血清铁蛋白与代谢相关脂肪性肝病发病关系的前瞻性队列研究

Prospective study of relationship between serum ferritin and metabolic associated fatty liver disease

目的探讨血清铁蛋白(SF)与新发代谢相关脂肪性肝病(MAFLD)的相关性。方法以2017年在天津医科大学总医院健康管理中心体检且符合入选标准的7980例受检者作为观察队列,按性别以基线SF水平四分位数分为Q_(1)~Q4组,随访各组2018—2020年健康体检时MAFLD的发病情况,比较各组MAFLD的累积发病率,用Cox比例风险回归模型分析不同SF与新发MAFLD的相关性,并按照性别、年龄、吸烟状况、体质指数(BMI)等进行分层分析。结果平均随访时间3.2年,共计随访25321人年,随访期间共发生MAFLD 1696例,Q_(1)~Q_(4)组MAFLD发病密度分别为53.30、56.39、72.80及85.78/千人年。MAFLD发病密度随着基线SF水平的升高而增加,当男性和女性SF分别≥162.47和49.94μg/L时,Q_(3)、Q4组MAFLD发病密度与Q_(1)组比较,均P<0.001。Q_(3)、Q4组MAFLD发病风险分别为Q_(1)组的1.173(95%CI:1.093~1.258)、1.174(95%CI:1.122~1.228)倍;采用Cox比例风险回归模型校正年龄、吸烟状况等多种混杂因素后,Q_(3)、Q4组MAFLD发病风险仍为Q_(1)组的1.092(95%CI:1.017~1.172)、1.084(95%CI:1.035~1.136)倍(均P<0.001)。按照性别、年龄、吸烟状况、BMI等进行分层分析,男性、较低年龄组、不吸烟、高BMI人群中,高SF与MAFLD发病关联差异有统计学意义。结论高SF水平与MAFLD发病相关,且受性别、年龄、吸烟状况、BMI等因素影响。

Objective To investigate the relationship between serum ferritin(SF)and metabolic associated fatty liver disease(MAFLD).Methods A total of 7980 adults from physical examination in Tianjin Medical University General Hospital who met selection criterion were recruited as participants.Subjects were divided into 4 groups(Q_(1)-Q_(4))according to quartiles of SF level by gender.The incidence of MAFLD in each group in 2018-2020 were observed and cumulative incidence of MAFLD was compared between each group.Cox regression model was used to analyze the correlation between different SF levels and new-onset MAFLD,and stratified analysis was performed according to factors as gender,age,smoking status and body mass index(BMI).Results The mean follow up period was 3.2 years,and there were 25323 person-years of follow-up,and 1696 subjects developed MAFLD.The incidence density of MAFLD in Q_(1)-Q_(4) groups were 53.30,56.39,72.80 and 85.78/1000 person-years,respectively.The incidence density of MAFLD increased along with the increase of SF levels,and the differences were statistically significant(P values between Q_(3),Q_(4) and Q_(1) groups were both<0.001)with SF≥162.47μg/L(male)and 49.94μg/L(female).The risk of MAFLD were 1.173(95%CI:1.093-1.258)and 1.174(95%CI:1.122-1.228)times higher in Q_(3) and Q_(4) group than that in Q_(1) group(P<0.001).After adjusting for age,smoking status and other confounding factors,the risks of MAFLD in the Q_(3) and Q_(4) groups were 1.092(95%CI:1.017-1.172)and 1.084(95%CI:1.035-1.136)times higher in Q_(3) and Q_(4) group than that in Q_(1) group(all P<0.001).The stratified analyses based on gender,age,smoking status,BMI and other factors indicated that high SF levels showed significant association with MAFLD risk in those with the male sex,younger age,non-smokers and higher BMI population.Conclusions High SF levels might increase the risk of MAFLD and this positive association might be associated with gender,age,smoking status and BMI.