理想心血管健康行为和因素对非酒精性脂肪性肝病发病的影响

赵东娜; 刘倩; 梁惠捷; 崔皓哲; 孟令群; 鄂慧良; 曹立瀛

doi:10.3969/j.issn.1001-5256.2022.01.019

理想心血管健康行为和因素对非酒精性脂肪性肝病发病的影响

DOI: 10.3969/j.issn.1001-5256.2022.01.019

1.
唐山市开滦总医院手术室，河北唐山 063000
2.
华北理工大学研究生院，河北唐山 063000
3.
唐山中心医院手术部，河北唐山 063000

基金项目:

河北省2020年度医学科学课题研究计划 (20201285)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：赵东娜、刘倩、梁惠捷负责课题设计，资料分析，撰写论文；崔皓哲、孟令群、鄂慧良参与收集数据，修改论文；曹立瀛负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
曹立瀛，caoliying1964@126.com

计量
- 文章访问数: 618
- HTML全文浏览量: 132
- PDF下载量: 44
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-05
- 录用日期: 2021-07-02
- 出版日期: 2022-01-20

Effect of ideal cardiovascular health metrics on the incidence rate of nonalcoholic fatty liver disease

1.
Operating Room of Kailuan General Hospital, Tangshan, Hebei 063000, China
2.
Graduate School of North China University of Science and Technology, Tangshan, Hebei 063000, China
3.
Operating Room of Tangshan Central Hospital, Tangshan, Hebei 063000, China

Research funding:

Medical Science Research Program of Hebei Province in 2020 (20201285)

摘要

摘要: 目的探究理想心血管健康行为和因素与非酒精性脂肪性肝病(NAFLD)发病的关系，为制订NAFLD的防控策略提供依据。方法采用回顾性队列的研究方法，收集2006年7月—2007年6月50 511例参加健康查体的开滦集团职工的体检资料，并在随后每2年1次的随访中，观察NAFLD的发病情况。正态分布的计量资料多组间比较采用单因素方差分析；偏态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ²检验。根据心血管简易评分(CHS)四分位水平将观察对象分为四组，采用人年发病率计算各组人群NAFLD的发病情况，使用限制性立方样条曲线(RCS)计算连续型变量与结局事件间的剂量-反应关系，采用Cox比例风险模型分析各组NAFLD的发病风险比及95%CI，并对心血管健康行为和因素各组分对NAFLD发病的影响进行了Cox比例风险模型分析。结果在平均5.58年的随访过程中，共发生NAFLD 15 265例，Q1、Q2、Q3、Q4组观察对象人年发病率分别为77.88/千人年、61.33/千人年、46.37/千人年、33.69/千人年。RCS结果表明，CHS连续型变量与NAFLD发病风险呈非直线关系(P＜0.05)。在多因素Cox模型分析中，与Q1组相比，Q2组、Q3组、Q4组NAFLD的发病风险比分别为0.78(0.74~0.81)、0.57(0.54~0.59)、0.38(0.36~0.41)，在不同性别及不同年龄组中也得到了相似的结果。在各组分的分析中发现理想BMI(HR=0.37，95%CI：0.36~0.39)、理想血糖(HR=0.80，95%CI：0.77~0.84)、理想血压(HR=0.72，95%CI：0.69~0.75)、理想总胆固醇(HR=0.86，95%CI：0.83~0.89)、理想饮食(HR=0.94，95%CI：0.90~0.99)是NAFLD发病的保护因素。结论理想心血管健康行为和因素是NAFLD发病的保护因素，保持健康的生活方式有助于预防NAFLD的发病。
- 非酒精性脂肪性肝病 /
- 健康生活方式 /
- 队列研究
Abstract: Objective To investigate the association of ideal cardiovascular health metrics with the incidence rate of nonalcoholic fatty liver disease (NAFLD), and to provide a basis for the prevention and control of NAFLD. Methods A prospective cohort study was conducted for the data of 50 511 employees of Kailuan Group who participated in physical examination from July 2006 to June 2007, and the onset of NAFLD was observed during follow-up once every two years. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test used for comparison of continuous data with skewed distribution between multiple groups; the chi-square test was used for comparison of categorical data between groups. The subjects were divided into four groups according to the quartile of cardiovascular health score (CHS), and person-year incidence rate was used to calculate the incidence rate of NAFLD in each group. Restricted cubic spline (RCS) curve was used to calculate the dose-response relation between continuous variables and outcome events; the Cox proportional hazards model was used to analyze hazard ratio (HR) and 95% confidence interval (CI) in each group and investigate the effect of ideal cardiovascular health metrics on the incidence rate of NAFLD. Results During the mean follow-up time of 5.58 years, a total of 15 265 cases of NAFLD were observed, and the incidence rate of NAFLD was 77.88/1000 person-year in the Q1 group, 61.33/1000 person-year in the Q2 group, 46.37/1000 person-year in the Q3 group, and 33.69/1000 person-year in the Q4 group. RCS results showed a non-linear relationship between CHS continuous variable and the risk of NAFLD (P < 0.05). The multivariate Cox proportional risk model analysis showed that compared with the Q1 group in terms of the risk of NAFLD, the Q2, Q3, and Q4 groups had an HR of 0.78 (95%CI 0.74~0.81), 0.57 (95%CI 0.54~0.59), and 0.38 (95%CI 0.36~0.41), respectively, and similar results were observed in subjects stratified by sex and age. The analysis of each component showed that ideal body mass index (HR=0.37, 95%CI: 0.36~0.39), ideal blood glucose (HR=0.80, 95%CI: 0.77~0.84), ideal blood pressure (HR=0.72, 95%CI: 0.69~0.75), ideal cholesterol (HR=0.86, 95%CI: 0.83~0.89), and ideal diet (HR=0.94, 95%CI: 0.90~0.99) were protective factors against NAFLD. Conclusion Ideal cardiovascular health metrics are protective factors against NAFLD, and maintaining a healthy lifestyle may help to prevent the onset of NAFLD.
- Non-alcoholic Fatty Liver Disease /
- Healthy Lifestyle /
- Cohort Studies

HTML全文

表 1 观察人群不同分组情况的一般情况比较

指标	Q1组(n=10 057)	Q2组(n=17 732)	Q3组(n=10 321)	Q4组(n=12 401)	统计值	P值
年龄(岁)	50.38±11.44	50.72±12.28	49.40±12.73	45.70±12.92	F=451.17	＜0.001
男性[例(%)]	9336(92.83)	14 723(83.03)	7492(72.59)	6402(51.62)	χ²=598.24	＜0.001
HDL-C(mmol/L)	1.53±0.39	1.54±0.40	1.54±0.39	1.52±0.36	F=7.77	＜0.001
TG (mmol/L)	1.54(1.09~2.33)	1.23(0.90~1.77)	1.10(0.79~1.51)	0.93(0.68~1.27)	χ²=52.83	＜0.001
UA (mmol/L)	305.12±87.04	284.01±77.00	369.96±74.26	255.54±71.72	F=825.22	＜0.001
ALT(U/L)	19.00(13.00~26.00)	18.00(12.00~23.00)	17.00(12.00~23.00)	15.00(11.00~21.00)	χ²=883.24	＜0.001
Hs-CRP (mg/L)	0.91(0.40~2.14)	0.70(0.29~1.82)	0.60(0.21~1.64)	0.50(0.20~1.40)	χ²=908.36	＜0.001
高等教育程度[例(%)]	760(7.56)	1202(6.78)	839(8.13)	1791(14.44)	χ²=584.02	＜0.001
高家庭收入[例(%)]	791(7.87)	1156(6.52)	623(6.04)	994(8.02)	χ²=51.74	＜0.001
理想BMI[例(%)]	1430(14.22)	5957(33.59)	5915(57.31)	10 337(83.36)	χ²=126.43	＜0.001
理想血压[例(%)]	523(5.20)	2505(14.13)	2545(24.66)	7278(58.69)	χ²=105.98	＜0.001
理想血糖[例(%)]	6440(64.04)	15 421(86.97)	9806(95.01)	12 210(98.46)	χ²=66.56	＜0.001
理想总胆固醇[例(%)]	3503(34.83)	10 357(58.41)	7658(74.20)	10 841(87.42)	χ²=737.19	＜0.001
理想吸烟[例(%)]	2710(26.95)	10 610(59.84)	8248(79.91)	11 537(93.03)	χ²=119.82	＜0.001
理想体育锻炼[例(%)]	1004(9.98)	2337(13.18)	1427(13.83)	2306(18.60)	χ²=362.34	＜0.001
理想饮食[例(%)]	570(5.67)	1280(7.22)	933(9.04)	1909(15.39)	χ²=795.99	＜0.001
注：Hs-CRP，超敏-C反应蛋白。

下载: 导出CSV

表 2 心血管健康评分影响NAFLD发病的Cox风险比例模型

项目	例数	发病例数	发病率(/千人年)	HR(95%CI)	P值
总体
Q1组	10 057	4104	77.88
Q2组	17 732	5956	61.33	0.78(0.74~0.81)	＜0.001
Q3组	10 321	2737	46.37	0.57(0.54~0.59)	＜0.001
Q4组	12 401	2468	33.69	0.38(0.36~0.41)	＜0.001
性别					＜0.001¹⁾
男
Q1组	9336	3655	73.94
Q2组	14 723	4492	54.84	0.77(0.73~0.80)	＜0.001
Q3组	7492	1725	39.79	0.57(0.53~0.60)	＜0.001
Q4组	6402	1097	28.92	0.52(0.39~0.45)	＜0.001
女
Q1组	721	449	137.57
Q2组	3009	1464	96.32	0.79(0.71~0.88)	＜0.001
Q3组	2829	1012	64.65	0.56(0.50~0.63)	＜0.001
Q4组	5999	1371	38.81	0.37(0.33~0.42)	＜0.001
年龄					＜0.001¹⁾
≤45岁
Q1组	3106	1164	67.79
Q2组	5584	1773	55.02	0.83(0.77~0.90)	＜0.001
Q3组	3751	890	39.91	0.58(0.53~0.64)	＜0.001
Q4组	6192	1016	27.14	0.37(0.34~0.41)	＜0.001
＞45岁
Q1组	6951	2940	82.75
Q2组	12 148	4183	64.46	0.76(0.72~0.79)	＜0.001
Q3组	6570	1847	50.29	0.56(0.53~0.60)	＜0.001
Q4组	6209	1452	40.54	0.42(0.39~0.45)	＜0.001
注：模型校正了年龄、性别、HDL-C、TG、ALT、Hs-CRP、家庭收入、受教育程度。1)P for interaction＜0.001。

下载: 导出CSV

表 3 CHS各组成影响NAFLD发病的Cox风险比例模型

组成	HR(95%CI)	P值
理想BMI[例(%)]	0.37(0.36~0.39)	＜0.001
理想血压[例(%)]	0.72(0.69~0.75)	＜0.001
理想血糖[例(%)]	0.80(0.77~0.84)	＜0.001
理想总胆固醇[例(%)]	0.86(0.83~0.89)	＜0.001
理想吸烟[例(%)]	0.98(0.94~1.02)	0.524
理想体育锻炼[例(%)]	1.02(0.98~1.08)	0.595
理想饮食[例(%)]	0.94(0.90~0.99)	0.006
注：模型校正了年龄、性别、HDL-C、TG、ALT、Hs-CRP、家庭收入、受教育程度。

下载: 导出CSV

参考文献(17)

[1]	GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the Global Burden of Disease Study 2015[J]. Lancet, 2016, 388(10053): 1459-1544. DOI: 10.1016/S0140-6736(16)31012-1.
[2]	BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. DOI: 10.3322/caac.21492.
[3]	LLOYD-JONES DM, HONG Y, LABARTHE D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association's strategic Impact Goal through 2020 and beyond[J]. Circulation, 2010, 121(4): 586-613. DOI: 10.1161/CIRCULATIONAHA.109.192703.
[4]	EFFOE VS, CARNETHON MR, ECHOUFFO-TCHEUGUI JB, et al. The American Heart Association Ideal Cardiovascular Health and Incident type 2 diabetes mellitus among blacks: The Jackson Heart Study[J]. J Am Heart Assoc, 2017, 6(6): e005008. DOI: 10.1161/JAHA.116.005008.
[5]	HOU J, LI J, HUANG J, et al. Relationship between the exposure to cumulative cardiovascular health behaviors and factors and chronic kidney disease-The Kailuan study[J]. PLoS One, 2018, 13(8): e0203171. DOI: 10.1371/journal.pone.0203171.
[6]	RASMUSSEN-TORVIK LJ, SHAY CM, ABRAMSON JG, et al. Ideal cardiovascular health is inversely associated with incident cancer: The Atherosclerosis Risk In Communities study[J]. Circulation, 2013, 127(12): 1270-1275. DOI: 10.1161/CIRCULATIONAHA.112.001183.
[7]	ZHU S, SHI J, JI C, et al. Association of the ideal cardiovascular behaviors and factors with the incidence of nonalcoholic fatty liver disease: A prospective study[J]. Eur J Gastroenterol Hepatol, 2018, 30(5): 578-582. DOI: 10.1097/MEG.0000000000001069.
[8]	CUI HZ, MA XM, LIU Q. Influence of the interaction between abdominal obesity and hypertriglyceridemia on the development of nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2020, 36(6): 1314-1319. DOI: 10.3969/j.issn.1001-5256.2020.06.025. 崔皓哲, 马向明, 刘倩, 等. 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[J]. 临床肝胆病杂志, 2020, 36(6): 1314-1319. DOI: 10.3969/j.issn.1001-5256.2020.06.025.
[9]	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. DOI: 10.3969/j.issn.1001-5256.2018.05.007. 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年更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007.
[10]	HU DY, MA CS. Practice of cardiology 2010: Standardized treatment[M]. Beijing: People's Medical Publishing House, 2010: 10-14. 胡大一, 马长生. 心脏病学实践2010——规范化治疗[M]. 北京: 人民卫生出版社, 2010: 10-14.
[11]	SHI JH, HAO YH, WU SL, et al. The prevalence and distribution of ideal cardiovascular health behavior in employees of Kailuan Group cohort[J]. Chin J Cardiol, 2012, 40(1): 62-67. DOI: 10.3760/cma.j.issn.0253-3758.2012.01.013. 施继红, 郝雁红, 吴寿岭, 等. 开滦研究人群理想心血管健康行为和因素分布调查[J]. 中华心血管病杂志, 2012, 40(1): 62-67. DOI: 10.3760/cma.j.issn.0253-3758.2012.01.013.
[12]	ZHU NB, ZHOU M, YU CQ, et al. Prevalence of healthy life style in Chinese adults[J]. Chin J Epidemiol, 2019, 40(2): 136-141. DOI: 10.3760/cma.j.issn.0254-6450.2019.02.003. 祝楠波, 周密, 余灿清, 等. 中国成年人健康生活方式状况分析[J]. 中华流行病学杂志, 2019, 40(2): 136-141. DOI: 10.3760/cma.j.issn.0254-6450.2019.02.003.
[13]	WANG L, LI M, ZHAO Z, et al. Ideal cardiovascular health is inversely associated with nonalcoholic fatty liver disease: A prospective analysis[J]. Am J Med, 2018, 131(12): 1515. e1-1515. e10. DOI: 10.1016/j.amjmed.2018.07.011.
[14]	LIU H, YAO Y, WANG Y, et al. Ideal cardiovascular health metrics and the risk of non-alcoholic fatty liver disease: A cross-sectional study in northern China[J]. Liver Int, 2019, 39(5): 950-955. DOI: 10.1111/liv.14060.
[15]	JANG EH, CHANG Y, RYU S, et al. Cardiovascular health metrics in the development and regression of nonalcoholic fatty liver disease: A cohort study[J]. J Clin Med, 2019, 8(5): 610. DOI: 10.3390/jcm8050610.
[16]	FARZANEGI P, DANA A, EBRAHIMPOOR Z, et al. Mechanisms of beneficial effects of exercise training on non-alcoholic fatty liver disease (NAFLD): Roles of oxidative stress and inflammation[J]. Eur J Sport Sci, 2019, 19(7): 994-1003. DOI: 10.1080/17461391.2019.1571114.
[17]	SHEN X, JIN C, WU Y, et al. Prospective study of perceived dietary salt intake and the risk of non-alcoholic fatty liver disease[J]. J Hum Nutr Diet, 2019, 32(6): 802-809. DOI: 10.1111/jhn.12674.