非酒精性脂肪性肝病患者估算的肾小球滤过率的变化及其影响因素分析  

Changes of estimated glomerular filtration rates in healthy check-up adults with nonalcoholic fatty liver diseases

作　　者：孙长贵 曾静[2] 孙婉璐[2] 陈光榆[2] 潘勤[2] 范建高[2] Sun Changgui Zeng Jing Sun Wanlu et al(Geriatric Hospital,Kunshan 215300,Jiangsu Province, China Department of Gastroenterology,Center for Fatty Liver Disease Study,Xinhua Haspital,Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092 China)

机构地区：[1]江苏省昆山市老年医院,215300 [2]上海交通大学医学院附属新华医院消化内科

出　　处：《实用肝脏病杂志》2017年第2期165-170,共6页Journal of Practical Hepatology

基　　金：国家科技部973课题(编号:2012CB517501)

摘　　要：目的探讨健康体检成人脂肪肝和肾小球滤过率估算值(eGFR)水平减低发生率及其影响因素。方法对600例机关职员进行年度健康体检,使用B超检查诊断脂肪肝,使用瞬时弹性检测仪测定肝脏受控衰减参数(CAP),常规进行血生化检查并计算eGFR。结果在符合纳入标准的292例成人中,B超证实非酒精性脂肪性肝病(NAFLD)患者154例(52.7%);与138例无脂肪肝组比,NAFLD组体质指数、腰围、血红蛋白、AST、ALT、碱性磷酸酶、谷氨酰转肽酶、白蛋白、甘油三酯、尿酸和CAP等指标显著增高,而eGFR(107.95±35.38 mL.min^(-1).per 1.73 m^2对122.95±66.19 mL.min^(-1).per 1.73 m^2)则显著降低(P<0.05);在292例研究对象中,eGFR与CAP值呈负相关(r=-0.137,P=0.020),并且eGFR随着CAP值的增高而降低(P<0.05);多因素Logistic回归分析提示性别、年龄、肌酐、CAP值是影响受检者肾功能的独立影响因素。结论 B超诊断的NAFLD患者存在亚临床型肾脏功能减退,肝脏脂肪含量增多与健康体检成人eGFR下降密切相关。因此,对NAFLD患者,需预防慢性肾病的发生。Objective To explore the changes of estimated glomerular filtration rates （eGFR） in healthy check-up adults with nonalcoholic fatty liver diseases （NAFLD）. Methods Six hundred individuals underwent routine check-up,and 292 without history of alcohol consumption,liver diseases and kidney diseases were enrolled in this study. Nonalcoholic fatty liver disease was diagnosed by B-mode ultrasound. Controlled attenuation parameter （CAP） was measured by FibroScan and blood biochemistry tests were routinely assayed. The eGFR was calculated. Results A total of 154 patients （52.7%） were found to have NAFLD out of 292 participants. The body mass index,waist circumference, blood haemoglobin,alanine aminotransferase,aspartate aminotransferase,gamma-glutamyltransferase,urea acid,and triglyceride were significantly increased in the NAFLD group as compared to 138 controls without NAFLD;eGFR in the NAFLD group was significantly lower than that in the control group [（107.95＋35.38 mLmin-1, per 1.73 m^2 vs. 122.95 66.19 mL.min^-1. per 1.73 m^2,P〈0.05];The eGFR was negatively correlated with CAP （r=-0.137,P=0.137）,and the eGFR was decreased sharply with increased CAP value in this 292 check-up individuals;There was no significant difference as respect to gender,age,blood urea nitrogen, serum creatinine levels between groups of NAFLD and control;The multivariate Logistic regression analysis showed that gender,age, serum creatinine levels and CAP were independent factors for renal damage in patients with NAFLD. Conclusion The findings in our study suggest that mild renal function reduction presenting with decreased eGFR exists in patients with NAFLD. Therefore, prevention of chronic kidney disease is necessary in patients with NAFLD.

关 键 词：非酒精性脂肪性肝病 受控衰减参数 肾小球滤过率估算值 

分 类 号：R575[医药卫生—消化系统]