兰州市社区40～75岁人群非酒精性脂肪性肝病发病与消退影响因素研究

Influencing factors of the incidence and remission of non-alcoholic fatty liver disease among adults aged 40-75 years in a community of Lanzhou

目的分析兰州市社区40～75岁人群非酒精性脂肪性肝病(NAFLD)发病和消退情况及其影响因素。方法 2011年对兰州市社区40～75岁人群进行NAFLD患病基线调查,于2014年进行随访调查,均完成问卷调查,测量身高及体质量,检测糖化血红蛋白(HbA1c)、血糖、血脂等,并行上腹部B超检查。结果基线无脂肪肝人群NAFLD 3年发病率为27.85%(291/1045);基线NAFLD患者3年消退率为26.98%(92/341)。NAFLD新发组比无脂肪肝组基线甘油三酯(TG)、空腹血糖、餐后血糖、HbA1c、ALT、γ-谷氨酰基转移酶、体质量指数(BMI)、收缩压升高,而高密度脂蛋白胆固醇(HDL-C)降低(均P<0.05)。NAFLD消退组较NAFLD持续组基线ALT、AST、BMI降低,HDL-C升高(均P<0.05)。随着基线BMI水平逐渐升高,NAFLD发病率持续升高(P<0.01),而NAFLD消退率不断降低(P<0.05);在各基线BMI水平,BMI差值>0者中NAFLD新发率高于BMI差值≤0者(P<0.01)。基线BMI、BMI差值、基线TG和基线HbA1c、HbA1c差值是NAFLD发病的独立危险因素,呈正相关;基线BMI、BMI差值和HbA1c差值是NAFLD消退的独立影响因素,呈负相关。结论兰州市社区40～75岁人群NAFLD发病率及消退率均较高,基线BMI及BMI随访较基线的变化与NAFLD发病和消退密切相关。

Objective To understand the incidence and remission of non-alcoholic fatty liver disease(NAFLD) and to analyze the influencing factors among adults aged 40-75 years in a community of Lanzhou with a 3-year follow-up. Methods A baseline survey was conducted among residents aged 40-75 years in 2011 and a followed up survey was performed in 2014 in a community of Lanzhou.On both occasions, a questionnaire on general information and blood samples were collected for anthropometric measurement and biochemical and serological tests.NAFLD was determined based on ultrasound criteria. Results The incidence of NAFLD at a 3-year follow-up was 27.85%(291/1 045).NAFLD remission rate during the study period was 26.98%(92/341).Subjects who developed NAFLD in 3 years had higher baseline levels of glycosylated hemoglobin A1 c(HbA1 c), fasting plasma glucose, postprandial 2 hours plasma glucose, triglycerides, alanine aminotransferase(ALT),γ-glutamyl transpeptidase(GGT), body mass index(BMI),systolic blood pressure and lower level of high-density lipoprotein cholesterol(HDL-C)compared to those with no NAFLD(P <0.05).The baseline levels of ALT,AST and BMI were significantly lower among subjects with NAFLD remission compared to those with no NAFLD remission(P<0.01).The incidence of NAFLD increased and the remission rate decreased with increasing baseline BMI in a dose-response manner(P<0.01).The incidence of NAFLD was higher in subjects with BMI change of more than 0 than those with BMI change of less than 0,regardless the baseline BMI level(P<0.01).Logistic regression analysis showed that,after adjustment for age and gender,baseline BMI,HbA1 c,triglycerides and change in BMI,HbA1 cwere significantly,positively and independently associated with the incidence of NAFLD;while,baseline BMI,change in BMI and HbA1 cwere independent influencing factor of NAFLD remission and were negatively correlated with NAFLD remission. Conclusions The incidence and remission rate of NAFLD among adults aged 40-75 years are relatively higher.Baseline BMI and change in BMI are closely associated with both incidence and remission of NAFLD.