河北省居民非酒精性脂肪性肝病的认知调查与分析

Investigation and analysis of the knowledge of nonalcoholic fatty liver disease among residents in HebeiProvince, China

目的通过对河北省医务人员及普通人群非酒精性脂肪性肝病（NAFLD）的认知调查，了解河北省居民对NAFLD的认知度，规范医务人员对于NAFLD的诊治，提升普通人群对NAFLD的正确认知，以促使其建立合理的生活方式，继而科学、有效地控制NAFLD的发病率及病死率。方法随机选取河北省30家医院及其周边学校和社区作为调查现场，以问卷方式对1300名医务人员及2000名普通人群进行NAFLD相关知识的调查。调查数据采用EpiData3．1软件进行录入，应用SPSS21．0软件对数据进行统计分析。率的差异比较用χ2检验。结果（1）医务人员调查结果：39．0％受访者能正确认知肝活组织检查（肝活检）是诊断NAFLD的金标准。受访者认为对肝纤维化的诊断最具参考价值的检查依次为肝活检（63．7％）、肝脏超声（61．0％）及肝脏CT（48．1％），认为改善胰岛素抵抗是NAFLD治疗首选的医务人员比例仅为1．2％；在486名曾诊治过NAFLD的医务人员中，仅1．2％认为NAFLD患者依从性良好。（2）普通人群调查结果：15．2％的受访者认为NAFLD具有传染性；58．6％的受访者认为NAFLD会进展为肝硬化或肝癌；17．8％体质指数（BMI）≥28kg／m2的受访者对自身患肥胖并不知情，在过去1年中未控制体质量的肥胖受访者比例达55．8％；NAFLD患者合并高脂血症、糖尿病、高血压病等伴发病的比例依次为50．5％、18。5％、29．5％；43．0％的NAFLD患者未曾接受过规范治疗，其余57．0％接受治疗的受访者，79．0％采用合理饮食及体育锻炼等非药物治疗方法；治疗无好转的NAFLD患者，其主要失败原因是未能坚持良好的生活习惯；电视、网络、报纸为NAFLD患者最愿意获取疾病相关健康知识的途径。结论医务人员对于NAFLD的认知不足，部分医务人员未能结合临床指南对NAFLD进行规范诊治；应加强对医务人员NAFLD相关知识的再教育，指导其对NAFLD患者做出准确的筛查、诊断、评估和治疗；普通人群对NAFLD的认知低，以及NAFLD患者治疗依从性不佳，是NAFLD的发病率升高及疾病进展的重要原因之一；应加强对普通人群NAFLD相关知识的宣教，促使其建立合理的生活方式。

Objective To investigate the knowledge of nonalcoholic fatty liver disease （NAFLD） among medical staff and general population in Hebei Province, China, understand the degree of awareness of NAFLD among residents, standardize the diagnosis and treatnaent of NAFLD, improve the correct awareness of NAFLD among general population, promote the establishment of a reasonable lifestyle, and scientifically and effectively control the incidence and mortality rates of NAFLD. Methods The investigation was performed in 30 hospitals and neighboring schools and commurtities in Hebei Province, and a questionnaire survey on the knowledge of NAFLD was performed for 1 300 medical workers and 2 000 persons from the general population.EpiData3.1 software was used to input data, and SPSS21.0 was used for statistical analysis. The chi-square test was used for comparison of rates between groups. Results Of all medical staff, 39.0% knew that liver biopsy was the gold standard for the diagnosis of NAFLD; 63.7% thought liver biopsy had the highest diagnostic value, followed by liver ultrasound （61.0%） and liver CT （48.1%）; only 1.2% thought improvement of insulin resistance was the preferred treatment for NAFLD. Among 486 medical workers who had participated in the diagnosis and treatment of NAFLD, only 1.2% thought that the patients had good compliance. Of all persons from the general population, 15.2% thought NAFLD was infectious and 58.6% thought NAFLD might progress to liver cirrhosis or liver cancer. Of all respondents with body mass index ≥ 28 kg/m2, 17.8% did not know that he/she had obesity, and as high as 55.8% were obese or did not control body weight within the past 1 year. Of all NAFLD patients, 50.5% were complicated by hyperlipidemia, 18.5% were complicated by diabetes, and 29.5% were complicated by hypertension; 43.0% had not received standardized treatment, and among the other 57.0% respondents who received treatment, 79.0% were given non-drug treatment such as reasonable diet and physical exercise. In NAFLD patients who were not improved after treatment, the major cause of failure was that they were not able to stick to healthy living habits. Most NAFLD patients were willing to obtain the knowledge of disease through television, website, and newspaper. Conclusion Medical staff do not have enough awareness of NAFLD, and some of them cannot perform standardized diagnosis and treatment of NAFLD with reference to clinical guidelines. Therefore, the education on NAFLD should be enhanced for medical staff to guide them to perform accurate screening, diagnosis, evaluation, and lleatment of NAFLD. The general population has low awareness of NAFLD and NAFLD patients have poor treatment compliance, which are important causes of increased incidence rate of NAFLD and disease progression. The general population should be educated about NAFLD to help them establish a reasonable lifestyle.