脂肪肝患者发生空腹血糖升高的风险:一项40 381人近10年的队列研究

The incidence risk of elevated fasting blood glucose in people with fatty liver disease:a cohort study of 40000 people over the past 10 years

目的分析克拉玛依市中心医院体检人群中,脂肪肝患者发生空腹血糖升高风险显著高于非脂肪肝者的时间点,分析影响脂肪肝患者发生空腹血糖升高的因素,及其危险因素聚集数量对发病的影响。方法对克拉玛依市中心医院2008年9月至2017年4月的体检资料进行回顾性分析,结合生存分析法,分析脂肪肝与非脂肪肝者发生空腹血糖升高的1、3、5、7年患病率,并用Z检验比较其各时间点的生存率差异,用Cox回归模型进行多因素分析,并分析危险因素聚集数量对发病的影响。结果脂肪肝组10802例,发生空腹血糖升高的发病密度为61/1000人年,1、3、5、7年患病率分别为2%、16%、28%、38%;非脂肪肝组29579人,发生空腹血糖升高的发病密度为23/1000人年,1、3、5、7年患病率为1%、7%、11%、16%。脂肪肝组发生空腹血糖升高的近期、远期风险明显高于非脂肪肝组(P<0.001),脂肪肝患者发生空腹血糖升高的风险从第1年起就显著高于非脂肪肝者(P<0.001)。≥50岁(HR=1.954,95%CI:1.792~2.132)、身体质量指数升高(HR=1.397,95%CI:1.198~1.629)、血压升高(HR=1.284,95%CI:1.181~1.397)、甘油三酯升高(HR=1.171,95%CI:1.077~1.274)是促进脂肪肝患者发生空腹血糖升高的独立危险因素;脂肪肝合并上述2个、3个、4个危险因素会明显增加空腹血糖升高的发病风险(P<0.001)。结论脂肪肝患者发生空腹血糖升高的风险从第1年起就显著高于非脂肪肝者;≥50岁、血压、身体质量指数及甘油三酯升高是促进脂肪肝患者发生空腹血糖升高的危险因素,脂肪肝合并上述2个、3个、4个危险因素会明显增加空腹血糖升高发病风险。

Objective To analyze the time point when patients with fatty liver disease had a significantly higher risk of elevated fasting blood glucose than those without in the physical examination group in Karamay Central Hospital,factors affecting the incidence of elevated blood glucose in patients with fatty liver disease,and the influence of the number of influencing factors on it.Methods Physical examination data from Karamay Central Hospital during September 2008 to April 2017 were retrospectively analyzed.Combined with the survival analysis,the 1-,3-,5-,and 7-year prevalence rates of elevated fasting glucose occurs in people with and without fatty liver disease were analyzed.Z-test was used to compare the survival rate difference at each time point.Cox regression model was used for multivariate analysis.Results 10802 people were in the fatty liver group.The elevated fasting blood glucose incidence density was 61/1000 person-years,and the 1-,3-,5-,and 7-year prevalence rates were 2%,16%,28%,and 38%,respectively.29579 people were in the non-fatty liver group.The elevated fasting blood glucose incidence density was 23/1000 person-years,and the 1-,3-,5-,and 7-year prevalence rates were 1%,7%,11%,and 16%,respectively.The short-term and long-term elevated fasting blood glucose incidence risk were significantly higher in fatty liver group than non-fatty liver group(P<0.001).The elevated fasting blood glucose incidence risk was apparently higher in fatty liver group than that of non-fatty liver group from the first year onward(P<0.001).Age≥50 year’s old(HR=1.954,95%CI:1.792-2.132),elevated body mass index(HR=1.397,95%CI:1.198-1.629),blood pressure(HR=1.284,95%CI:1.181-1.397),triglycerides(HR=1.171,95%CI:1.077-1.274)were independent risk factors,which promoted the elevated fasting blood glucose incidence risk in patients with fatty liver disease.Fatty liver combined with the above 2,3,and 4 risk factors had apparently increased the incidence risk of elevated fasting blood glucose(P<0.001).Conclusion People with fatty liver disease had a higher risk of elevated fasting blood glucose from the first year than those without.Age≥50 year’s old,elevated blood pressure,body mass index and triglyceride might increase risk of elevated fasting blood glucose in patients with fatty liver disease,combined with the above 2,3 or 4 risk factors can increase the risk of elevated fasting blood glucose.