健康体检人群非酒精性脂肪肝的影响因素分析:基于巢式病例对照研究

Analysis of influencing factors of nonalcoholic fatty liver disease in healthy people:Based on nested case control study

目的基于北京市体检中心职业人群队列,探讨影响非酒精性脂肪肝(nonalcoholic fatty liver,NAFLD)的相关因素,为NAFLD的高危人群筛查和早期诊断提供一定的科学依据。方法以2009年1—12月在北京市体检中心进行健康体检的职业人群队列为基础,收集其体检指标,建立随访时间为3年的回顾性生存队列。按照巢式病例对照研究的思想,采用不放回随机抽样方法对每一个病例随机匹配相同性别、相同年龄且体检时间在相同月份的对照,采用匹配之后的数据进行条件Logistic回归建模。通过受试者工作特征曲线(ROC)分析相关指标对NAFLD的诊断价值。结果采用1:1对病例和对照人群进行匹配,共纳入1194名研究对象,其中男684名(57.3%,684/1194);女510名(42.7%,510/1194)。年龄(50.8±11.6)岁,年龄范围24.0~88.0岁。NAFLD患者共597例,其中男342例,女255例。Logistics回归分析结果显示,体质量指数、高密度脂蛋白胆固醇、血红蛋白、血小板计数、尿酸、尿素氮在男性模型中均有统计学意义(P均<0.05),其中体质量指数(OR=1.242,95%CI 1.143~1.349,P<0.001)、血红蛋白(OR=1.034,95%CI 1.015~1.053,P<0.001)、血小板计数(OR=1.005,95%CI 1.002~1.009,P=0.005)、尿酸(OR=1.004,95%CI 1.001~1.006,P=0.004)均为影响男性患者发生NAFLD的危险因素;高密度脂蛋白胆固醇(OR=0.377,95%CI 0.184~0.775,P=0.008)、尿素氮(OR=0.807,95%CI 0.693~0.938,P=0.005)均为影响男性患者发生NAFLD的保护因素。体质量指数(OR=1.552,95%CI 1.366~1.762,P<0.001)、甘油三酯(OR=2.606,95%CI 1.616~4.204,P<0.001)、血糖(OR=2.199,95%CI 1.332~3.631,P=0.002)、尿酸(OR=1.005,95%CI 1.001~1.010,P=0.024)在女性模型中均有统计学意义(P均<0.05),且均为影响女性患者发生NAFLD的危险因素。结论不同性别、年龄的NAFLD发病率存在差异,体质量指数、高密度脂蛋白胆固醇、血红蛋白、血小板计数、尿酸、尿素氮、甘油三酯、血糖等指标与NAFLD的发病密切相关。

Objective Based on the occupational cohort of Beijing Medical Examination Center,to explored the relevant factors of nonalcoholic fatty liver disease(NAFLD),and to provide scientific basis for screening and early diagnosis of NAFLD in high-risk population.Methods Based on the cohort of occupational population who underwent physical examination in Beijing physical examination center from January to December 2009,the physical examination indexes were collected,and a retrospective survival cohort with a follow-up period of 3 years was established.According to the idea of nested case-control study,each case was randomly matched with the same gender,age and physical examination time in the same month by using the method of random sampling without putting back.Conditional logistic regression model was established by using the matched data.The diagnostic value of related indicators for NAFLD was analyzed by receiver operating characteristic curve(ROC).Results A total of 1194 subjects were included,including 684 males(57.3%,684/1194)and 510 females(42.7%,510/1194).The age was(50.8±11.6)years.The age ranged from 24.0 to 88.0 years.There were 597 patients with NAFLD,including 342 males and 255 females.Logistic regression analysis showed that body mass index,high density lipoprotein cholesterol,hemoglobin,platelet count,uric acid and urea nitrogen were statistically significant in male model(all P<0.05).Body mass index(OR=1.242,95%CI 1.143-1.349,P<0.001),hemoglobin(OR=1.034,95%CI 1.015-1.053,P<0.001),platelet(OR=1.005,95%CI 1.002-1.009,P=0.005),uric acid(OR=1.004,95%CI 1.001-1.006,P=0.004),high density lipoprotein cholesterol(OR=0.377,95%CI 0.184-0.775,P=0.008)and urea nitrogen(OR=0.807,95%CI 0.693-0.938,P=0.005)were protective factors for NAFLD in male patients..Body mass index(OR=1.552,95%CI 1.366-1.762,P<0.001),triglyceride(OR=2.606,95%CI 1.616-4.204,P<0.001),blood glucose(OR=2.199,95%CI 1.332-3.631,P=0.002),uric acid(OR=1.005,95%CI 1.001-1.010,P=0.024)in female model were statistically significant(P<0.05),and were risk factors for NAFLD in female patients.Conclusion The incidence rate of NAFLD was different among different gender and age,body mass index,high density lipoprotein cholesterol,hemoglobin,platelet count,uric acid,urea nitrogen,triglyceride and blood glucose were closely related to the incidence of NAFLD.