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尿液铊与非酒精性脂肪性肝病的相关性分析

刘亚杰 王睿林 梁子晗 李佳辉 郝玉洁

引用本文:
Citation:

尿液铊与非酒精性脂肪性肝病的相关性分析

DOI: 10.12449/JCH240408
基金项目: 

国家自然科学基金 (81673806);

中国医药教育协会科研课题 (2020KTY001)

伦理学声明:国家健康与营养检查调查研究项目获得美国国家卫生统计中心(NCHS)研究伦理审查委员会(ERB)批准,NCHS IRB/ERB协议编号:Continuation of Protocol#2011-17;Protocol #2018-01。所有调查对象均提供了书面知情同意。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:刘亚杰负责论文撰写,统计学分析,绘制图表;梁子晗、李佳辉、郝玉洁参与了研究数据的获取过程;王睿林教授负责拟定写作思路,指导撰写及提供研究经费支持。
详细信息
    通信作者:

    王睿林, wrl7905@163.com (ORCID: 0000-0002-7129-016X)

Association between urinary thallium and nonalcoholic fatty liver disease

Research funding: 

National Natural Science Foundation of China (81673806);

China Medical Education Association Research Project (2020KTY001)

More Information
    Corresponding author: WANG Ruilin, wrl7905@163.com (ORCID: 0000-0002-7129-016X)
  • 摘要:   目的  探讨尿液铊(TL)与非酒精性脂肪性肝病(NAFLD)的关系。  方法  选取2017—2020年美国健康与营养检查调查数据(NHANES)中年龄≥18岁的注册参与者,并排除缺乏肝脏瞬时弹性成像数据、尿液TL指标及患有乙型肝炎、丙型肝炎、饮酒量显著的人群。将纳入人群分为NAFLD组和Non-NAFLD组,采用高效液相色谱-电喷雾电离-串联质谱和在线固相萃取联合同位素稀释等方法定量检测尿液TL水平,比较两组人群年龄、性别、种族、婚姻状况、教育、家庭收入与贫困比比值(FMPIR)、体质量指数(BMI)、吸烟、喝酒、糖尿病(DM)、高血压(HTN)、高脂血症(HL)、尿液TL水平。计量资料两组间比较采用成组t检验或Wilicoxon秩和检验;计数资料两组间比较采用χ2检验。通过描述性分析、多因素Logistic回归、限制性三次样条回归分析、亚组分析、交互作用,探究尿液TL与NAFLD的风险关联。  结果  共纳入2 511例,NAFLD组1 612例(64.20%),Non-NAFLD组899例(35.80%),NAFLD组尿液TL水平明显高于Non-NAFLD组,差异具有统计学意义[0.18(0.11~0.26)μg/L vs 0.16(0.09~0.25)μg/L,Z=-2.76,P=0.01]。调整年龄、性别、种族、教育、婚姻状况、FMPIR、BMI、吸烟、喝酒、DM、HTN、HL协变量后,尿液TL Q4组[比值比(OR)=1.90,95%CI:1.48~2.44]患NAFLD风险显著增加(P<0.01)。尿液TL与患NAFLD的风险存在正向剂量-反应关系(P<0.01)且为非线性关系(P<0.01)。尿液TL与吸烟、BMI之间存在显著的交互作用(P<0.05),一生吸烟≥100支的人群尿液TL每上升一个四分位数患NAFLD的风险增加50%(OR=1.50,95%CI:1.24~1.80),一生吸烟<100支的人群尿液TL每上升一个四分位数患NAFLD的风险增加20%(OR=1.20,95%CI:1.03~1.40),BMI≥30 kg/m2的人群尿液TL每上升一个四分位数患NAFLD的风险增加30%(OR=1.30,95%CI:1.05~1.70),差异具有统计学意义(P<0.05)。  结论  尿液TL水平与患NAFLD的风险显著相关。

     

  • 图  1  筛选流程图

    Figure  1.  Filter flow chart

    图  2  尿液TL与NAFLD之间的剂量-反应关系

    Figure  2.  Dose-response relationship between urinary TL and NAFLD

    表  1  研究对象基本特征

    Table  1.   Basic characteristics of research objects

    变量 总人数(n=2 511) Non-NAFLD组(n=899) NAFLD组(n=1 612) 统计值 P
    年龄(岁) 51(34~64) 42(28~61) 54(40~65) Z=-4.55 <0.01
    年龄分组[例(%)] χ2=23.22 <0.01
    18~39岁 822(32.74) 419(46.61) 403(25.00)
    40~59岁 806(32.10) 220(24.47) 586(36.35)
    ≥60岁 883(35.17) 260(28.92) 623(38.65)
    性别[例(%)] χ2=10.63 <0.01
    1 262(50.26) 491(54.62) 771(47.83)
    1 249(49.74) 408(45.38) 841(52.17)
    种族[例(%)] χ2=20.94 <0.01
    墨西哥裔美国人 326(12.98) 88(9.79) 238(14.76)
    非西班牙裔黑人 672(26.76) 279(31.03) 393(24.38)
    非西班牙裔白人 828(32.97) 288(32.04) 540(33.50)
    其他 685(27.28) 244(27.14) 441(27.36)
    教育[例(%)] χ2=1.85 0.26
    大专或以上学历 1 371(54.60) 501(55.73) 870(53.97)
    高中或同等学历 666(26.52) 241(26.81) 425(26.36)
    高中以下 474(18.88) 157(17.46) 317(19.67)
    吸烟[例(%)] χ2=0.08 0.82
    一生吸烟<100支 1 502(59.82) 541(60.18) 961(59.62)
    一生吸烟≥100支 1 009(40.18) 358(39.82) 651(40.38)
    婚姻状况[例(%)] χ2=24.41 <0.01
    已婚/与伴侣同居 1 450(57.75) 485(53.95) 965(59.86)
    从来没有结过婚 527(20.99) 237(26.36) 290(17.99)
    丧偶/离婚/分居 534(21.27) 177(19.69) 357(22.15)
    喝酒[例(%)] χ2=10.66 <0.01
    277(11.03) 120(13.35) 157(9.74)
    2 234(88.97) 779(86.65) 1 455(90.26)
    FMPIR 2.26(1.17~4.14) 2.19(1.16~4.14) 2.32(1.17~4.15) Z=-0.99 0.34
    BMI(kg/m2 28.40(24.55~33.75) 24.60(21.60~27.90) 30.85(27.10~35.80) Z=-24.99 <0.01
    BMI分组[例(%)] χ2=76.56 <0.01
    BMI<25 kg/m2 685(27.28) 477(53.06) 208(12.90)
    BMI≥30 kg/m2 1 031(41.06) 138(15.35) 893(55.40)
    25 kg/m2≤BMI<30 kg/m2 795(31.66) 284(31.59) 511(31.70)
    HTN[例(%)] χ2=18.44 <0.01
    2 077(82.72) 770(85.65) 1 307(81.08)
    434(17.28) 129(14.35) 305(18.92)
    HL[例(%)] χ2=51.83 <0.01
    2 223(88.53) 851(94.66) 1 372(85.11)
    288(11.47) 48(5.34) 240(14.89)
    DM[例(%)] χ2=67.38 <0.01
    2 163(86.14) 852(94.77) 1 311(81.33)
    348(13.86) 47(5.23) 301(18.67)
    尿液TL(μg/L) 0.17(0.10~0.26) 0.16(0.09~0.25) 0.18(0.11~0.26) Z=-2.76 0.01
    下载: 导出CSV

    表  2  尿液TL与NAFLD的Logistic分析

    Table  2.   Logistic analysis of urinary TL and NAFLD

    变量 Model 1 P Model 2 P Model 3 P
    OR(95%CI OR(95%CI OR(95%CI
    尿液TL 1.13(1.02~1.25) 0.03 1.29(1.15~1.44) <0.01 1.30(1.16~1.46) <0.01
    尿液TL(人数/构成比)
    Q1(682/27.16%)
    Q2(631/25.13%) 1.21(0.97~1.50) 0.10 1.29(1.03~1.62) 0.03 1.29(1.02~1.63) 0.03
    Q3(648/25.81%) 1.28(1.02~1.61) 0.03 1.48(1.17~1.87) <0.01 1.52(1.20~1.94) <0.01
    Q4(550/21.90%) 1.36(1.08~1.71) 0.01 1.86(1.46~2.39) <0.01 1.90(1.48~2.44) <0.01
    下载: 导出CSV

    表  3  尿液TL与NAFLD的亚组分析及交互作用

    Table  3.   Subgroup analysis and interaction effect of urinary TL and NAFLD

    变量 OR(95%CI P 交互作用P
    年龄分组 0.58
    18~39岁 1.22(1.09~1.36) <0.01
    40~59岁 1.44(1.15~1.81) <0.01
    ≥60岁 1.09(0.91~1.31) 0.36
    性别 0.34
    1.35(1.13~1.60) <0.01
    1.28(1.09~1.50) <0.01
    种族 0.25
    墨西哥裔美国人 1.44(1.01~2.06) 0.04
    非西班牙裔黑人 1.33(1.07~1.66) 0.01
    非西班牙裔白人 1.41(1.15~1.72) <0.01
    其他 1.12(0.89~1.41) 0.34
    教育 0.74
    高中以下 1.45(1.09~1.93) 0.01
    高中或同等学历 1.22(0.99~1.51) 0.06
    大专或以上学历 1.32(1.13~1.54) <0.01
    婚姻状况 0.90
    已婚/与伴侣同居 1.30(1.12~1.51) <0.01
    从来没有结过婚 1.42(1.08~1.88) 0.01
    丧偶/离婚/分居 1.22(0.95~1.57) 0.11
    FMPIR 0.14
    <1.30 1.40(1.14~1.73) <0.01
    1.30≤FMPIR<3.50 1.31(1.08~1.59) 0.01
    ≥3.50 1.18(0.97~1.44) 0.10
    BMI分组 0.02
    <25 kg/m2 1.00(0.78~1.27) 0.37
    ≥30 kg/m2 1.30(1.05~1.70) 0.04
    25 kg/m2≤BMI<30 kg/m2 1.20(0.97~1.48) 0.09
    吸烟 0.03
    一生吸烟≥100支 1.50(1.24~1.80) <0.01
    一生吸烟<100支 1.20(1.03~1.40) 0.02
    喝酒 0.65
    1.30(1.15~1.47) <0.01
    1.28(0.91~1.80) 0.15
    DM 0.16
    1.64(1.01~2.64) 0.04
    1.29(1.15~1.46) <0.01
    HTN 0.37
    1.23(0.94~1.62) 0.14
    1.32(1.16~1.50) <0.01
    HL 0.14
    1.36(0.86~2.14) 0.19
    1.30(1.15~1.46) <0.01
    下载: 导出CSV
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