社区人群非酒精性脂肪性肝病的发病及转归的影响因素

Non-alcoholic fatty liver disease related health outcomes and influencing factors among community inhabitants

【目的】描述社区自然人群非酒精性脂肪性肝病(NAFLD)随访前后的发病及转归情况,分析随访期间人群各项指标变化量与不同NAFLD病情终点的关联。【方法】基于上海市自然人群队列松江子队列,收集研究人群身高、体重、腰围、臀围、血压等体格测量指标,测定空腹血糖、糖化血红蛋白(HbA1c)、血清三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肝转氨酶等血生化检测指标以及腹部B型超声检查影像诊断结果。使用中华医学会《非酒精性脂肪性肝病诊疗指南》作为NAFLD诊断标准,应用配对t检验比较不同NAFLD病情终点人群的各项指标变化情况。采用多因素logistic回归模型分析各指标的变化与不同NAFLD终点的关联性。【结果】对12 076名研究对象进行中位时间为2.94年的随访,社区人群NAFLD累积发病率、累积患病后未缓解率及累积患病后缓解率分别为21.57%、27.96%及31.15%。随访前后NAFLD新发人群血压、体重指数(BMI)、空腹血糖及TG等升高;NAFLD缓解人群血压、BMI、腰臀比(WHR)及TG等降低。收缩压(SBP)、WHR、BMI、HbA1c及LDL-C水平升高可能是NAFLD发病的风险因素,WHR、BMI、TC、LDL-C水平降低及HDL-C水平升高可能是NAFLD缓解的影响因素。【结论】社区自然人群NAFLD检出率较高,BMI、WHR、空腹血糖及血脂水平变化可能是NAFLD不同病情终点的影响因素。

[Objective]To describe different non-alcoholic fatty liver disease(NAFLD)outcomes among community inhabitants,and further to explore the correlation between bio-indicator level variance and the outcomes.[Methods]Physical indicators(height,weight,waist circumstances,hip circumstances,blood pressure,etc),biochemical indicators[fasting plasma glucose,HbA1c,serum triglycerides(TG),serum total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),liver related transaminase,etc]and clinical imaging(B-scan ultrasonography)were collected during the follow-up from the Songjiang Natural Population Sub-cohort.The identification of NAFLD was supported by the definition criteria from Guidelines for the diagnosis and treatment of non-alcoholic fatty liver disease.Paired t-test and multifactorial logistic regression model were used to compare the difference between the indicator level of the subjects from different outcome subgroups and to further analyze the correlation between these indicator variance and different NAFLD outcomes.[Results]During a median follow-up time of 2.94 years,12076 subjects were involved.The cumulative NAFLD incidence and remission rate were 21.57%and 31.15%,respectively.The proportion of subjects who still had NAFLD was 27.96%.Among subjects with newly-developed NAFLD,indicators including blood pressure,BMI,fasting plasma glucose,and plasma lipid level increased,while in the remission subgroup,blood pressure,BMI(WHR),waist-hip ratio(WHR),and TG level were significantly decreased.Increased level of systolic pressure,WHR,BMI,HbA1c,and LDL-C might be the risk factors to the occurrence of NAFLD.While decreased level of WHR,BMI,TC and LDL-C level and elevated HDL-C level were likely to be the influencing factors of NAFLD remission process.[Conclusion]The NAFLD morbidity in the community inhabitants is relatively high.BMI,WHR,fasting plasma sugar and plama lipid level variance may act as the influencing factors towards different NAFLD outcomes.