上海市崇明区中老年人群脂肪性肝病的流行病学调查及其与糖代谢异常的关系

Epidemiological investigation of fatty liver and its relationship with the disorder of glucose metabolism in middle-aged and elderly people in Chongming area,Shanghai

目的了解上海市崇明区中老年人群脂肪性肝病(以下简称脂肪肝)的患病情况、危险因素及其与糖代谢异常的关系。方法采用随机整群抽样方法调查上海市崇明区8个城镇社区和4个农村社区40~70岁的常住居民,内容包括问卷调查、体格检查、口服葡萄糖耐量试验(OGTT)、血脂等生化检测和肝脏超声检查。结果共10 061名居民参加调查,其中血生化、腹部超声检查和问卷资料完整9 913人,其中男3 218人、女6 695人,平均年龄为(56.0±7.8)岁,经腹部超声检查确诊为脂肪肝者4 185例(脂肪肝患病率为42.22%,脂肪肝组),余5 728人为无脂肪肝组。脂肪肝组患者的腹型肥胖、肥胖、代谢综合征、糖尿病、糖尿病前期、单纯糖耐量受损(i-IGT)、空腹血糖异常(IFG)+糖耐量受损(IGT)的患者比例均显著高于无脂肪肝组,年龄、收缩压、舒张压、腰围、臀围、腰臀比、BMI、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)、OGTT2h血糖、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、采用稳态模型评估胰岛素抵抗指数(HOMA-IR)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)水平均显著高于无脂肪肝组(P值分别<0.01、0.05);而单纯空腹血糖异常(i-IFG)患者、正常糖耐量(NGT)人群比例,高密度脂蛋白胆固醇(HDL-C)水平和AST/ALT比值均显著低于无脂肪肝组(P值均<0.01)。糖尿病前期人群中脂肪肝患者比例显著高于NGT人群(P<0.001),其中i-IFG患者中脂肪肝患者比例显著高于NGT人群(P<0.001)、显著低于i-IGT患者(P<0.001),IFG+IGT患者中脂肪肝患者比例显著高于i-IGT患者(P<0.001)。糖尿病患者中脂肪肝患者比例显著高于IFG+IGT患者(P<0.001)。以年龄、性别、腰围、臀围、BMI、FPG、OGTT 2h血糖、HbA1c、HOMA-IR、TC、三酰甘油(TG)、HDL-C、低密度脂蛋白胆固醇(LDL-C)、收缩压和舒张压作为协变量,采用Logistic回归分析脂肪肝的患病风险因素,结果显示,腰围(OR=1.042,95%CI为1.033~1.051,P<0.001)、BMI(OR=1.222,95%CI为1.190~1.256,P<0.001)、OGTT 2h血糖(OR=1.106,95%CI为1.084~1.130,P<0.001)、HbA1c(OR=1.230,95%CI为1.125~1.345,P<0.001)、HOMA-IR(OR=1.163,95%CI为1.113~1.215,P<0.001)、HDL-C(OR=0.689,95%CI为0.497~0.954,P=0.025)、LDL-C(OR=3.236,95%CI为2.542~4.120,P<0.001)和TG(OR=1.905,95%CI为1.726~2.101,P<0.001)均为脂肪肝发病的独立危险因素。以年龄、性别、腰围、臀围、BMI、FPG、OGTT 2h血糖、HbA1c、HOMA-IR、TC、TG、HDL-C、LDL-C、收缩压、舒张压和脂肪肝作为协变量,采用Logistic回归分析糖尿病的患病风险因素,结果显示,FPG(OR=16.054,95%CI为12.997~19.831,P<0.001)、OGTT 2h血糖(OR=2.744,95%CI为2.573~2.927,P<0.001)、HbA1c(OR=2.314,95%CI为1.832~2.922,P<0.001)和HDL-C(OR=2.196,95%CI为1.184~4.073,P=0.013)均为糖尿病发病的独立危险因素。结论上海市崇明区的中老年人群脂肪肝高发。脂肪肝患者易发生糖代谢异常,糖代谢异常者也易发生脂肪肝。

Objective To investigate the prevalence and risk factors of fatty liver and its relationship with the disorder of glucose metabolism in middle-aged and elderly people in Ohongming area, Shanghai. Methods We conducted a population-based cross-sectional study in the residents aged 40 - 70 years from 8 urban communities and 4 rural communities of Chongming area, Shanghai. A questionnaire interview and an oral glucose tolerance test （OGTT） were carried out for each participant and the anthropometric measurements, blood pressure, plasma lipids, liver enzyme profiles were also obtained from each of them. Fatty liver was diagnosed by hepatic ultrasound. Results A total of 10 061 subjects were recruited in this survey. Complete investigation data were collected from 9 913 subjects. There were 3 218 males and 6 695 females with a mean age of （56.0±7.8） years. Totally 4 185 subjects （42.22%） were diagnosed as fatty liver by abdominal ultrasound examination. The subjects with fatty liver were older than those without fatty liver. The prevalence of obesity, abdominal obesity, metabolic syndrome, diabetes, prediabetes, isolated impaired glucose tolerance （i-IGT）, and a combination of impaired fasting glucose （IFG） and impaired glucose tolerance （IGT） in fatty liver group were significantly higher than those in non-fatty liver group. The systolic blood pressure, diastolic blood pressure, waist circumference, hip circumference, waist hip ratio, body mass index （BMI）, insulin resistance index （HOMA-IR）, low density lipoprotein cholesterol （LDL-C）, triglyceride （TG1, total cholesterol （TC）, OGTT 2-hour blood glucose, fasting blood glucose （ FPG 1, glycosylated hemoglobin （ HbA1c ）, alanine aminotransferase （ ALT ）, aspartate aminotransferase （AST）, and gamma glutamyltransferase （γ-GT） levels in fatty liver group were also significantly higher than those in non-fatty liver group （P〈0.01 or 0.05）. But the constituent ratio between subjects with i-IFG and normal glucose tolerance （NGT）, HDL-C level and AST/ALT in fatty liver group were significantly lower than those in non-fatty liver group （all P〈0.01）. The prevalence of fatty liver in prediabetes subjects was significantly higher than that in NGT population （P〈0. 001）. The prevalence of fatty liver in subjects with isolated IFG （i-IFG） was significantly higher than that in NGT subjects （P〈0. 001 ）, but significantly lower than that in subjects with i-IGT （P〈0. 001）. The prevalence of fatty liver in subjects with a combination of IFG and IGT was significantly higher than that in subjects with i-IGT （P〈0. 001）, but was much lower than that in subjects with diabetes （P〈0. 001）. Logistic regression analysis showed that waist circumference （OR = 1. 042, 95% CI= 1. 033 - 1. 051, P〈0.001）, BMI （OR = 1.222, 95% CI： 1. 190- 1.256, P〈0.001）, OGTT 2 h glucose （OR = 1. 106, 95% CI： 1.084-1.130, P〈0.001）, HbA1c （OR=1.230, 95%CI： 1.125-1.345, P〈0.001）, HOMA-IR （OR= 1.163, 95%CI：1.113-1.215, P〈0.001）, HDL-C（OR=0.689, 95%CI： 0.497-0.954, P=0.025）, LDL-C （OR=3.236, 95%CI：2.542-4.120, P〈0.001） and TG （OR= 1.905, 95%CI： 1.726-2.101, P〈0.001） were independent risk factors of fatty liver diseases after adjustment of potential cofounder; FPG （OR = 16.0 95%CI：12.997-19.831, P〈0.001）, OGTT2 hglucose （OR=2.744, 95%CI：2.573-2.927, P〈0.001）, HbA1c （OR=2.314, 95%CI：1.832-2.922,P〈0.001） and HDL-C （OR=2.196, 95%CI：1.184-4.0 P = 0. 013） were independent risk factors of diabetes after adjustment of potential covariate factors. Conclusions Fatty liver is highly prevalent in Ohongming area, Shanghai. Fatty liver is associated with diabetes and prediabetes.