血清25-羟维生素D与非酒精性脂肪性肝病发病风险的前瞻性SPECT-China队列研究

Serum 25-hydroxyvitamin D and incident nonalcoholic fatty liver disease from SPECT-China study

目的 探讨25-羟基维生素D[25-hydroxyvitamin D,25(OH)D]与中国非酒精性脂肪性肝病(non-alcoholic fatty liver disease, NAFLD)发病风险的相关性,并评估是否受遗传易感性的影响。方法 数据来源于中国华东地区代谢性疾病流行及危险因素调查(SPECT-China)队列。根据超声评估,纳入1 624名基线时无NAFLD的参与者。对1 126名参与者计算NAFLD的加权遗传风险评分。采用logistic回归模型分析NAFLD发病风险的OR和95%CI。结果 经过5年的随访,共记录了197例新发NAFLD病例。在调整年龄、性别和BMI后,血清25(OH)D水平与NAFLD发病风险显著负相关[每1-标准差(SD)增量,OR=0.81,95%CI为0.68~0.97],在25(OH)D四分位数中NAFLD风险有显著降低的趋势(趋势P=0.01;Q4比Q1,OR=0.61,95%CI为0.39~0.96)。在进一步调整吸烟状态、饮酒状态、糖尿病、高血压、TG等代谢因素后,这种关联在很大程度上减弱了(每1-SD增量,OR=0.87,95%CI为0.73~1.04),模型3中的趋势显著性减弱(趋势P=0.09)。此外,维生素D、遗传易感性与新发NAFLD间无显著的交互作用(交互P=0.81)。结论 血清25(OH)D水平与NAFLD的发生在统计学上未发现显著相关性,且与遗传易感性无显著交互作用。

Objective To investigate the association between 25-hydroxyvitamin D[25(OH)D]and the risk of incident non-alcoholic fatty liver disease(NAFLD)in East China and evaluate whether the association was modified by genetic predisposition.Methods The data were obtained from the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors(SPECT-China)cohort.According to ultrasonic assessments,1624 participants free of NAFLD at baseline were included.A weighted genetic risk score for NAFLD were calculated in 1126 participants.Logistic regressive models were used to examine the OR and 95%CI for the risk of NAFLD.Results After a 5-year follow-up,a total of 197 NAFLD cases were documented.After adjusting for age,sex and BMI,serum 25(OH)D levels were significantly associated with incident NAFLD[per 1-SD increment,OR=0.81,95%CI:0.68-0.97]and there was a significant decreasing trend of NAFLD risk across 25(OH)D quartiles(P for trend 0.01;quartile 4 vs.1,OR=0.61,95%CI:0.39-0.96).However,after further adjusting for smoking status,drinking status,diabetes,hypertension,and triglycerides,the association was largely attenuated(per 1-SD increment,OR=0.87,95%CI=0.73-1.04)and the trend significance was also attenuated in the final model(P for trend=0.09).Additionally,no significant interaction effect was observed among 25(OH)D,genetic predisposition and incident NAFLD.Conclusion Serum 25(OH)D levels are not statistically associated with incident NAFLD regardless of genetic predisposition.Studies with larger sample size and intervention nature are warranted.