非肥胖型脂肪肝患病率及影响因素分析

邓江; 韩致毅; 肖彩兰; 孙雅亭; 吉亚军; 敖丽; 张永红; 鲁晓岚

doi:10.3969/j.issn.1001-5256.2021.11.022

非肥胖型脂肪肝患病率及影响因素分析

DOI: 10.3969/j.issn.1001-5256.2021.11.022

邓江^1a,
韩致毅^2a,
肖彩兰^1b,
孙雅亭^1b,
吉亚军³,
敖丽³,
张永红^2b, ,,
鲁晓岚^{1b, 3, ,}

1a.
西安交通大学第二附属医院感染科，西安 710004
1b.
西安交通大学第二附属医院消化科，西安 710004
2a.
克拉玛依市中心医院消化科，新疆克拉玛依 834099
2b.
克拉玛依市中心医院体检中心，新疆克拉玛依 834099
3.
复旦大学附属浦东医院消化科，上海 201399

基金项目:

上海市自然基金 (20ZR1450100);

浦东医院人才课题基金 (YJRCJJ201801);

中央高校基本科研业务费专项资金资助 (xjh012019063);

国家十三五重点研发计划课题资助 (2018YFC1311504)

详细信息

通信作者:
张永红，813467534@qq.com

鲁晓岚，xiaolan_lu@163.com

中图分类号: R575.5
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出版历程
- 收稿日期: 2021-04-05
- 录用日期: 2021-04-28
- 出版日期: 2021-11-20

Prevalence rate of non-obese fatty liver disease and related influencing factors

Jiang DENG^1a,
Zhiyi HAN^2a,
Cailan XIAO^1b,
Yating SUN^1b,
Yajun JI³,
Li AO³,
Yonghong ZHANG^{2b
, ,},
Xiaolan LU^{1b, 3
, ,}

1a.
Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
1b.
Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
2a.
Department of Gastroenterology, Karamay Central Hospital, Karamay, Xinjiang 834099, China
2b.
Physical Examination Center, Karamay Central Hospital, Karamay, Xinjiang 834099, China
3.
Department of Gastroenterology, Pudong Hospital Affiliated to Fudan University, Shanghai 201399, China

Research funding:

Shanghai Natural Science Foundation of China (20ZR1450100);

Talents Training Program of Pudong Hospital affiliated to Fudan University (YJRCJJ201801);

the Fundamental Research Funds for the Central Universities (xjh012019063);

National Key Research and Development Program of China during the 13th Five-Year Plan Period (2018YFC1311504)

摘要

摘要: 目的分析非肥胖型脂肪肝的患病率及影响因素，为其防治提供参考依据。方法筛选克拉玛依市中心医院2015年1月—12月腹部超声、BMI、年龄及性别资料完整的体检者23 545例，分析脂肪肝患病率，继续筛选TG、空腹血糖及ALT等资料完整的正常BMI体检者7484例进行多因素分析。正态分布的定量资料两组间比较采用t检验，非正态分布的定量资料两组间比较采用Mann-Whitney U检验；计数资料组间比较采用χ²检验。采用多因素logistic回归分析非肥胖型脂肪肝的独立影响因素。结果克拉玛依市中心医院2015年体检者脂肪肝患病率为30.2% (7116/23 545)。按BMI分层，消瘦、正常BMI、超重及肥胖体检者脂肪肝的患病率依次升高(P值均＜0.05)，分别为0.8%(6/706)、9.3%(919/9899)、38.4%(3404/8870)及68.5%(2787/4070)；男性脂肪肝患病率均高于女性(P值均＜0.05)。在919例非肥胖型脂肪肝患者中，青年、中年及老年占比分别为40.7%(374例)、46.1%(424例)及13.2%(121例)。在BMI正常体检者中，中年及老年体检者脂肪肝患病率无显著差异(14.5% vs 16.8%，P＞0.05)，但都高于青年(6.0%)体检者(P值均＜0.05)。青年及中年男性体检者脂肪肝患病率高于同年龄段女性(χ²值分别为99.40、43.29，P值均＜0.001)，老年男性体检者脂肪肝患病率则低于同年龄段女性(χ²=9.81，P=0.002)。在BMI正常体检者中，TG不高者脂肪肝患病率为5.0%(311/6273)，TG升高者脂肪肝患病率为26.8%(325/1211)，两者差异有统计学意义(χ²=624.90，P＜0. 001)。61.5%的非肥胖型脂肪肝患者合并糖脂代谢紊乱。logistic回归分析显示，年龄、BMI、ALT、空腹血糖、TG及血尿酸水平是正常BMI体检者发生非肥胖型脂肪肝的独立影响因素(P值均＜0. 001)。结论克拉玛依市中心医院体检者中，非肥胖型脂肪肝患病率较高。血清TG水平或可作为非肥胖型脂肪肝简易且有效的筛查指标。
- 脂肪肝 /
- 患病率 /
- 危险因素
Abstract: Objective To investigate the prevalence rate of non-obese fatty liver disease and its influencing factors, and to provide a reference for the prevention and treatment of fatty liver disease. Methods A total of 23 545 individuals who underwent physical examination in Karamay Central Hospital from January to December 2015 and had complete data of abdominal ultrasound, body mass index (BMI), age, and sex were screened out to analyze the prevalence rate of fatty liver disease, and 7484 individuals with normal BMI who had complete data of triglyceride (TG), fasting blood glucose, and alanine aminotransferase (ALT) were further screened out to perform a multivariate analysis. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed to investigate independent influencing factors for non-obese fatty liver disease. Results In 2015, the prevalence rate of fatty liver disease was 30.2% (7116/23 545) among the individuals who underwent physical examination in Karamay Central Hospital. A stratified analysis based on BMI showed that the individuals with emaciation, normal BMI, overweight, and obesity had a prevalence rate of 0.8% (6/706), 9.3% (919/9899), 38.4% (3404/8870), and 68.5% (2787/4070), respectively (all P < 0.05), and male individuals had a significantly higher prevalence rate of fatty liver disease than female individuals (all P < 0.05). Among the 919 patients with non-obese fatty liver disease, young, middle-aged, and elderly patients accounted for 40.7% (374/919), 46.1% (424/919), and 13.2% (121/919), respectively. For the individuals with normal BMI, there was no significant difference in the prevalence rate of fatty liver disease between middle-aged and elderly individuals (14.5% vs 16.8%, P > 0.05), while both of them had a significantly higher prevalence rate than the young individuals (14.5%/16.8% vs 6.0%, P < 0.05). Young and middle-aged male individuals had a significantly higher prevalence rate of fatty liver disease than their female counterparts (χ²=99.40 and 43.29, both P < 0.001), while the elderly male individuals had a significantly lower prevalence rate than their female counterparts (χ²=9.81, P=0.002). For the individuals with normal BMI, the individuals with normal TG had a prevalence rate of fatty liver disease of 5.0% (311/6273), while those with elevated TG had a prevalence rate of 26.8% (325/1211), with a significant difference between the two groups (χ²=624.90, P < 0.001). The multivariate logistic regression analysis showed that age, BMI, ALT, fasting blood glucose, TG, and serum uric acid level were independent influencing factors for fatty liver disease in individuals with normal BMI (all P < 0.001). Conclusion There is a relatively high prevalence rate of non-obese fatty liver disease among individuals undergoing physical examination in Karamay Central Hospital, and 61.5% of the patients with non-obese fatty liver disease have glucose or lipid metabolic disorders. Serum TG level may be used as a simple and effective screening index for non-obese fatty liver disease.
- Fatty Liver Disease /
- Prevalence /
- Risk Factors

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表 1 克拉玛依市中心医院2015年体检者按BMI分层后脂肪肝患病率

BMI(kg/m²)	总体(%)	男性(%)	女性(%)	χ²值	P值
＜18.5	0.8 (6/706)	2.4(4/170)	0.4 (2/536)	3.88	0.049
18.5~23.9	9.3 (919/9899)	12.3 (551/4473)	6.8 (368/5426)	89.23	＜0.001
24.0~27.9	38.4 (3404/8870)	40.5 (2580/6367)	32.9 (824/2503)	43.89	＜0.001
≥28.0	68.5 (2787/4070)	70.2 (2126/3028)	63.4 (661/1042)	16.49	＜0.001

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表 2 2015年正常BMI体检者按年龄段分层后脂肪肝患病率

年龄段	总体(%)	男性(%)	女性(%)	χ²值	P值
青年	6.0 (374/6244)	9.2 (267/2901)	3.2 (107/3343)	99.40	＜0.001
中年	14.5 (424/2934)	20.0 (219/1096)	11.2 (205/1838)	43.29	＜0.001
老年	16.8 (121/721)	13.7 (65/476)	22.3 (56/245)	9.81	0.002
注：18~44岁为青年，45~59岁为中年，＞59岁为老年。

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表 3 2015年正常BMI体检者非脂肪肝组及脂肪肝组基线资料比较

指标	脂肪肝组(n=636)	非脂肪肝组(n=6848)	统计值	P值
男/女(例)	423/213	3098/3750	χ²=105.68	＜0.001
年龄(岁)	44(35~50)	38(28~45)	Z=12.70	＜0.001
BMI(kg/m²)	23.0(22.1~23.5)	21.8(20.5~22.9)	Z=18.39	＜0.001
空腹血糖(mmol/L)	5.1 (4.7~5.6)	4.9(4.6~5.3)	Z=7.96	＜0.001
收缩压(mmHg)	124±16	118±15	t=9.40	＜0.001
ALT(U/L)	24.8(18.0~33.9)	16.0(12. 0~22.8)	Z=19.53	＜0.001
总胆红素(μmol/L)	14.0(10.3~17.7)	13.0(9.7~16.7)	Z=4.00	＜0.001
TC(mmol/L)	1.9(1.3~2.7)	1.0 (0.8~1.4)	Z=24.69	＜0.001
TG(mmol/L)	4.9±1.0	4.5±0.8	t=10.87	＜0.001
血尿酸(μmol/L)	328.7±81.0	280.2±74.2	t=14.53	＜0.001

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表 4 非肥胖型脂肪肝logistic回归分析

因素	B值	P值	OR	95%CI
年龄(岁)	0.037	＜0.001	1.038	1.027~1.048
BMI(kg/m²)	0.469	＜0.001	1.598	1.472~1.735
空腹血糖(mmol/L)	0.114	＜0.001	1.121	1.053~1.192
ALT(U/L)	0.013	＜0.001	1.013	1.009~1.017
TG(mmol/L)	0.448	＜0.001	1.566	1.440~1.702
血尿酸(μmol/L)	0.005	＜0.001	1.005	1.004~1.006
性别	0.123	0.297	1.131	0.898~1.425
收缩压(mmHg)	0.001	0.804	1.001	0.995~1.007
总胆红素(μmol/L)	0.006	0.366	1.006	0.993~1.020
TC(mmol/L)	0.081	0.133	1.084	0.976~1.204

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