克拉玛依市居民2009年—2016年脂肪性肝病患病率变化及影响因素分析

邓江; 张永红; 党双锁; 王亚涛; 史海涛; 步丽梅; 韩致毅; 鲁晓岚

doi:10.3969/j.issn.1001-5256.2021.07.026

克拉玛依市居民2009年—2016年脂肪性肝病患病率变化及影响因素分析

DOI: 10.3969/j.issn.1001-5256.2021.07.026

邓江^1a,
张永红^2a,
党双锁^1a,
王亚涛^1b,
史海涛^1b,
步丽梅³,
韩致毅^1b, ,,
鲁晓岚^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体检中心，新疆克拉玛依 834099
2b.
克拉玛依市中心医院消化科，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:

中国肝炎防治基金会王宝恩肝纤维化研究基金 (WBE20181025);

浦东医院人才课题基金 (YJRCJJ201801);

陕西省重点研发计划项目 (2020SF-297);

国家十三五重点研发计划 (2018YFC1311504)

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：邓江、鲁晓岚、韩致毅负责课题设计，资料分析，撰写论文；张永红、韩致毅、鲁晓岚、邓江、王亚涛、史海涛、步丽梅负责收集数据，修改论文；鲁晓岚、邓江、党双锁、韩致毅负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
韩致毅，hzyklmy@163.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: 2020-12-07
- 录用日期: 2021-01-26
- 出版日期: 2021-07-20

The change in the prevalence of fatty liver disease and related influencing factors among Karamay residents in 2009-2016 and related influencing factors

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.
Medical Examination Center, Karamay Central Hospital, Karamay, Xinjiang 834099, China
2b.
Department of Gastroenterology, Karamay Central Hospital, Karamay, Xinjiang 834099, China
3.
Department of Gastroenterology, Pudong Hospital Affiliated to Fudan University, Shanghai 201399, China

Research funding:

Wang Baoen Liver Fibrosis Research Foundation of Chinese Foundation for Hepatitis Prevention and Control (WBE20181025);

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

Shannxi Province General Projects-Social Development (2020SF-297);

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

摘要

摘要: 目的分析2009年—2016年克拉玛依市中心医院体检者脂肪性肝病(FLD)患病率变化及影响因素，为FLD防治提供参考。方法 2009年1月—2016年12月克拉玛依市中心医院体检行腹部超声检查且性别资料齐全者共230 330人次，分析FLD患病率变化，对比历年男女性FLD患病率差异；选取2016年年龄、BMI、空腹血糖及甘油三酯等体检资料完整的33 195例体检者，分析不同年龄、BMI、性别体检者FLD患病率。采用多因素logistic回归分析FLD发生的独立影响因素。计数资料2组间比较采用χ²检验；正态分布的计量资料2组间比较采用t检验；非正态分布的计量资料2组间比较采用Mann-Whitney U秩和检验。结果 2009年—2016年，克拉玛依市中心医院体检者FLD患病率从19.4%增长至31.9%(P＜0.001)，男性患病率从22.8%增长至39.5%(P＜0.001)；女性患病率从11.8%增长至21.6%(P＜0.001)，男性历年患病率均高于女性(P值均＜0.001)。在2016年体检者中，青(18~44岁)、中(45~59岁)和老年(＞59岁)体检者分别为17 848、10 017、5330例，FLD患病率依次升高，分别为26.1%、37.3%及41.7%(P＜0.01)；青中年男性体检者FLD患病率高于同年龄段女性(P值均＜0.001)，老年男性体检者FLD患病率低于同年龄段女性(P=0.022)。消瘦、正常、超重及肥胖体检者分别为865、13 510、12 755、6065例，FLD患病率依次升高，分别为0.8%、9.5%、39.6%及70.6%(P＜0.01)；各BMI分层男性FLD患病率均高于女性(P值均＜0.05)。Logistic回归分析显示，年龄、性别、BMI、收缩压、舒张压、ALT、TBil、空腹血糖、甘油三酯、总胆固醇、血尿酸水平是FLD发生的独立影响因素(P值均＜0.05)。结论克拉玛依市居民FLD患病率近年增长迅速，危险因素众多，应加强当地政策干预，主动宣传教育，筛查高危人群，尽早落实防治措施，以降低相关医疗负担。
- 脂肪肝 /
- 影响因素 /
- 新疆[维吾尔自治区]
Abstract: Objective To investigate the change in the prevalence rate of fatty liver disease (FLD) and related influencing factors among individuals undergoing physical examination in Karamay Central Hospital from 2009 to 2016, and to provide a reference for the prevention and treatment of FLD. Methods Abdominal ultrasound (230 330 cases) was performed in Karamay Central Hospital from January 2009 to December 2016, and related data were used to analyze the change in the prevalence rate of FLD and compare the difference between male and female individuals. A total of 33 195 individuals who underwent physical examination in 2016 and had complete data of age, body mass index (BMI), fasting blood glucose, and triglyceride were selected to analyze the prevalence rate of FLD among the individuals with different ages, BMIs, and sexes. A multivariate logistic regression analysis was used to investigate independent influencing factors for the development of FLD. The chi-square test was used for comparison of categorical data between groups; the t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. Results From 2009 to 2016, the prevalence rate of FLD increased from 19.4% to 31.9% among the individuals who underwent physical examination in Karamay Central Hospital (P < 0.001); the prevalence rate increased from 22.8% to 39.5% among male individuals (P < 0.001), and the prevalence rate increased from 11.8% to 21.6% among female individuals (P < 0.001), suggesting that male individuals had a significantly higher prevalence rate than female individuals in each year (P < 0.001). Among the individuals who underwent physical examination in 2016, the prevalence rate of FLD was 26.1% in 17 848 young individuals, 37.3% in 10 017 middle-aged individuals, and 41.7% in 5330 elderly individuals (P < 0.001); the young and middle-aged male individuals had a significantly higher risk of FLD than the female individuals in the same age group (both P < 0.001), and the elderly male individuals had a significantly lower risk of FLD than the female individuals in the same age group (P=0.022). There were 865 individuals with emaciation, 13 510 with normal body weight, 12 755 with overweight, and 6065 with obesity, with a prevalence rate of FLD of 0.8%, 9.5%, 39.6%, and 70.6%, respectively (P < 0.001), and the stratified analysis based on BMI showed that male individuals had a significantly higher prevalence rate of FLD than females individuals (P < 0.05). The multivariate logistic regression analysis showed that age, sex, BMI, systolic pressure, diastolic pressure, alanine aminotransferase, total bilirubin, fasting blood glucose, triglyceride, total cholesterol, and serum uric acid were independent influencing factors for FLD (all P < 0.05). Conclusion There is a rapid increase in the prevalence rate of FLD among the residents of Karamay, and there are various risk factors. It is recommended to strengthen policy intervention, provide public education, screen out the high-risk population, and implement preventive and treatment measures as early as possible, so as to reduce related medical burden.
- Fatty Liver /
- Risk Factors /
- XINJIANG

HTML全文

表 1 克拉玛依市中心医院体检者2009年—2016年FLD患病率

时间	总患病率	男性患病率	女性患病率	χ²值	P值
2009年	19.4%(2539/13 107)	22.8%(2056/9007)	11.8%(483/4100)	220.1	＜0.001
2010年	18.4%(5018/27 227)	24.2%(3619/14 967)	11.4%(1399/12 260)	730.9	＜0.001
2011年	23.4%(7354/31 443)	29.0%(5968/20 575)	12.8%(1386/10 868)	1 048.4	＜0.001
2012年	28.5%(9066/31 834)	36.0%(6617/18 397)	18.2%(2449/13 437)	1 200.1	＜0.001
2013年	24.1%(7710/32 032)	30.2%(5687/18 860)	15.4%(2023/13 172)	928.9	＜0.001
2014年	35.1%(9927/28 250)	45.0%(7880/17 518)	19.1%(2047/10 732)	1 960.0	＜0.001
2015年	29.7%(7273/24 452)	37.0%(5341/14 445)	19.3%(1932/10 007)	883.1	＜0.001
2016年	31.9%(13 406/41 985)	39.5%(9562/24 216)	21.6%(3844/17 769)	1 502.9	＜0.001

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表 2 2016年体检者不同年龄段、性别分层的FLD患病率比较

年龄	总患病率	男性患病率	女性患病率	χ²值	P值
18~44岁	26.1%(4653/17 848)	35.6%(3728/10 461)	12.5%(925/7387)	1 200.3	＜0.001
45~59岁	37.3%(3741/10 017)	46.4%(2740/5904)	24.3%(1001/4113)	504.7	＜0.001
＞59岁	41.7%(2223/5330)	40.7%(1526/3749)	44.1%(697/1581)	5.2	0.022

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表 3 2016年体检者不同BMI、性别分层的FLD患病率比较

BMI	总患病率	男性患病率	女性患病率	χ²值	P值
＜18.5 kg/m²	0.8%(7/865)	2.6%(5/195)	0.3%(2/670)	7.0	0.008
18.5~23.9 kg/m²	9.5%(1277/13 510)	12.8%(773/6032)	6.7%(504/7478)	144.0	＜0.001
24.0~27.9 kg/m²	39.6%(5049/12 755)	42.0%(3912/9314)	33.0%(1137/3441)	84.3	＜0.001
≥28 kg/m²	70.6%(4284/6065)	72.3%(3304/4573)	65.7%(980/1492)	23.4	＜0.001
注：1277例正常BMI脂肪肝体检者中，中年525例，老年271例；ALT、AST、TBil、总胆固醇、甘油三酯、空腹血糖水平升高分别为209、70、373、270、564和213例。

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表 4 2016年体检者FLD组与非FLD组基线资料比较

项目	FLD组(n=10 617)	非FLD组(n=22 578)	统计值	P值
性别(例)			χ2=1412.8	＜0.001
男	7994	12 120
女	2623	10 458
年龄(岁)	46(37~53)	42(32~49)	Z=29.3	＜0.001
BMI(kg/m²)	27.56±3.45	23.48±3.17	t=103.2	＜0.001
空腹血糖(mmol/L)	5.25(4.80~5.92)	4.91(4.57~5.33)	Z=42.5	＜0.001
收缩压(mm Hg)	133.87±17.73	122.87±17.27	t=53.2	＜0.001
舒张压(mm Hg)	82.93±12.22	75.64±11.72	t=51.3	＜0.001
ALT(U/L)	27.80(19.76~41.00)	17.00(12.60~24.20)	Z=72.4	＜0.001
TBil(μmol/L)	13.84(10.53~18.16)	13.31(10.04~17.52)	Z=7.8	＜0.001
甘油三酯(mmol/L)	1.86(1.29~2.60)	1.06(0.76~1.53)	Z=77.1	＜0.001
总胆固醇(mmol/L)	4.89±1.00	4.53±0.89	t=32.1	＜0.001
血尿酸(μmol/L)	357.32±85.66	298.35±80.09	t=59.7	＜0.001
注：FLD患者中，76例AST/ALT＞2，其中仅21例AST＞40 U/L；8071例ALT/AST＞1，其中2700例ALT＞40 U/L。据此推算，酒精性FLD占比非常少。本研究缺少病毒性肝炎相关数据。

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表 5 2016年体检者发生FLD的logistic回归分析

因素	B值	P值	OR	95%CI
性别	0.298	＜0.001	1.347	1.249~1.454
年龄(岁)	0.017	＜0.001	1.017	1.014~1.020
BMI(kg/m²)	0.302	＜0.001	1.353	1.339~1.367
空腹血糖(mmol/L)	0.123	＜0.001	1.131	1.108~1.154
收缩压(mm Hg)	0.003	0.013	1.003	1.001~1.006
舒张压(mm Hg)	0.006	0.001	1.006	1.002~1.009
ALT(U/L)	0.015	＜0.001	1.015	1.014~1.017
TBil(μmol/L)	0.007	0.002	1.007	1.003~1.012
总胆固醇(mmol/L)	0.088	＜0.001	1.092	1.056~1.129
甘油三酯(mmol/L)	0.338	＜0.001	1.402	1.361~1.445
血尿酸(μmol/L)	0.004	＜0.001	1.004	1.004~1.005

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