理想心血管健康行为和因素对非酒精性脂肪性肝病发病的影响  

Effect of ideal cardiovascular health metrics on the incidence rate of nonalcoholic fatty liver disease

作　　者：赵东娜[1] 刘倩 梁惠捷 崔皓哲 孟令群 鄂慧良 曹立瀛[1] ZHAO Dongna;LIU Qian;LIANG Huijie;CUI Haozhe;MENG Lingqun;E Huiliang;CAO Liying(Operating Room of Kailuan General Hospital,Tangshan,Hebei 063000,China;Graduate School of North China University of Science and Technology,Tangshan,Hebei 063000,China;Operating Room of Tangshan Central Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市开滦总医院手术室,河北唐山063000 [2]华北理工大学研究生院,河北唐山063000 [3]唐山中心医院手术部,河北唐山063000

出　　处：《临床肝胆病杂志》2022年第1期124-128,共5页Journal of Clinical Hepatology

基　　金：河北省2020年度医学科学课题研究计划(20201285)。

摘　　要：目的探究理想心血管健康行为和因素与非酒精性脂肪性肝病(NAFLD)发病的关系,为制订NAFLD的防控策略提供依据。方法采用回顾性队列的研究方法,收集2006年7月—2007年6月50511例参加健康查体的开滦集团职工的体检资料,并在随后每2年1次的随访中,观察NAFLD的发病情况。正态分布的计量资料多组间比较采用单因素方差分析;偏态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ^(2)检验。根据心血管简易评分(CHS)四分位水平将观察对象分为四组,采用人年发病率计算各组人群NAFLD的发病情况,使用限制性立方样条曲线(RCS)计算连续型变量与结局事件间的剂量-反应关系,采用Cox比例风险模型分析各组NAFLD的发病风险比及95%CI,并对心血管健康行为和因素各组分对NAFLD发病的影响进行了Cox比例风险模型分析。结果在平均5.58年的随访过程中,共发生NAFLD 15265例,Q1、Q2、Q3、Q4组观察对象人年发病率分别为77.88/千人年、61.33/千人年、46.37/千人年、33.69/千人年。RCS结果表明,CHS连续型变量与NAFLD发病风险呈非直线关系(P<0.05)。在多因素Cox模型分析中,与Q1组相比,Q2组、Q3组、Q4组NAFLD的发病风险比分别为0.78(0.74~0.81)、0.57(0.54~0.59)、0.38(0.36~0.41),在不同性别及不同年龄组中也得到了相似的结果。在各组分的分析中发现理想BMI(HR=0.37,95%CI:0.36~0.39)、理想血糖(HR=0.80,95%CI:0.77~0.84)、理想血压(HR=0.72,95%CI:0.69~0.75)、理想总胆固醇(HR=0.86,95%CI:0.83~0.89)、理想饮食(HR=0.94,95%CI:0.90~0.99)是NAFLD发病的保护因素。结论理想心血管健康行为和因素是NAFLD发病的保护因素,保持健康的生活方式有助于预防NAFLD的发病。Objective To investigate the association of ideal cardiovascular health metrics with the incidence rate of nonalcoholic fatty liver disease(NAFLD),and to provide a basis for the prevention and control of NAFLD.Methods A prospective cohort study was conducted for the data of 50511 employees of Kailuan Group who participated in physical examination from July 2006 to June 2007,and the onset of NAFLD was observed during follow-up once every two years.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test used for comparison of continuous data with skewed distribution between multiple groups;the chi-square test was used for comparison of categorical data between groups.The subjects were divided into four groups according to the quartile of cardiovascular health score(CHS),and person-year incidence rate was used to calculate the incidence rate of NAFLD in each group.Restricted cubic spline(RCS)curve was used to calculate the dose-response relation between continuous variables and outcome events;the Cox proportional hazards model was used to analyze hazard ratio(HR)and 95%confidence interval(CI)in each group and investigate the effect of ideal cardiovascular health metrics on the incidence rate of NAFLD.Results During the mean follow-up time of 5.58 years,a total of 15265 cases of NAFLD were observed,and the incidence rate of NAFLD was 77.88/1000 person-year in the Q1 group,61.33/1000 person-year in the Q2 group,46.37/1000 person-year in the Q3 group,and 33.69/1000 person-year in the Q4 group.RCS results showed a non-linear relationship between CHS continuous variable and the risk of NAFLD(P<0.05).The multivariate Cox proportional risk model analysis showed that compared with the Q1 group in terms of the risk of NAFLD,the Q2,Q3,and Q4 groups had an HR of 0.78(95%CI:0.74~0.81),0.57(95%CI:0.54~0.59),and 0.38(95%CI:0.36~0.41),respectively,and similar results were observed in subjects stratified by sex and age.The analysis of each

关 键 词：非酒精性脂肪性肝病 健康生活方式 队列研究 

分 类 号：R575.5[医药卫生—消化系统]