不同非酒精性脂肪性肝病发病年龄与新发糖尿病的关联

Correlation of nonalcoholic fatty liver disease at different ages of onset with new-onset diabetes mellitus

目的探讨非酒精性脂肪性肝病(NAFLD)不同发病年龄对新发糖尿病的影响。方法采用队列研究方法, 以开滦集团公司在职、离退休职工为研究对象, 排除基线已确诊的NAFLD、既往有糖尿病病史、长期大量饮酒史, 最终43 317例纳入队列。将研究对象按年龄分为5组(<30岁为1组, 30~39岁为2组, 40~49岁为3组, 50~59岁为4组, ≥60岁为5组), 比较各组NAFLD人群与非脂肪肝人群新发糖尿病发病率和发病密度, 采用多因素Cox回归模型分析NAFLD不同发病年龄对新发糖尿病的影响。采用单因素方差分析、χ^(2)检验或多因素Cox回归模型进行统计学分析。结果与非脂肪肝人群相比NAFLD人群的糖尿病发病率和发病密度均明显增高, 不同年龄分组糖尿病的发病率分别为6.45%、6.88%、9.94%、10.83%、11.43%, 各年龄组发病密度分别是9.21/千人年、11.10/千人年、16.17/千人年、18.72/千人年、22.13/千人年;差异有统计学意义(P<0.001)。多因素Cox回归模型结果显示, 在校正性别、收缩压、空腹血糖等混杂因素后, 各年龄组发生糖尿病的HR(95%CI)分别为3.992(1.897, 8.400)、2.321(1.589, 3.392)、2.041(1.667, 2.500)、2.007(1.708, 2.360)、1.908(1.570, 2.319);差异有统计学意义(P<0.001)。结论新发NAFLD是新发糖尿病的独立危险因素, NAFLD暴露得越早与同年龄相比糖尿病的发病风险越大。年龄越轻发生NAFLD更应重视和积极治疗。

To investigate the effect of nonalcoholic fatty liver(NAFLD)at different ages of onset with new-onset diabetes mellitus.Methods The cohort study was conducted in Kailuan Group Company.Active and retired employees were used as study subjects.After excluding NAFLD diagnosed at baseline,previous history of diabetes mellitus,and long-term history of heavy drinking,43317 cases were finally included in the cohort.The study subjects were divided into five groups according to age(<30 years old as group 1,30-39 years old as group 2,40-49 years as group 3,50-59 years as group 4,and≥>60 years as group 5).The prevalence and incidence density of new-onset diabetes mellitus were compared between each NAFLD and non-fatty liver population group.The effect of NAFLD at different ages of onset with new-onset diabetes mellitus was analyzed by multivariate Cox's regression model.Statistical analysis was performed using one-way ANOVA,χ^(2) test or multivariate Cox's regression model.Results The prevalence and incidence density of diabetes mellitus was significantly higher in NAFLD than non-fatty liver population.The prevalence of diabetes mellitus in different age groups were 6.45%,6.88%,9.94%,10.83%,and 11.43%,respectively.The incidence density of each age group was 9.21/1000 person-years,11.10/1000 person-years,16.17/1000 person-years,18.72/1000 person-years,and 22.13/1000 person-years,and the differences were statistically significant(P<0.001).Multivariate Cox's regression model result showed that after adjusting for confounding factors such as gender,systolic blood pressure,and fasting blood glucose,the HRs(95%CI)for diabetes mellitus in each age group were 3.992(1.897,8.400),2.321(1.589,3.392),2.041(1.667,2.500),2.007(1.708,2.360),and 1.908(1.570,2.319),and the differences were statistically significant(P<0.001).Conclusion Newly developed NAFLD is an independent risk factor for new-onset diabetes mellitus.Early exposure to NAFLD increases the risk of developing diabetes mellitus compared with the same age group.Younger age of onset of NAFLD should be given attention and active treatment.