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)；

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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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