幽门螺杆菌感染联合传统危险因素预测代谢相关脂肪性肝病发生风险的价值分析

包萨如拉; 杜晓旭; 戈宏焱

doi:10.3969/j.issn.1001-5256.2023.06.011

幽门螺杆菌感染联合传统危险因素预测代谢相关脂肪性肝病发生风险的价值分析

DOI: 10.3969/j.issn.1001-5256.2023.06.011

包萨如拉^{1, 2},
杜晓旭¹,
戈宏焱^3, , ,

1.
内蒙古民族大学临床医学院，内蒙古通辽 028000
2.
内蒙古民族大学附属医院消化内科，内蒙古通辽 028000
3.
内蒙古民族大学医学院，内蒙古通辽 028000

伦理学声明：本研究由内蒙古民族大学附属医院医学伦理委员会于2022年4月6日批准，批号为NM-LL-2022-04-06-03。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：包萨如拉负责课题设计，搜集资料，统计分析，论文撰写等工作；杜晓旭负责数据搜集和整理资料；戈宏焱负责写作思路的制订，论文的写作指导，修稿以及最终定稿等工作。

详细信息

通信作者:
戈宏焱，gehongyan_1999@126.com (ORCID: 0000-0003-3691-2805)

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出版历程
- 收稿日期: 2022-10-09
- 录用日期: 2023-02-13
- 出版日期: 2023-06-20

Value of Helicobacter pylori infection combined with traditional risk factors in predicting the risk of metabolic associated fatty liver disease

Sarula BAO^{1, 2},
Xiaoxu DU¹,
Hongyan GE^{3
, ,
,}

1.
Clinical Medical College, Inner Mongolia Minzu University, Tongliao, Inner Mongolia 028000, China
2.
Department of Gastroenterology, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, Inner Mongolia 028000, China
3.
Medical College, Inner Mongolia Minzu University, Inner Mongolia 028000, China

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Corresponding author: GE Hongyan, gehongyan_1999@126.com(ORCID: 0000-0003-3691-2805)

摘要

摘要: 目的研究幽门螺杆菌(HP)感染与新命名的“代谢相关脂肪性肝病(MAFLD)”之间的关系，并分析HP感染与传统危险因素对MAFLD的联合作用。方法对内蒙古民族大学附属医院2017年1月—2021年12月收治的350例接受碳13尿素呼气试验住院患者进行回顾性分析。按腹部超声是否确诊脂肪肝将其分为MAFLD组(n=190)和非脂肪肝组(n=160)。正态分布计量资料两组间比较采用成组t检验；非正态分布计量资料两组间比较采用Mann-Whitney U秩和检验；计数资料组间比较采用χ²检验。MAFLD的危险因素分析采用二元Logistic回归分析。结果与非脂肪肝组相比，MAFLD组受试者的BMI(t=8.73)、收缩压(Z=-3.67)、舒张压(Z=-3.62)、TG(Z=-8.93)、空腹血糖(Z=-9.13)、AST(Z=-2.03)、GGT(Z=-8.56)水平，以及男性(χ²=12.09)、高血压(χ²=37.91)、糖尿病(χ²=73.62)、超重/肥胖(χ²=42.82)、高甘油三酯血症(χ²=59.12)、HP感染(χ²=4.53)比例均较高，HDL-C(Z=-6.81)水平较低(P值均＜0.05)。Logistic回归结果显示，空腹血糖(OR=1.255，95%CI: 1.091~1.445)、HP感染(OR=1.899，95%CI: 1.048~3.440)、高血压(OR=2.589, 95%CI: 1.468~4.567)、糖尿病(OR=2.202，95%CI: 1.123~4.315)、超重/肥胖(OR=4.571，95%CI: 2.308~9.052)、高甘油三酯血症(OR=4.187，95%CI: 2.411~7.271)是MAFLD发生的危险因素(P值均＜0.05)。Logistic回归分析结果显示，联合作用后HP感染提高了糖尿病、超重/肥胖、高甘油三酯血症、高血压受试者的MAFLD发病风险(OR分别为12.267、14.005、7.911、7.364，P值均＜0.05)。结论 HP感染与MAFLD的发病风险增高有关，与传统危险因素的联合可能进一步增加MAFLD的发病风险。
- 幽门螺杆菌 /
- 非酒精性脂肪性肝病 /
- 危险因素
Abstract: Objective To investigate the association between Helicobacter pylori (HP) infection and newly named "metabolic associated fatty liver disease (MAFLD)" and the value of HP infection combined with traditional risk factors in predicting MAFLD. Methods A retrospective analysis was performed for the clinical data of 350 patients who were admitted to Affiliated Hospital of Inner Mongolia University for the Nationalities and underwent carbon-13 urea breath test from January 2017 to December 2021, and according to whether fatty liver disease was diagnosed by abdominal ultrasound, they were divided into MAFLD group with 190 patients and non-fatty liver disease group with 160 patients. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U rank sum 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 binary Logistic regression analysis was used to investigate the risk factors for MAFLD. Results Compared with the non-fatty liver disease group, the MAFLD group had significantly higher body mass index (t=8.73, P < 0.05), systolic blood pressure (Z=-3.67, P < 0.05), diastolic blood pressure (Z=-3.62, P < 0.05), triglyceride (Z=-8.93, P < 0.05), fasting blood glucose (Z=-9.13, P < 0.05), aspartate aminotransferase (Z=-2.03, P < 0.05), gamma-glutamyl transpeptidase (Z=-8.56, P < 0.05), proportion of male patients (χ²=12.09, P < 0.05), and proportion of patients with hypertension (χ²=37.91, P < 0.05), diabetes (χ²=73.62, P < 0.05), overweight/obesity (χ²=42.82, P < 0.05), hypertriglyceridemia (χ²=59.12, P < 0.05), or HP infection (χ²=4.53, P < 0.05), as well as a significantly lower level of high-density lipoprotein cholesterol (Z=-6.81, P < 0.05). The Logistic regression analysis showed that fasting blood glucose (odds ratio [OR]=1.255, 95% confidence interval [CI]: 1.091-1.445, P < 0.05), HP infection (OR=1.899, 95%CI: 1.048-3.440, P < 0.05), hypertension (OR=2.589, 95%CI: 1.468-4.567, P < 0.05), diabetes (OR=2.202, 95%CI: 1.123-4.315, P < 0.05), overweight/obesity (OR=4.571, 95%CI: 2.308-9.052, P < 0.05), and hypertriglyceridemia (OR=4.187, 95%CI: 2.411-7.271, P < 0.05) were risk factors for MAFLD, and it also showed that HP infection combined with traditional risk factors significantly increased the risk of MAFLD in subjects with diabetes, overweight/obesity, hypertriglyceridemia, and hypertension (OR=12.267, 14.005, 7.911, and 7.364, all P < 0.05). Conclusion HP infection is associated with an increased risk of MAFLD, and its combination with traditional risk factors may further increase the risk of MAFLD.
- Helicobacter Pylori /
- Non-alcoholic Fatty Liver Disease /
- Risk Factors

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表 1 MAFLD组与非脂肪肝组临床资料比较结果

Table 1. Comparison of clinical data between MAFLD and non-fatty liver groups

临床指标	MAFLD组(n=190)	非脂肪肝组(n=160)	统计值	P值
性别[例(%)]			χ²=12.09	0.001
女	87(45.8)	103(64.4)
男	103(54.2)	57(35.6)
年龄(岁)	57(48~64)	58(49~64)	Z=-0.60	0.550
BMI(kg/m²)	26.64±3.31	23.67±3.01	t=8.73	＜0.001
收缩压(mmHg)	136.00(125.00~149.00)	128.00(114.25~142.75)	Z=-3.67	＜0.001
舒张压(mmHg)	86(77~93)	80(72~88)	Z=-3.62	＜0.001
TG(mmol/L)	2.26(1.54~3.60)	1.30(0.98~1.72)	Z=-8.93	＜0.001
LDL-C(mmol/L)	2.87(2.36~3.52)	2.91(2.43~3.56)	Z=-0.76	0.450
胆固醇(mmol/L)	5.05(4.43~5.76)	5.02(4.42~5.65)	Z=-0.74	0.460
HDL-C(mmol/L)	1.09(0.90~1.30)	1.33(1.11~1.51)	Z=-6.81	＜0.001
空腹血糖(mmol/L)	6.74(5.47~9.37)	5.08(4.66~5.75)	Z=-9.13	＜0.001
ALT(U/L)	20.15(14.80~32.38)	15.25(12.00~20.10)	Z=-5.87	＜0.001
AST(U/L)	18.20(14.48~24.13)	17.45(14.33~20.60)	Z=-2.03	0.040
GGT(U/L)	35.90(25.08~52.90)	19.20(14.80~26.60)	Z=-8.56	＜0.001
超重/肥胖[例(%)]	166(87.4)	90(56.3)	χ²=42.82	＜0.001
高甘油三酯血症[例(%)]	127(66.8)	41(25.6)	χ²=59.12	＜0.001
高血压[例(%)]	116(61.1)	45(28.1)	χ²=37.91	＜0.001
HP感染[例(%)]	74(38.9)	45(28.1)	χ²=4.53	0.033
糖尿病[例(%)]	125(65.8)	32(20.0)	χ²=73.62	＜0.001

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表 2 MAFLD患者中HP阳性组与阴性组的其他相关疾病的分布特征

Table 2. Distribution characteristics of other related diseases in HP positive and negative groups in MAFLD group

其他相关疾病	HP阴性组(n=115)	HP阳性组(n=75)	χ²值	P值
高血压[例(%)]	71(61.2)	45(60.8)	0.003	0.956
糖尿病[例(%)]	71(61.2)	54(73.0)	2.779	0.096
高TG(≥1.7 mmol/L)[例(%)]	83(71.6)	44(59.5)	2.981	0.084
高LDL-C(≥3.4 mmol/L)[例(%)]	31(26.7)	25(33.8)	1.083	0.298
低HDL-C(＜1.0 mmol/L)[例(%)]	45(38.8)	28(37.8)	0.017	0.895
高TC(≥5.2 mmol/L)[例(%)]	53(45.7)	36(48.6)	0.580	0.446
高ALT(≥40 U/L)[例(%)]	16(13.8)	11(14.9)	0.043	0.837
高AST(≥40 U/L)[例(%)]	3(2.6)	3(4.1)	0.318	0.573
高GGT(≥50 U/L)[例(%)]	34(29.3)	19(25.7)	0.297	0.586

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表 3 MAFLD的危险因素多因素分析

Table 3. Multivariate analysis of risk factors for MALD

项目	B值	OR	95%CI	P值
HP感染	0.641	1.899	1.048~3.440	0.035
超重/肥胖	1.520	4.571	2.308~9.052	＜0.001
高血压	0.951	2.589	1.468~4.567	0.001
糖尿病	0.789	2.202	1.123~4.315	0.022
高甘油三酯血症	1.432	4.187	2.411~7.271	＜0.001
空腹血糖	0.227	1.255	1.091~1.445	0.002

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表 4 HP感染和传统危险因素对MAFLD的患病风险分析结果

Table 4. Risk analysis of HP infection and traditional risk factors for MAFLD

项目	例数	B值	OR(95%CI)	P值
糖尿病+HP感染
糖尿病(-)HP(-)	137		1.000
糖尿病(-)HP(+)	56	0.127	1.136(0.591~2.181)	0.702
糖尿病(+)HP(-)	94	1.842	6.311(3.498~11.387)	＜0.001
糖尿病(+)HP(+)	63	2.507	12.267(5.564~27.045)	＜0.001
超重/肥胖+HP感染
超重/肥胖(-)HP(-)	56		1.000
超重/肥胖(-)HP(+)	38	1.225	3.406(1.297~8.942)	0.013
超重/肥胖(+)HP(-)	175	2.106	8.217(3.785~17.840)	＜0.001
超重/肥胖(+)HP(+)	81	2.639	14.005(5.897~33.263)	＜0.001
高血压+HP感染
高血压(-)HP(-)	126		1.000
高血压(-)HP(+)	63	0.429	1.535(0.83~2.840)	0.172
高血压(+)HP(-)	105	1.324	3.759(2.174~6.499)	＜0.001
高血压(+)HP(+)	56	1.997	7.364(3.467~15.640)	＜0.001
高甘油三酯血症+HP感染
高甘油三酯血症(-)HP(-)	122		1.000
高甘油三酯血症(-)HP(+)	60	0.992	2.697(1.415~5.139)	0.003
高甘油三酯血症(+)HP(-)	109	2.153	8.610(4.750~15.604)	＜0.001
高甘油三酯血症(+)HP(+)	59	2.068	7.911(3.893~16.078)	＜0.001

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