腹型肥胖与甘油三酯的交互作用对非酒精性脂肪性肝病发病的影响

崔皓哲; 马向明; 刘倩; 孙苗苗; 赵利; 王万超; 刘四清; 曹立瀛

doi:10.3969/j.issn.1001-5256.2020.06.025

腹型肥胖与甘油三酯的交互作用对非酒精性脂肪性肝病发病的影响

DOI: 10.3969/j.issn.1001-5256.2020.06.025

1. 华北理工大学研究生院
2. 开滦总医院肝胆外科

基金项目:

河北省2020年度医学科学研究课题计划(20200933)；

详细信息

中图分类号: R575.5
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出版历程
- 出版日期: 2020-06-20

Influence of the interaction between abdominal obesity and hypertriglyceridemia on the development of nonalcoholic fatty liver disease

Research funding:

摘要

摘要:
目的探究腹型肥胖与高TG血症对非酒精性脂肪性肝病（NAFLD）的发病是否存在协同作用。方法采用前瞻性队列的研究方法,收集2006年7月-2007年6月70 776例参加健康查体的开滦集团在职及离退休职工的体检资料,并在随后每两年1次的随访中,观察NAFLD的发病情况。根据不同腰围身高比、TG水平将观察对象分为4组,即非腹型肥胖合并非高TG血症组、非腹型肥胖合并高TG血症组、腹型肥胖合并非高TG血症组、腹型肥胖合并高TG血症组,计算各组的NAFLD人年发病率。符合正态分布的计量资料多组间比较采用单因素方差分析;非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料组间比较用χ2检验。Kaplan-Meier计算各组NAFLD的累计发病率,并用log-rank检验比较组间累计发病率的差异。以非腹型肥胖合并非高TG血症组为对照组,采用Cox比例风险模型分析各组NAFLD的发病风险（HR）及95%可信区间（95%CI）,并进一步分析腹型肥胖与高TG血症对NAFLD发病影响的交互作用。结果本研究平均随访（5. 03±1. 67）年,共发生NAFLD...
- 非酒精性脂肪性肝病 /
- 肥胖,腹部 /
- 队列研究
Abstract:
Objective To investigate whether abdominal obesity and hypertriglyceridemia have a synergistic effect on the development of nonalcoholic fatty liver disease( NAFLD). Methods A prospective cohort study was conducted. Physical examination data were collected from 70 776 on-the-job or retired employees of Kailuan Group who underwent physical examination from July 2006 to June 2007,and the development of NAFLD was observed during the follow-up every two years. The subjects were divided into four groups according to the waist-to-height ratio and triglyceride( TG) level,and the person-year incidence rate was calculated. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups,and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups.The life-table method was used to calculate the cumulative incidence rate of NAFLD in each group,and the log-rank test was used for comparison between groups. With the non-abdominal obesity and non-hypertriglyceridemia group as the control group,the Cox proportional hazards model was used to analyze the risk of NAFLD and related 95% confidence interval( CI) for each group,and the influence of the interaction between abdominal obesity and hypertriglyceridemia on the development of NAFLD was further analyzed. Results During the mean follow-up time of 5. 03 ± 1. 67 years in this study,a total of 15 684 cases of NAFLD were observed,with a 6-year cumulative incidence rate of 25. 44% and a person-time incidence rate of 44. 03/1000 person-years. The log-rank test showed a significant difference in cumulative incidence rate between groups( χ2= 2479. 40,P < 0. 001). With the non-abdominal obesity and non-hypertriglyceridemia group as the control group,after adjustment for related confounding factors,the abdominal obesity-hypertriglyceridemia group had a hazard ratio( HR) of 2. 50( 95% CI: 2. 38-2. 62) for the development of NAFLD,which was significantly higher than the HR of 1. 99( 95%CI: 1. 92-2. 07) in the abdominal obesity and non-hypertriglyceridemia group and the HR of 1. 71( 95% CI: 1. 59-1. 84) in the non-abdominal obesity and hypertriglyceridemia group. After adjustment for the same confounding factors,the interaction analysis showed multiplicative interaction between abdominal obesity and hypertriglyceridemia( P < 0. 001),and co-existence of abdominal obesity and hypertriglyceridemia had a relative excess risk of 0. 77( 95% CI: 0. 68-0. 86),an attributable proportion of 30. 83%,and an interaction index of 2. 06( 95% CI: 1. 90-2. 24). Conclusion Abdominal obesity and hypertriglyceridemia have a synergistic effect on the development of NAFLD.
- non-alcoholic fatty liver disease /
- obesity,abdominal /
- cohort studies

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参考文献(36)

[1] BELLENTANI S. The epidemiology of non-alcoholic fatty liver disease[J]. Liver Int,2017,37(Suppl 1):81-84.

[2] WILLIAMS R. Global challenges in liver disease[J]. Hepatology,2006,44(3):521-526.

[3] ANGULO P. GI epidemiology:Nonalcoholic fatty liver disease[J]. Aliment Pharmacol Ther,2007,25(8):883-889.

[4] VERNON G,BARANOVA A,YOUNOSSI ZM. Systematic review:The epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults[J]. Aliment Pharmacol Ther,2011,34(3):274-285.

[5] FAN JG,FARRELL GC. Epidemiology of non-alcoholic fatty liver disease in China[J]. J Hepatol,2009,50(1):204-210.

[6] WANG FS,FAN JG,ZHANG Z,et al. The global burden of liver disease:The major impact of China[J]. Hepatology,2014,60(6):2099-2108.

[7] FAN JG,SAIBARA T,CHITTURI S,et al. What are the risk factors and settings for non-alcoholic fatty liver disease in Asia-Pacific?[J]. J Gastroenterol Hepatol,2007,22(6):794-800.

[8] HU X,HUANG Y,BAO Z,et al. Prevalence and factors associated with nonalcoholic fatty liver disease in Shanghai workunits[J]. BMC Gastroenterol,2012,12:123.

[9] MOTAMED N,RABIEE B,HEMASI GR,et al. Body roundness index and waist-to-height ratio are strongly associated with non-alcoholic fatty liver disease:A population-based study[J]. Hepat Mon,2016,16(9):e39575.

[10] PANG Q,ZHANG JY,SONG SD,et al. Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index[J]. World J Gastroenterol,2015,21(5):1650-1662.

[11] NIRIELLA MA,PATHMESWARAN A,de SILVA ST,et al. Incidence and risk factors for non-alcoholic fatty liver disease:A7-year follow-up study among urban,adult Sri Lankans[J]. Liver Int,2017,37(11):1715-1722.

[12] LEE SW,LEE TY,YANG SS,et al. Risk factors and metabolic abnormality of patients with non-alcoholic fatty liver disease:Either non-obese or obese Chinese population[J]. Hepatobiliary Pancreat Dis Int,2018,17(1):45-48.

[13] JIN C,CHEN S,VAIDYA A,et al. Longitudinal change in fasting blood glucose and myocardial infarction risk in a population without diabetes[J]. Diabetes Care,2017,40(11):1565-1572.

[14] SUN MM,CAO LY,SUN WD,et al. Association of serum highdensity lipoprotein cholesterol with new-onset cholelithiasis[J].J Clin Hepatol,2019,35(8):1745-1750.(in Chinese)孙苗苗，曹立瀛，孙卫东，等．血清高密度脂蛋白胆固醇与新发胆石症的关系[J]．临床肝胆病杂志，2019,35(8):1745-1750.

[15] HSIEH SD,YOSHINAGA H. Abdominal fat distribution and coronary heart disease risk factors in men-waist/height ratio as a simple and useful predictor[J]. Int J Obes Relat Metab Disord,1995,19(8):585-589.

[16] Joint committee for guideline revision. 2016 Chinese guidelines for the management of dyslipidemia in adults[J]. J Geriatr Cardiol,2018,15(1):1-29.

[17] National Workshop on Fatty Liver and Alcoholic Liver Disease,Chinese Society of Hepatology,Chinese Medical Association;Fatty Liver Expert Committee,Chinese Medical Doctor Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease:A 2018 update[J]. J Clin Hepatol,2018,34(5):947-957.(in Chinese)中华医学会肝病学分会脂肪肝和酒精性肝病学组，中国医师协会脂肪性肝病专家委员会．非酒精性脂肪性肝病防治指南(2018更新版)[J]．临床肝胆病杂志，2018,34(5):947-957.

[18] Writing Group of 2018 Chinese Guidelines for the Management of Hypertension,Chinese Hypertension League,Chinese Society of Cardiology,et al. 2018 Chinese guidelines for the management of hypertension[J]. Chin J Cardiovasc Med,2019,24(1):24-56.(in Chinese)中国高血压防治指南修订委员会，高血压联盟(中国)，中华医学会心血管病学分会，等．中国高血压防治指南(2018年修订版)[J]．中国心血管杂志，2019,24(1):24-56.

[19] Chinese Diabetes Society. Guidelines for the prevention and control of type 2 diabetes in China(2017 Edition)[J]. Chin J Diabetes Mellitus,2018,10(1):4-67.(in Chinese)中华医学会糖尿病学分会．中国2型糖尿病防治指南(2017年版)[J]．中华糖尿病杂志，2018,10(1):4-67.

[20] YUAN Y,LI N,REN AG,et al. Analysis of the application of the additive model and the multiplicative statistical model in biologial interaction[J]. Mod Pre Med,2015,42(6):961-965,975.(in Chinese)袁悦，李楠，任爱国，等．流行病学研究中相加和相乘尺度交互作用的分析[J]．现代预防医学，2015,42(6):961-965,975.

[21] XU C,YU C,MA H,et al. Prevalence and risk factors for the development of nonalcoholic fatty liver disease in a nonobese Chinese population:The Zhejiang Zhenhai Study[J]. Am J Gastroenterol,2013,108(8):1299-1304.

[22] FAN JG,ZHOU Q,WO QH. Effect of body weight mass and its change on the incidence of nonalcoholic fatty liver disease[J]. Chin J Hepatol,2010,18(9):676-679.(in Chinese)范建高，周琪，沃千红．人体质量指数及其变化与非酒精性脂肪性肝病发病的关系[J]．中华肝脏病杂志，2010,18(9):676-679.

[23] YANG RX,FAN JG. Prevalence of nonalcoholic fatty liver disease[J]. J Clin Intern Med,2015,32(5):293-296.(in Chinese)杨蕊旭，范建高．非酒精性脂肪性肝病的流行现状[J]．临床内科杂志，2015,32(5):293-296.

[24] CHEN XF,WANG HP,ZHOU T. A meta-analysis of the influential factors of nonalcoholic fatty liver disease in Chinese people[J]. J Clin Res,2014,31(7):1273-1276,1277.(in Chinese)陈小芳，王惠平，周滔．中国人群非酒精性脂肪肝发病影响因素的Meta分析[J]．医学临床研究，2014,31(7):1273-1276,1277.

[25] LEE SW,LEE TY,YANG SS,et al. The association of nonalcoholic fatty liver disease and metabolic syndrome in a Chinese population[J]. Hepatobiliary Pancreat Dis Int,2017,16(2):176-180.

[26] ZHENG S,YANG JH,YOU LY,et al. Correlation between metabolic syndrome-related parameters and nonalcoholic fatty liver disease in physical examination population[J]. Chin Gen Pract,2013,16(6):605-607.(in Chinese)郑盛，杨晋辉，尤丽英，等．体检人群非酒精性脂肪性肝病与代谢综合征相关指标的关系研究[J]．中国全科医学，2013,16(6):605-607.

[27] SAOKAEW S,KANCHANASUWAN S,APISARNTHANARAK P,et al. Clinical risk scoring for predicting non-alcoholic fatty liver disease in metabolic syndrome patients(NAFLD-MS score)[J]. Liver Int,2017,37(10):1535-1543.

[28] LU FB,HU ED,XU LM,et al. The relationship between obesity and the severity of non-alcoholic fatty liver disease:Systematic review and meta-analysis[J]. Expert Rev Gastroenterol Hepatol,2018,12(5):491-502.

[29] PARK SK,RYOO JH,CHOI JM,et al. The risk of abdominal obesity according to the degree of non-alcoholic fatty liver disease in Korean Men[J]. J Korean Med Sci,2016,31(3):410-416.

[30] PIMENTA NM,CORTEZ-PINTO H,MELO X,et al. Waist-toheight ratio is independently related to whole and central body fat,regardless of the waist circumference measurement protocol,in non-alcoholic fatty liver disease patients[J]. J Hum Nutr Diet,2017,30(2):185-192.

[31] GAO LJ. Anthropometric indexes identifying non-alcoholic fatty liver and its related metabolic parameters,exploring the optimal threshold[D]. Hengyang:University of South China,2014.(in Chinese)高丽娟．人体测量学指标对非酒精性脂肪肝及其相关代谢参数预测价值及相应切点研究[D]．衡阳:南华大学，2014.

[32] ZHANG L,WU CZ,GAO YS,et al. Relationship between the waist-to-height ratio and the non-alcoholic fatty liver disease[J]. Clin Med China,2017,33(4):304-308.(in Chinese)张丽，吴成忠，高永生，等．腰围身高比值与非酒精性脂肪肝的相关性分析[J]．中国综合临床，2017,33(4):304-308.

[33] ZHANG YM,ZHANG M,JIANG XZ,et al. Prediction of the incidence of nonalcoholic fatty liver in type 2 diabetes mellitus by triglyrcerid levels[J]. Prac Pre Med,2015,22(4):438-441.(in Chinese)张艳敏，张萌，蒋晓忠，等．甘油三酯对2型糖尿病患者新发非酒精性脂肪肝的预测价值[J]．实用预防医学，2015,22(4):438-441.

[34] SUN Y,WEI C,LI HR,et al. The mechanism of insulin resistance induced by obesity[J]. Chin J Gerontol,2015,35(21):6268-6271.(in Chinese)孙颖，魏聪，李红蓉，等．肥胖诱导胰岛素抵抗机制研究进展[J]．中国老年学杂志，2015,35(21):6268-6271.

[35] ZHU CY,WEI L,JIA WP. Progress in the study of the association between abnormal triglyceride metabolism and insulin resistance[J]. Chin J Endocrinol Metab,2011,27(4):357-359.(in Chinese)祝超瑜，魏丽，贾伟平．甘油三酯代谢异常与胰岛素抵抗关系的研究进展[J]．中华内分泌代谢杂志，2011,27(4):357-359.

[36] PARDINA E,BAENA-FUSTEGUERAS JA,LLAMAS R,et al.Lipoprotein lipase expression in livers of morbidly obese patients could be responsible for liver steatosis[J]. Obes Surg,2009,19(5):608-616.

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