects, those with NAFLD had higher levels of WC, BMI, FPG, TG, SBP, DBP and greater prevalence of metabolic syndrome, but lower levels of physical activity and HDL-C. After adjusted for covariates, the OR for each standard deviation change was 2.70 （95%CI： 2.45-2.98） for WC, 1.47 （95% CI： 1.35-1.59） for SBP, 1.48 （95%CI： 1.37-1.60） for DBP, 1.88 （95%CI： 1.66-2.12） for TG, 1.25 （95% CI： 1.15-1.36） for FPG and 0.51 （95%CI： 0.47-0.56） for HDL-C （all P〈0.001 ）. Higher levels of WC, BMI, TG, SBP, DBP and FPG were significantly related with the increase in degree of NAFLD （P-trend〈0.001）. Conclusion There is a relatively high prevalence of NAFLD in middle-aged and elderly adults in China. NAFLD is closely related with the different forms of metabolic syndrome, and WC is the leading risk factor for NAFLD.