成人非酒精性脂肪肝与2型糖尿病发病关系的前瞻性队列研究  

Relationship Between Non-alcoholic Fatty Liver Disease and the Incidence of Type 2 Diabetes Mellitus:A Prospective Cohort Study

作　　者：李卫东[1] 傅坤发[2] 连燕舒[3] 陈允菊 夏金荣[1] 

机构地区：[1]东南大学附属中大医院消化科,江苏省南京市210009 [2]江苏省老年医院干部科 [3]江苏建康职业学院公共卫生教研室 [4]南京市职业病防治院职业健康管理中心

出　　处：《中国全科医学》2015年第28期3426-3429,共4页Chinese General Practice

摘　　要：目的探讨成人非酒精性脂肪肝(NAFLD)与2型糖尿病(T2DM)发病的关系。方法以南京市三所医院(东南大学附属中大医院、江苏省老年医院、南京市职业病防治院)体检职工人群为前瞻性研究随访队列,2008年基线调查其一般资料、既往病史、吸烟、饮酒、身体活动情况及体检资料等,2009—2012年连续随访4年,以首次诊断为T2DM为观察终点。将资料完整并符合要求的2 464例体检职工纳入分析,其中男1 445例,女1 019例。根据基线B超检查和饮酒情况将体检职工分为NAFLD组(n=365例)和对照组(n=2 099例)。采用COX比例风险回归模型分析NAFLD与T2DM发病风险的关系。结果经过平均3.8年的随访(9 695人年,其中NAFLD组1 397人年,对照组8 298人年),共有32例发生T2DM,累积发病率为3.30/1 000人年。其中NAFLD组中有12例发生T2DM,累积发病率为8.59/1 000人年;对照组中有20例发生T2DM,累积发病率为2.41/1 000人年。Kaplan-Meier分析显示,两组累积发病率间差异有统计学意义(χ2=21.374,P<0.001)。调整年龄、性别、教育程度、家庭收入、吸烟、饮酒、糖尿病家族史、手术史、每日身体活动量、空腹血糖(FBG)、总胆固醇(TC)、丙氨酸氨基转移酶(ALT)、血尿酸(BUA)及体质指数(BMI)后,与对照组相比,NAFLD组发生T2DM的HR(95%CI)为2.936(1.380,6.247)。结论 NAFLD会增加T2DM的发病风险,是T2DM的独立危险因素。为减少糖尿病发生,成年人应重视和积极治疗NAFLD。Objective To investigate the relation between non- alcoholic fatty liver disease（ NAFLD） and the incidence of type 2 diabetes mellitus（ T2DM）. Methods A prospective follow- up cohort study was conducted with employees who received physical examination in three hospitals（ Zhongda Hospital Affiliated to Southeast University, Jiangsu Geriatrics Hospital and Nanjing Occupational Disease Precaution Clinic） in Nanjing. At baseline in 2008,general data,medical history,smoking,alcohol use,physical activities and physical examination data were investigated. Follow- up was undertaken from 2009 to 2012 consecutively for 4 years,and observation ended at the first diagnosis of T2 DM. We included 2 464 subjects who had complete data and accorded with inclusion criteria,among which 1 445 were males and 1 019 were females. According to baseline B ultrasound examination and alcohol use, the subjects were divided into NAFLD group（ n = 365） and control group（ n= 2 099）. Cox proportion risk regression model was employed to analyze the relationship between NAFLD and T2 DM. Results After an average follow- up of 3. 8 years（ 9 695 person- years; 1 397 person- years for NAFLD group; 8 298 person- years for control group）,T2 DM occurred in 32 patients,with an accumulated morbidity of 3. 30 /1 000 person- years. In NAFLD group,T2 DM occurred in 12 patients,with an accumulated morbidity of 8.59 /1 000 person-years; in control group,T2 DM occurred in 20 patients,with an accumulated morbidity of 2.41 /1 000 person-years. Kaplan-Meier analysis showed that the two groups were significantly different in accumulated morbidity（ χ2= 21. 374,P〈0. 001）. After adjusting for age, sex, educational level,family income,smoking,alcohol use,family history of diabetes,previous surgeries,daily physical activities,FBG,TC,ALT,BUA and BMI,the HR（ 95% CI） of T2 DM in NAFLD group was 2. 936（ 1. 380,6. 247）,compared with control group. Conclusion NAFLD may increase the incidence of T2 DM and is an independent risk factor for

关 键 词：脂肪肝 糖尿病 2型 发病率 队列研究 

分 类 号：R575[医药卫生—消化系统] R587.1[医药卫生—内科学]