体质量指数联合腰围对2型糖尿病患者新发非酒精性脂肪肝的预测价值  

Predictive value of body mass index combined with waist circumference for new-onset nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus

作　　者：王珊[1] 张健[1] 张卫欢[1] 汪海涛[1] 侯婧悦 张瑞秀 刘红芬[2] 吴寿岭[1] WANG Shan;ZHANG Jian;ZHANG Weihuan;WANG Haitao;HOU Jingyue;ZHANG Ruixiu;LIU Hongfen;WU Shouling(Kailuan General Hospital,Tangshan 063000,China;First Hospital of Shijiazhuang,Shijiazhuang 050000,China)

机构地区：[1]开滦总医院,河北唐山063000 [2]石家庄市第一医院,河北石家庄050000

出　　处：《南方医科大学学报》2019年第11期1293-1297,共5页Journal of Southern Medical University

基　　金：河北省卫生计生委专项科研基金(20171449)

摘　　要：目的探讨体质量指数(BMI)联合腰围对2型糖尿病患者新发非酒精性脂肪肝(NAFLD)的预测价值。方法采用队列研究方法,以参加2006~2007年度健康体检的开滦集团员工中无NAFLD的2型糖尿病患者3501例作为观察队列,按基线BMI及腰围将观察对象分为A组(BMI、腰围均正常)、B组(BMI正常、腰围升高)、C组(BMI升高、腰围正常)、D组(BMI、腰围均升高),纳入最终统计分析的有效数据为2920例,随访各组2008~2009、2010~2011、2012~2013、2014~2015、2016~2017年度健康体检时NAFLD的发病情况,用Cox比例风险回归模型分析BMI和腰围与NAFLD发病风险的关系。结果(1)A、B、C、D组NAFLD累积发病率逐渐上升,分别为50%、66%、68%、77%,差异有统计学意义(P<0. 01);(2)影响NAFLD发病的Cox比例风险回归模型分析显示,校正多种混杂因素后,与A组比较,B、C、D组NAFLD的发病风险均增加,HR值分别为1.62、1.98、2.47,差异有统计学意义(P<0.01)。结论高水平的BMI和腰围均为NAFLD发病的独立危险因素,BMI联合腰围对NAFLD的预测价值高于单一指标。Objective To investigate the predictive value of body mass index(BMI) combined with waist circumference(WC) for new-onset nonalcoholic fatty liver disease(NAFLD) in patients with type 2 diabetes mellitus(T2 DM). Methods This community-based prospective cohort study was conducted among 3501 T2 DM patients without NAFLD recruited from the staff of Kailuan Company, who underwent routine physical examination in the year 2006 and 2007, and a total of 2920 subjects were included in the final analysis. According to the baseline BMI and WC, the subjects were divided into group A(with normal BMI and WC), group B(with normal BMI but elevated WC), group C(with elevated BMI but a normal WC) and group D(with elevated BMI and WC). The subjects in the 4 groups were followed for the occurrence of NAFLD by reviewing their reports of physical examinations during the periods of 2008-2009, 2010-2011, 2012-2013, 2014-2015 and 2016-2017. The cumulative incidence of NAFLD was compared across the 4 groups and Cox regression analysis was used to test the correlation of BMI and WC with new onset of NAFLD. Results The cumulative incidence of NAFLD increased progressively in the 4 groups(50%, 66%, 68% and 77%, respectively). Cox regression analysis showed that compared with group A, groups B, C and D had increased risks of NAFLD after adjusting for age, gender and other risk factors, with HR values of 1.62, 1.98 and2.47, respectively. Conclusion Elevated BMI and WC are both independent risk factors for NAFLD in type 2 diabetic patients,and the combination of BMI and WC has a greater predictive value for NAFLD than either of them alone.

关 键 词：体质量指数 腰围 2型糖尿病 非酒精性脂肪肝 队列研究 

分 类 号：R57[医药卫生—消化系统]