高海拔与低海拔地区代谢相关性脂肪性肝病患者临床特征的回顾性分析

Retrospective analysis of clinical characteristics of patients with metabolic-associated fatty liver disease at high and low altitude areas

目的探讨高海拔与低海拔地区代谢相关脂肪性肝病(MAFLD)患者临床特征在不同年龄段及不同血红蛋白水平的差异,为进一步研究慢性缺氧对MAFLD的影响提供依据。方法回顾性分析青海省西宁地区1458名和浙江省湖州地区1633名MAFLD体检人群的肝功能指标、无创纤维化指标、代谢指标、血常规等。对两地总人群间进行比较分析;以血红蛋白180 g/L为界,将西宁人群分层为高、低血红蛋白组进行比较分析;两地人群按年龄分层分为5组(≤30岁、31~40岁、41~50岁、51~60岁、≥61岁),多因素调整后,分别比较不同年龄段高、低血红蛋白组两地人群及MAFLD特征。用t检验或χ^(2)检验进行统计学分析。结果西宁地区人群观测指标检测值高于湖州人群的有:纤维化指数(FIB4,1.08±0.02比1.19±0.02)、红细胞计数(5.14±0.13比5.30±0.13)、血红蛋白(156.82±0.37比164.19±0.39)、丙氨酸转氨酶(ALT,33.70±0.66比43.68±0.70),天冬氨酸转氨酶(AST,24.34±0.28比29.23±0.30)、γ-谷氨酰转移酶(42.40±1.02比51.82±1.53)、碱性磷酸酶(77.92±0.56比84.63±0.85)、甘油三酯(TG,2.07±0.04比2.74±0.05)、尿酸(UA,383.42±2.15比406.44±2.36),湖州人群高于西宁人群的观测指标检测值有:血小板计数(220.54±1.32比181.62±1.40),总胆固醇(TC,5.10±0.02比5.04±0.03)、空腹血糖(FBG)值(5.67±0.04比5.29±0.04);差异均有统计学意义(P值均<0.01)。西宁人群高血红蛋白组UA、体质量指数高于低血红蛋白组,其他参数差异无统计学意义;西宁人群按年龄分组后发现FIB4在31~40岁和51~60岁年龄段、ALT在>61岁年龄段、AST及UA在31~40岁年龄段高、低血红蛋白组间差异有统计学意义(P<0.01)。结论MAFLD患者在高原缺氧环境下更易出现纤维化、肝功能损害、代谢紊乱等,且严重程度与年龄变化存在一定联系,提示慢性缺氧可加速MAFLD进展。

Objective To explore differences in clinical characteristics and hemoglobin levels between different age groups in patients with metabolic-associated fatty liver disease(MAFLD)at high and low altitude areas,so as to provide a basis for further research on the effect of chronic hypoxia on MAFLD.Methods Liver function indexes,non-invasive fibrosis indexes,metabolic indexes,and routine blood test of 1458(Xining area of Qinghai province)and 1633 cases(Huzhou area,Zhejiang province)with MAFLD who underwent physical examination were retrospectively analyzed.The total population of the two places were compared and analyzed with the hemoglobin reference limit of 180 g/L.The population of Xining was divided into high and low hemoglobin groups for comparative analysis.The population of the two places was divided into five groups according to age stratification(≤30 years old,31-40 years old,41-50 years old,51-60 years old,≥61 years old).After multivariate adjustment,the characteristics of high and low hemoglobin groups and MAFLD were compared between the two groups.Statistical analysis was performed with t-test orχ^(2) test.Results The detected indexes values observed were higher in Xining than Huzhou area population[fibrosis indexes(FIB4,1.08±0.02 vs.1.19±0.02),erythrocyte(5.14±0.13 vs.5.30±0.13),hemoglobin(156.82±0.37 vs.164.19±0.39),alanine aminotransferase(ALT,33.70±0.66 vs.43.68±0.70),aspartate aminotransferase(AST,24.34±0.28 vs.29.23±0.30),γ-glutamyltransferase(42.40±1.02 vs.51.82±1.53),alkaline phosphatase(77.92±0.56 vs.84.63±0.85),triglyceride(TG,2.07±0.04 vs.2.74±0.05),uric acid(UA,383.42±2.15 vs.406.44±2.36)].The detected indexes values observed were higher in Huzhou than Xining area population[platelet count(220.54±1.32 vs.181.62±1.40),total cholesterol(TC,5.10±0.02 vs.5.04±0.03),fasting blood glucose(FBG,5.67±0.04 vs.5.29±0.04)].The differences were statistically significant(P<0.01).Xining population UA and body mass index were increased in high hemoglobin group than low hemoglobin group,and the other parameters difference were not statistically significant.After the population in Xining was grouped by age,high and low FIB4,ALT,and AST and UA levels were detected in the age group of 31-40 and 51-60 years old,>61 years old,31-40 years old,and the difference between hemoglobin groups were statistically significant(P<0.01).Conclusion Patients with MAFLD are more likely to develop fibrosis,liver function impairment,metabolic disorders and so on under high-altitude hypoxic environment.Additionally,there is certain correlation with disease severity and age changes,suggesting that chronic hypoxia can accelerate MAFLD progression.