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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
Influence of the interaction between abdominal obesity and hypertriglyceridemia on the development of nonalcoholic fatty liver disease
文章发布日期:2020年06月01日  来源:  作者:崔皓哲,马向明,刘倩,等  点击次数:185次  下载次数:46次

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【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 15 684例,6年累计发病率为25.44%,人时发病率为44.03/千人年。经log-rank检验,累计发病率的组间比较差异有统计学意义(χ2=2479.40,P<0.001)。以非腹型肥胖合并非高TG血症组为对照组,校正各混杂因素后,腹型肥胖合并高TG血症组发生NAFLD的HR值为2.50(95%CI:2.38~2.62),且高于腹型肥胖合并非高TG血症组(HR=1.99,95%CI:1.92~2.07)及非腹型肥胖合并高TG血症组(HR=1.71,95%CI:1.59~1.84)。在校正相同的混杂因素后,交互作用分析显示,腹型肥胖及高TG血症存在相乘交互作用(P<0.001), 腹型肥胖及高TG血症同时存在时超相对危险比为0.77(95%CI:0.68~0.86),归因比为30.83%,交互作用指数为2.06(95%CI:1.90~2.24)。结论 腹型肥胖与高TG血症对NAFLD的发病存在交互作用,为协同作用。
【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.
【关键字】:非酒精性脂肪性肝病; 肥胖,腹部; 队列研究
【Key words】:non-alcoholic fatty liver disease; obesity,abdominal; cohort studies
【引证本文】:CUI HZ, MA XM, LIU Q, et al. 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. (in Chinese)
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.

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