腹型肥胖与甘油三酯的交互作用对非酒精性脂肪性肝病发病的影响  

Influence of the interaction between abdominal obesity and hypertriglyceridemia on the development of nonalcoholic fatty liver disease

作　　者：崔皓哲 马向明[2] 刘倩 孙苗苗 赵利[2] 王万超[2] 刘四清[2] 曹立瀛[2] CUI Haozhe;MA Xiangming;LIU Qian;SUN Miaomiao;ZHAO Li;WANG Wanchao;LIU Siqing;CAO Liying(Graduate School of North China University of Science and Technology, Tangshan, Hebei 063000, China;Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, Hebei 063000, China)

机构地区：[1]华北理工大学研究生院,河北唐山063000 [2]开滦总医院肝胆外科,河北唐山063000

出　　处：《临床肝胆病杂志》2020年第6期1314-1319,共6页Journal of Clinical Hepatology

基　　金：河北省2020年度医学科学研究课题计划(20200933)。

摘　　要：目的探究腹型肥胖与高TG血症对非酒精性脂肪性肝病(NAFLD)的发病是否存在协同作用。方法采用前瞻性队列的研究方法,收集2006年7月-2007年6月70776例参加健康查体的开滦集团在职及离退休职工的体检资料,并在随后每两年1次的随访中,观察NAFLD的发病情况。根据不同腰围身高比、TG水平将观察对象分为4组,即非腹型肥胖合并非高TG血症组、非腹型肥胖合并高TG血症组、腹型肥胖合并非高TG血症组、腹型肥胖合并高TG血症组,计算各组的NAFLD人年发病率。符合正态分布的计量资料多组间比较采用单因素方差分析;非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料组间比较用χ^2检验。Kaplan-Meier计算各组NAFLD的累计发病率,并用log-rank检验比较组间累计发病率的差异。以非腹型肥胖合并非高TG血症组为对照组,采用Cox比例风险模型分析各组NAFLD的发病风险(HR)及95%可信区间(95%CI),并进一步分析腹型肥胖与高TG血症对NAFLD发病影响的交互作用。结果本研究平均随访(5.03±1.67)年,共发生NAFLD 15684例,6年累计发病率为25.44%,人时发病率为44.03/千人年。经log-rank检验,累计发病率的组间比较差异有统计学意义(χ^2=2479.40,P<0.001)。以非腹型肥胖合并非高TG血症组为对照组,校正各混杂因素后,腹型肥胖合并高TG血症组发生NAFLD的HR值为2.50(95%CI:2.38~2.62),且高于腹型肥胖合并非高TG血症组(HR=1.99,95%CI:1.92~2.07)及非腹型肥胖合并高TG血症组(HR=1.71,95%CI:1.59~1.84)。在校正相同的混杂因素后,交互作用分析显示,腹型肥胖及高TG血症存在相乘交互作用(P<0.001),腹型肥胖及高TG血症同时存在时超相对危险比为0.77(95%CI:0.68~0.86),归因比为30.83%,交互作用指数为2.06(95%CI:1.90~2.24)。结论腹型肥胖与高TG血症对NAFLD的发病存在交互作用,为协同作用。Objective To investigate whether abdominal obesity and hypertriglyceridemia have a synergistic effect on the development of nonalcoholic fatty liver disease(NAFLD).Methods A prospective cohort study was conducted.Physical examination data were collected from 70776 on-the-job or retired employees of Kailuan Group who underwent physical examination from July 2006 to June 2007,and the development of NAFLD was observed during the follow-up every two years.The subjects were divided into four groups according to the waist-to-height ratio and triglyceride(TG)level,and the person-year incidence rate was calculated.A one-way analysis of variance was used for comparison of normally distributed continuous data between groups,and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.The life-table method was used to calculate the cumulative incidence rate of NAFLD in each group,and the log-rank test was used for comparison between groups.With the non-abdominal obesity and non-hypertriglyceridemia group as the control group,the Cox proportional hazards model was used to analyze the risk of NAFLD and related 95%confidence interval(CI)for each group,and the influence of the interaction between abdominal obesity and hypertriglyceridemia on the development of NAFLD was further analyzed.Results During the mean follow-up time of 5.03±1.67 years in this study,a total of 15684 cases of NAFLD were observed,with a 6-year cumulative incidence rate of 25.44%and a person-time incidence rate of 44.03/1000 person-years.The log-rank test showed a significant difference in cumulative incidence rate between groups(χ^2=2479.40,P<0.001).With the non-abdominal obesity and non-hypertriglyceridemia group as the control group,after adjustment for related confounding factors,the abdominal obesity-hypertriglyceridemia group had a hazard ratio(HR)of 2.50(95%CI:2.38-2.62)for the development of NAFLD,which was significan

关 键 词：非酒精性脂肪性肝病 肥胖 腹部 队列研究 

分 类 号：R575.5[医药卫生—消化系统]