非酒精性脂肪性肝病与抑郁症关系的系统评价及Meta分析

李淑娣; 曹帅兵; 巴明玉; 李素领; 段飞; 禄保平

doi:10.12449/JCH250914

非酒精性脂肪性肝病与抑郁症关系的系统评价及Meta分析

DOI: 10.12449/JCH250914

李淑娣¹,
曹帅兵¹,
巴明玉³,
李素领⁴,
段飞⁴,
禄保平^2, , ,

1.
河南中医药大学研究生院，郑州 450000
2.
河南中医药大学教务部，郑州 450000
3.
河南中医药大学第一附属医院内分泌科，郑州 450000
4.
河南中医药大学第一附属医院脾胃肝胆病科，郑州 450000

基金项目:

第七批全国老中医药专家学术经验继承项目 (National Traditional Chinese Medicine Education Letter ［2022］ No. 76);

河南省省级科技研发计划联合基金 (242301420081)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：李淑娣负责设计论文框架，起草论文；李淑娣、曹帅兵、巴明玉负责操作及研究过程的实施；李淑娣负责数据收集，统计学分析，绘制图表；李素领、段飞负责论文修改；禄保平负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
禄保平， lbp1921@sohu.com （ORCID： 0000-0002-3707-2185）

计量
- 文章访问数: 149
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- 被引次数: 0
出版历程
- 收稿日期: 2024-12-15
- 录用日期: 2025-01-16
- 出版日期: 2025-09-25

Association between non-alcoholic fatty liver disease and depression： A systematic review and Meta-analysis

1.
Graduate School Henan University of Chinese Medicine Zhengzhou 450000
2.
Academic Affairs Department，Henan University of Chinese Medicine Zhengzhou 450000
3.
Department of Endocrinology The First Affiliated Hospital of Henan University ofChinese Medicine，Zhengzhou 450000，China
4.
Department of Hepatology and Spleen-Stomach The First Affiliated Hospital of Henan University ofChinese Medicine，Zhengzhou 450000，China

Research funding:

The 7th Batch of National Traditional Chinese Medicine Experts Academic Experience Inheritance Project (National Traditional Chinese Medicine Education Letter ［2022］ No. 76);

Henan Provincial Science and Technology Research and Development Joint Fund Project (242301420081)

More Information

Corresponding author: LU Baoping， lbp1921@sohu.com （ORCID： 0000-0002-3707-2185）

摘要

摘要: 目的系统评价非酒精性脂肪性肝病（NAFLD）与抑郁症的关联性，为临床协同管理提供依据。方法本研究根据PRISMA指南完成，PROSPERO注册号：CRD42023482013。检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普、CBM数据库建库至2024年11月1日公开发表的NAFLD和抑郁症二者相关性的研究文献，根据纳入和排除标准筛选文献并提取数据。采用RevMan 5.3进行Meta分析。结果共纳入18项研究，涉及396 793例参与者。12项研究探讨NAFLD对抑郁症的影响，共涉及224 269例参与者，其中包含75 574例NAFLD患者。Meta分析显示，NAFLD显著增加抑郁症发生风险（OR=1.21，95%CI： 1.12～1.30，P<0.001）。6项研究分析抑郁症对NAFLD的影响，共涉及172 524例参与者，其中包含29 368例抑郁症患者。Meta分析显示，抑郁症导致NAFLD风险显著增加（OR=1.13，95%CI： 1.05～1.22，P=0.001）。结论 NAFLD与抑郁症存在显著的双向关联。在初诊和随访时，建议对NAFLD患者行抑郁症筛查并加强心理健康监测；对抑郁症患者需重视代谢功能评估并实施运动干预。
- 非酒精性脂肪性肝病 /
- 抑郁症 /
- Meta分析
Abstract: Objective To systematically review the association between non-alcoholic fatty liver disease （NAFLD） and depression， and to provide a basis for synergistic management in clinical practice. Methods This study was conducted according to the PRISMA guidelines， with the PROSPERO registration number of CRD42023482013. PubMed， Embase， the Cochrane Library， Web of Science， CNKI， Wanfang Data， VIP， and CBM were searched for articles on the association between NAFLD and depression published up to November 1， 2024. The articles were screened according to the inclusion and exclusion criteria， and related data were extracted. RevMan 5.3 was used to perform the Meta-analysis. Results A total of 18 studies were included， involving 396 793 participants. Among these studies， 12 discussed the influence of NAFLD on depression， involving 224 269 participants， among whom there were 75 574 patients with NAFLD. The Meta-analysis showed that NAFLD was significantly associated with the risk of depression （odds ratio ［OR］=1.21， 95% confidence interval ［CI］： 1.12 — 1.30， P<0.001）. Six studies examined the influence of depression on NAFLD， involving 172 524 participants， among whom there were 29 368 patients with depression. The meta-analysis showed that depression caused a significant increase in the risk of NAFLD （OR=1.13， 95%CI： 1.05 — 1.22， P=0.001）. Conclusion There is a significant bidirectional association between NAFLD and depression. It is recommended to perform the screening for depression and enhance mental health monitoring in patients with NAFLD， and metabolic function assessment and exercise intervention should be performed for patients with depression.
- Non-Alcoholic Fatty Liver Disease /
- Depressive Disorder /
- Meta-Analysis

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图 1 文献筛选流程

Figure 1. Document screening flow chart

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图 2 NAFLD对抑郁症风险的影响

Figure 2. The effect of non-alcoholic fatty liver disease on the risk of depression

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图 3 NAFLD对抑郁症风险影响的亚组分析

Figure 3. Subgroup analysis of the effect of non-alcoholic fatty liver disease on the risk of depression

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图 4 抑郁症对NAFLD风险的影响

Figure 4. The effect of depression on the risk of non-alcoholic fatty liver disease

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图 5 抑郁症对NAFLD风险的影响

Figure 5. Subgroup analysis of the effects of depression on the risk of non-alcoholic fatty liver disease

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图 6 发表偏倚风险漏斗图

Figure 6. Funnel plot of publication bias risk

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表 1 纳入研究的基本特征

Table 1. Basic features of the included study

作者及发表年份	国家或地区	总样本量（例）	研究对象数量（例）	研究对象年龄（岁）	研究类型	OR/RR/HR （95%CI）	调整的变量	NOS评分（分）
NAFLD对抑郁症的影响
Choi，2021^［22］	韩国	25 333	7 846 NAFLD	48.4±10.1	回顾性研究	1.09（0.95～1.26）	年龄、性别、糖尿病、血压、吸烟	7
Elwing，2006^［23］	美国	72	36 NASH	51.4±2.0	前瞻性研究	3.8（1.40～10.20）	年龄	7
Filipovic，2018^［24］	塞尔维亚	283	40 NAFLD	47.88±6.07	前瞻性研究	1.65（1.16～2.36）	BMI、高血压、代谢综合征	8
Goulart，2023^［25］	巴西	7 241	2 223 NAFLD	49.0	前瞻性研究	1.17（1.00～1.38）	年龄、性别	7
Jung，2019^［26］	韩国	112 797	31 635 NAFLD		前瞻性研究	1.32（1.17～1.48）	年龄、性别、家庭月收入、婚姻状况、工作、平均饮酒量、吸烟、收缩压、TC、HDL-C、糖尿病、体力活动、BMI、HOMA-IR	7
Labenz，2020^［27］	德国	39 742	19 871 NAFLD	58.5±14.2	回顾性研究	1.21（1.14～1.26）	糖尿病、心血管疾病、哮喘、慢性阻塞性肺病、癌症	6
Lee，2013^［28］	美国	10 231	497 NAFLD	49.62±0.72	回顾性研究	0.92（0.68～1.24）	性别、家庭收入、吸烟、BMI、血脂异常、心脏病、慢性肝病、药物使用史	6
Ng，2022^［29］	美国	21 414	6 726 NAFLD	52.16	回顾性研究	1.12（1.00～1.26）	年龄、性别、种族、糖尿病、超重	7
Noon，2021^［30］	美国	160	160 NAFLD	15±1.8	前瞻性研究	1.60（1.11～2.52）	BMI、ALT、AST、GGT	9
Younossi， 2022^［31］	18个国家或地区^1）	5 691	5 691 NAFLD	51	回顾性研究	1.94（1.41～2.67）	年龄、性别、肥胖、焦虑、2型糖尿病、高脂血症、高血压、心肌梗死、中风、充血性心力衰竭	6
Youssef，2013^［32］	美国	567	567 NAFLD	49±1.0	回顾性研究	1.30（0.80～2.11）	年龄、性别、种族、BMI、糖尿病、高血压	7
杨旭瑶，2022^［33］	中国	738	282 NAFLD	41.17±11.57	回顾性研究	1.10（1.03～1.16）	性别、BMI、TC、TG	6
抑郁症对NAFLD的影响
Cai，2023^［34］	美国	3 263	3 263抑郁症	48.0	回顾性研究	1.05（1.02～1.08）	年龄、性别、种族/民族、教育水平、家庭贫困收入比、婚姻状况、体力活动、过度饮酒、吸烟、BMI、乙型/丙型肝炎、糖尿病、高血压、心血管疾病	6
Cho，2021^［35］	韩国	142 005	16 961抑郁症	34.8	回顾性研究	1.07（1.03～1.11）	年龄、性别、教育水平、BMI、吸烟、体力活动、总能量摄入、糖尿病、高血压、心血管疾病、收缩压、血糖、TC、TG、HDL-C、 HOMA-IR、Hs-CRP	8
Kamari，2023^［36］	印度	7 114	7 114抑郁症	45.78±7.80	回顾性研究	1.30（0.72～2.35）	年龄、婚姻状况、居住地、饮酒情况	6
Kim，2019^［37］	美国	10 484	1 162抑郁症	49.5±0.6	回顾性研究	1.48（1.17～1.87）	年龄、性别、种族/民族、教育水平、婚姻状况、经济状况、吸烟、高血压、体力活动、TC、糖尿病、腰围、BMI	7
Lee，2021^［38］	韩国	4 688	422抑郁症	50.1	回顾性分析	1.63（1.26～2.10）	年龄、性别、婚姻状况、个人收入、吸烟、糖尿病、高血压、心血管疾病	7
廖倩，2017^［39］	中国	4 970	446抑郁症	46	前瞻性研究	1.11（0.95～1.31）	年龄、性别、教育水平、现在或既往吸烟和饮酒、打鼾、收缩压、舒张压、睡眠持续时间、糖尿病、BMI、步行时间、血脂	6
注：HDL-C，高密度脂蛋白胆固醇；HOMA-IR，稳态模型的胰岛素抵抗指数；Hs-CRP，超敏C反应蛋白。1）包括中国内地、中国香港、中国台湾、澳大利亚、古巴、埃及、希腊、印度、意大利、日本、沙特阿拉伯、马来西亚、墨西哥、巴基斯坦、俄罗斯、西班牙、土耳其和美国。

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