非酒精性脂肪肝与慢性肾脏病关系的回顾性队列研究

Association between nonalcoholic fatty liver disease and chronic kidney disease: a retrospective cohort study

目的探讨非酒精性脂肪肝（NAFLD）对慢性肾脏病（CKD）发病的影响。方法以山东大学附属省立医院健康体检中心接受常规健康体检的人群建立回顾性队列。队列人群为2005~2010年期间体检3次及以上并且在首次体检无CKD者。应用t检验、χ2检验比较基线有无NAFLD两组人群的特征,应用Kaplan-Meier法分别估计基线有无NAFLD两组人群CKD的累计发病率,Log-rank检验用于比较其差异。单因素Cox用于探索CKD发生风险与相关因素如人口统计学特征、生化指标等的关系,应用多元Cox回归模型控制混杂因素后,分析NAFLD与CKD的关联。结果研究队列包含10 775人,共随访34 878人年（平均3.24±0.99年/人）。研究期间,CKD共发生1 068例,发病密度为30.62/1 000人年。基线有NAFLD组CKD的累计发病率显著高于无NAFLD组（22.76%vs 12.07%,P〈0.01）。多因素Cox回归模型中,调整年龄、性别、体质量指数（BMI）、收缩压、空腹血糖、甘油三酯、高密度脂蛋白、血红蛋白、血小板压积、是否患高血压、是否患糖尿病、是否患代谢综合征及有无冠心病病史后,HR值为1.20（95%CI：1.05~1.38,P=0.01）。结论调整多种已知的CKD危险因素后,NAFLD与CKD发病的关系仍具有统计学差异,说明NAFLD为CKD发病的独立危险因素。该结果对CKD的预防有重要意义。

Objective To explore the effect of nonalcoholic fatty liver disease（ NAFLD） on the incidence of chronic kidney disease（ CKD）. Methods A retrospective cohort study was conducted using the data of regular physical examinations derived from the Health M anagement Center of Shandong Provincial Hospital. Participants who had physical examinations ≥3 times during 2005 and 2010 and whose renal function was normal at the first examination were included. Comparisons of the baseline characteristics between the participants with and without NAFLD were conducted with Student-t test or Pearson chi-square test. The cumulative incidences of CKD were estimated using Kaplan-M eier method for subjects with and without NAFLD at baseline respectively. Log-rank test was adopted to identify the difference between groups. Firstly,univariate Cox regression models were used to explore the association between the hazard ofCKD and the relevant factors such as demographic characteristics and biochemical measures. Further,multiple Cox regression model was used to estimate the effect of NAFLD on the incidence of CKD after adjusting these potential confounders. Results The cohort included 10 775 subjects and 34 878 person-years（ average 3. 24 ± 0. 99 years per person） were followed up. There were 1 068 CKD cases during the study period,and the incidence was 30. 62 /1 000 person-years. The cumulative CKD incidence of subjects with NAFLD at baseline was significantly higher than that of without NAFLD（ 22. 76 vs 12. 07,P 〈0. 01）. After adjusting the factors including age,gender,body mass index,systolic blood pressure,fasting blood-glucose,triglyceride,high density lipoprotein,hemoglobin,thrombocytocrit,hypertension,diabetes,metabolic syndrome and history of coronary heart disease,the HR of NAFLD to non-NAFLD on CKD was 1. 20（ 95% CI： 1. 05-1. 38,P = 0. 01）. Conclusion The existence of NAFLD was confirmed to be one independent risk factor for CKD in Chinese population. This finding will be helpful for prevention of CKD.