中老年人非酒精性脂肪肝与糖化血红蛋白关系的流行病学研究  

An epidemiologic study of the relation between non-alcoholic fatty liver disease and glycosylated hemoglobin among middle-aged and aged people

作　　者：陈长喜[1,2] 杜娟[2] 徐益敏[2] 陈晓斐 余荣[2] 毛玉山[3] 郭传勇[4] 

机构地区：[1]宁波市镇海区炼化医院内科,315207 [2]苏州大学附属第一医院消化内科 [3]宁波大学附属医院内分泌科 [4]上海市同济大学附属第十人民医院消化内科

出　　处：《中华内科杂志》2015年第6期517-520,共4页Chinese Journal of Internal Medicine

基　　金：宁波市社会发展科技计划项目（2013C50044,2011C50021）;宁波市镇海区社会发展科技项目（2013S1002）

摘　　要：目的 探讨中老年人群中非酒精性脂肪性肝病（NAFLD）与糖化血红蛋白（HbA1c）的关系.方法 调查符合入选条件的4 127名年龄45岁及以上的宁波市某石化企业在职和退休员工,测定其腰围、BMI、血压、空腹血糖、血脂谱、γ-谷氨酰转肽酶（γ-GT）、HbA1c,并行上腹部B超检查.按HbA1c水平的四分位数进行分层,分为Q1～Q4组（HbA1c水平分别为：Q1组≤5.2％,Q2组＞5.2％～5.4％,Q3组＞5.4％～5.6％,Q4组＞5.6％）,分析各组的NAFLD患病率情况及临床特征,并采用logistic多元回归进行NAFLD患病危险因素分析.结果 NAFLD患病率27.2％,其中男性31.9％、女性21.0％,男性患病率较女性高（P ＜0.001）;Q1、Q2、Q3、Q4组NAFLD的患病率分别为18.5％（178/961）、22.8％（185/812）、25.6％（280/1 095）、38.1％（480/1 259）,随着HbA1c水平的增高NAFLD的患病率逐渐升高;1 123例NAFLD患者年龄、收缩压、TC、LDL-C、空腹血糖均随着HbA1c水平的升高而递增;logistic多元回归分析显示高HbA1c水平为NAFLD患病的危险因素（OR=1.67,95％CI 1.15 ～2.43,P=0.007）.结论 HbA1c是NAFLD患病的危险因素,且两者都与血脂代谢紊乱联系紧密.Objective To study the correlation between non-alcoholic fatty liver disease （NAFLD）and glycosylated hemoglobin （HbA1 c） in middle-aged and aged population.Methods A total of 4 127 inservice workers and retirees aged 45 years old or above from one petrochemical enterprise in Ningbo were enrolled in our study.The waistline,body mass index,blood pressure,fasting blood-glucose,blood lipid profile,glutamyltranspeptidase,HbA1c and epigastrium B ultrasound were investigated.According to the quartile of HbA1c level,participants were divided into four groups,namely,Q1 group ≤5.2%,Q2 group 〉 5.2%-5.4%,Q3 〉 5.4%-5.6% and Q4 group 〉 5.6%.The prevalence of NAFLD and clinical characteristics of each group were analyzed.Logistic regression was used to predict independent risk factors of NAFLD.Results The morbidity of NAFLD was 27.2% with 31.9% in male and 21% in female,which was significantly higher in men.In Q1,Q2,Q3 and Q4 group,the prevalence of NAFLD were 18.5% （178/961）,22.8% （185/812）,25.6% （280/1 095）,38.1% （480/1 259） respectively.With the increase of HbA1 c level,the morbidity of NAFLD increased synchronously.The age,systolic pressure,total cholesterol,low densitylipoprotein cholesterin and fasting blood-glucose were all elevated according to the increase of HbA1 c in 1 123 NAFLD patients.Multi-factor logistic regression analysis indicated that high HbAlc level was the risk factor of NAFLD （OR =1.67,95% CI 1.15-2.43,P =0.007）.Conclusion HbA1c is an independent risk factor of NAFLD and both of these are closely related to blood lipid metabolism disorder.

关 键 词：流行病学 中年人 老年人 非酒精性脂肪性肝病 糖化血红蛋白 

分 类 号：R575.5[医药卫生—消化系统]