Prevalence of nonalcoholic fatty liver disease and its prognostic factors
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摘要:
目的探讨非酒精性脂肪性肝病(NAFLD)的患病情况、自然史、死亡原因及相关影响因素。方法选取2011年1月1日-12月31日在上海长征医院和上海85医院进行体检且自2011年起每年在上海长征医院或上海85医院随访的离退休老干部及部分单位职员,最终共纳入833例,2011年12月31日前确诊NAFLD的为NAFLD组(n=459),无肝脏及胆道系统疾病的为对照组(n=374)。收集患者临床资料,包括身高、体质量、收缩压、舒张压及血生化检查,是否有糖尿病、高脂血症、心脑血管疾病、恶性肿瘤等疾病,吸烟及饮酒情况,死亡对象明确其死亡时间和死亡原因。分析该研究人群NAFLD患病情况、自然病程、发病危险因素及预后影响因素。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,采用多因素二元Logistic回归分析NAFLD发病危险因素,多分类Logistic回归分析NAFLD病情加重、减轻的影响因素。结果 NAFLD组中男性NAFLD患病比例高于女性(58.0%vs 46.7%,χ2=4.962,P=0.026)。NAFLD组BMI、收缩压、舒张压、ALT、空腹血糖、血尿酸、甘油三酯(TG)、...
Abstract:Objective To investigate the prevalence,natural history,and causes of death of nonalcoholic fatty liver disease( NAFLD),as well as related influencing factors. Methods A total of 833 retired cadres and staff members who underwent physical examination in Shanghai Changzheng Hospital and Shanghai 85 Hospital of the PLA from January 1 to December 31,2011 and received follow- up visits in either hospital every year since 2011 were enrolled as study subjects,and were divided into NAFLD group( 459 patients who were diagnosed with NAFLD before December 31,2011) and control group( 374 patients without liver or biliary diseases). The patients' clinical data were collected,including body height,body weight,systolic pressure,diastolic pressure,blood biochemical parameters,presence or absence of diabetes,hyperlipidemia,cerebrovascular and cardiovascular diseases,and malignant tumor,and smoking and drinking,and the death time and causes of death were clarified for the patients who died. The prevalence and natural course of NAFLD and related risk factors and prognostic factors were analyzed in this population. The t- test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,the multivariate binary logistic regression was applied to analyze the risk factors for the pathogenesis of NAFLD,and the multinomial logistic regression was applied to analyze the influencing factors for aggravation or alleviation of NAFLD. Results The patients in NAFLD group accounted for 55. 1% of all subjects,and the proportion of male patients was higher than that of female patients( 58. 0% vs 46. 7%,χ2= 4. 962,P = 0. 026). Compared with the control group,the NAFLD group had significantly higher body mass index( BMI),systolic pressure,diastolic pressure,alanine aminotransferase( ALT),fasting blood glucose,serum uric acid,and triglyceride( TG),a significantly higher proportion of male patients,and significantly higher proportions of patients with hypertension,diabetes,metabolic syndrome,newly- onset diabetes,and newly- onset metabolic syndrome( all P < 0. 05),as well as a significantly lower high- density lipoprotein cholesterol level( t =- 9. 818,P < 0. 001). Of all 374 patients in the control group,64( 17. 1%) had newly- onset NAFLD,and the incidence rate of newly- onset NAFLD showed no significant difference between male and female patients( 18% vs 15%,χ2= 0. 349,P > 0. 05); BMI and TG were the independent risk factors for newly- onset NAFLD( OR =1. 304,95% CI: 1. 153- 1. 474,P < 0. 001; OR = 1. 509,95% CI: 1. 080- 2. 166,P = 0. 016). At the end of follow- up in NAFLD group,235 patients( 51. 2%) achieved a stable disease,40( 8. 7%) achieved improvement,144( 31. 4%) achieved remission,and 40( 8. 7%) experienced aggravation. The increase in BMI increased the risk of aggravation of NAFLD( OR = 1. 163,95% CI: 1. 028- 1. 316,P = 0. 016),while reductions in BMI and serum uric acid were the protective factors against NAFLD( OR = 0. 849,95% CI: 0. 781-0. 923,P < 0. 001; OR = 0. 997,95% CI: 0. 995- 1. 000,P = 0. 038). Ten patients in NAFLD group died( including 5 patients with malignant tumor and 2 patients with cerebrovascular and cardiovascular diseases),and 6 patients in the control group died( including 2 patients with malignant tumor,no patients with cerebrovascular and cardiovascular diseases),and the risk of death showed no significant difference between the two groups( P > 0. 05). Conclusion The prognosis of NAFLD is relatively good in people who underwent physical examination,and BMI,TG,and serum uric acid are the factors affecting the prognosis of such patients. The major causes of death in NAFLD patients are malignant tumor and cerebrovascular and cardiovascular diseases,rather than end- stage liver disease.
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Key words:
- fatty liver /
- prognosis /
- risk factors
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[1]FUNG J,LEE CK,CHAN M,et al.High prevalence of non-alcoholic fatty liver disease in the Chinese-results from the Hong Kong liver health census[J].Liver Int,2015,35(2):542-549. [2]BANG KB,CHO YK.Comorbidities and metabolic derangement of NAFLD[J].J Lifestyle Med,2015,5(1):7-13. [3]ADAMS LA,LYMP JF,ST SAUVER J,et al.The natural history of nonalcoholic fatty liver disease:a population-based cohort study[J].Gastroenterology,2005,129(1):113-121. [4]ONNERHAG K,NILSSON PM,LINDGREN S.Increased risk of cirrhosis and hepatocellular cancer during long-term follow-up of patients with biopsy-proven NAFLD[J].Scand J Gastroenterol,2014,49(9):1111-1118. [5]ZHOU YJ,LI YY,NIE YQ,et al.Natural course of nonalcoholic fatty liver disease in southern China:a prospective cohort study[J].J Dig Dis,2012,13(3):153-160. [6]Group of Fatty Liver and Alcoholic Liver Diseases,Society of Hepatology,Chinese Medical Association.Guidelines for management of nonalcoholic fatty liver disease(revised in February 2006)[J].Mod Digest Interv,2007,12(4):266-268.(in Chinese)中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南(2006年2月修订)[J].现代消化及介入诊疗,2007,12(4):266-268. [7]Group of Fatty Liver and Alcoholic Liver Diseases,Society of Hepatology,Chinese Medical Association.Guidelines for management of non-alcoholic fatty liver disease[J].J Clin Hepatol,2010,26(2):120-124.(in Chinese)中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].临床肝胆病杂志,2010,26(2):120-124. [8]LU YH,LU JM,WANG SY,et al.Comparison of the diagnostic criteria of metabolic syndrome by International Diabetes Federation and that by Chinese Medical Association Diabetes Branch[J].Natl Med J Chin,2006,86(6):386-389.(in Chinese)卢艳慧,陆菊明,王淑玉,等.国际糖尿病联盟与中国糖尿病学会关于代谢综合征诊断标准的比较分析[J].中华医学杂志,2006,86(6):386-389. [9]YU S,GUO X,YANG H,et al.An update on the prevalence of metabolic syndrome and its associated factors in rural northeast China[J].BMC Public Health,2014,14:877. [10]ZHANG F,HUANG YQ,BAO ZJ.Prevalence of nonalcoholic fatty liver disease in urban areas in China[J].Chin J Dig,2014,34(6):430-432.(in Chinese)张帆,黄一沁,保志军.非酒精性脂肪性肝病在我国城市地区的流行现状[J].中华消化杂志,2014,34(6):430-432. [11]HU X,HUANG Y,BAO Z,et al.Prevalence and factors associated with nonalcoholic fatty liver disease in Shanghai work-units[J].BMC Gastroenterol,2012,12(35):123. [12]FAN JG,ZHU J,LI XJ,et al.Prevalence of and risk factors for fatty liver in a general population of Shanghai,China[J].J Hepatol,2005,43(3):508-514. [13]LI H,DONG K,FANG Q,et al.High serum level of fibroblast growth factor 21 is an independent predictor of non-alcoholic fatty liver disease:a 3-year prospective study in China[J].J Hepatol,2013,58(3):557-563. [14]ZELBER-SAGI S,LOTAN R,SHLOMAI A,et al.Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up[J].J Hepatol,2012,56(5):1145-1151. [15]SODERBERG C,PASKLING S,ASKLING J,et al.Decreased survival of subjects with elevated liver function tests during a 28-year follow-up[J].Hepatology,2010,51(2):595-602. [16]ZHANG T,ZHANG C,ZHANG Y,et al.Metabolic syndrome and its components as predictors of nonalcoholic fatty liver disease in a northern urban Han Chinese population:a prospective cohort study[J].Atherosclerosis,2015,240(1):144-148. [17]HUANG CM,LI YY,ZHOU YJ,et al.Epidemiology of nonalcoholic fatty liver disease:a follow-up study for 4 years[J].Chin J Dig,2010,30(8):512-517.(in Chinese)黄春明,李瑜元,周永健,等.非酒精性脂肪性肝病流行病学4年对照研究[J].中华消化杂志,2010,30(8):512-517. [18]SERTOGLU E,ERCIN CN,CELEBI G,et al.The relationship of serum uric acid with non-alcoholic fatty liver disease[J].Clin Biochem,2014,47(6):383-388. [19]ANGULO P.Long-term mortality in nonalcoholic fatty liver disease:is liver histology of any prognostic significance[J].Hepatology,2010,51(51):373-375. [20]DAM-LARSEN S,BECKER U,FRANZMANN MB,et al.Final results of a long-term,clinical follow-up in fatty liver patients[J].Scand J Gastroenterol,2009,44(10):1236-1243. [21]EKSTEDT M,FRANZEN LE,MATHIESEN UL,et al.Longterm follow-up of patients with NAFLD and elevated liver enzymes[J].Hepatology,2006,44(4):865-873. [22]LAZO M,HERNAEZ R,BONEKAMP S,et al.Non-alcoholic fatty liver disease and mortality among US adults:prospective cohort study[J].BMJ,2011,343(46):1245.
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