基于社区老年人群比较代谢相关脂肪性肝病与非酒精性脂肪性肝病的人群差异  

Population differences of metabolic associated fatty liver disease and nonalcoholic fatty liver disease based on a community elderly population

作　　者：张爽 刘晓慧[1] 王罡[2] 张丽 朱云杰 吴剑[3] 柳雅立[1] 张晶[1] ZHANG Shuang;LIU Xiaohui;WANG Gang;ZHANG Li;ZHU Yunjie;WU Jian;LIU Yali;ZHANG Jing(The Third Unit,Department of Hepatology,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;Department of General Practice,Menkuang Hospital,Beijing Jingmei Group General Hospital,Beijing 102399,China;School of Kinesiology and Health,Capital University of Physical Education and Sports,Beijing 100191,China)

机构地区：[1]首都医科大学附属北京佑安医院脂肪性肝病诊疗中心,北京100069 [2]北京京煤集团总医院门矿医院全科医学科,北京102399 [3]首都体育学院运动科学与健康学院,北京100191

出　　处：《临床肝胆病杂志》2022年第3期547-552,共6页Journal of Clinical Hepatology

基　　金：北京慢性病防治与健康教育研究会科研项目(BJMB0012021025002)。

摘　　要：目的本研究拟比较新命名“代谢相关脂肪性肝病”(MAFLD)与旧命名“非酒精性脂肪性肝病”(NAFLD)的人群差异。方法选择2020年11月—2021年1月在北京某社区体检的65岁以上老年人群共624例进行横断面调查,收集人口学、既往史、实验室指标以及肝脏超声和弹性等指标。按照超声诊断有无脂肪肝分为2组:脂肪肝组389例,非脂肪肝组235例。正态分布的计量资料两组间比较采用独立样本t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U秩和检验,计数资料两组间比较采用χ^(2)检验。结果389例脂肪肝患者中,387例(99.5%)符合MAFLD诊断;368例(94.6%)符合NAFLD诊断;合并大量饮酒史19例,表面抗原阳性2例。同时符合MAFLD和NAFLD诊断的患者366例,分别占MAFLD和NAFLD患者的94.6%和99.5%。与非脂肪肝组相比,MAFLD组的BMI(t=-11.228)、腰围(Z=-8.532)、臀围(Z=-6.449)、腰臀比(Z=-5.708)、ALT(Z=-5.027)、AST(Z=-2.880)、PLT(t=-3.623)、TG(Z=-8.489)、空腹血糖(Z=-3.516)、HbA1c(Z=-2.884)、稳态模型计算胰岛素抵抗指数(Z=-0.394)、超敏C反应蛋白(Z=-4.912)、控制衰减参数(t=13.744)、肝硬度值(Z=-7.69)均增加,差异均有统计学意义(P值均<0.05),而HDL-C(t=6.348,P<0.001)水平下降。同时,MAFLD患者合并更多的代谢相关疾病,如超重、肥胖、中心性肥胖、血脂异常、高血压(χ^(2)值分别为9.978、65.472、36.571、9.797、5.128,P值均<0.05)。在MAFLD组中,30.7%的患者为非肥胖脂肪肝(BMI≥25 kg/m2),11.1%为瘦人脂肪肝(BMI<23 kg/m2);与肥胖MAFLD患者相比,非肥胖MAFLD患者年龄(Z=-3.042)、BMI(Z=-15.705)、腰围(Z=-9.589)、臀围(Z=-10.275)、稳态模型计算胰岛素抵抗指数(Z=-2.081)、控制衰减参数(t=-3.468)、肝硬度值(Z=-3.630)、NFS(t=-4.433)更低(P值均<0.05)。根据肝硬度值进行判断,进展期肝纤维化占MAFLD人群的3.6%,不能排除进展期肝纤维化占10%。结论在老年人群中,MAFLD的诊断基本能够覆盖NObjective To investigate the population differences of the newly named“metabolic associated fatty liver disease”(MAFLD)and the former name“nonalcoholic fatty liver disease”(NAFLD).Methods From November 2020 to January 2021,a cross-sectional survey was conducted among 624 elderly individuals aged above 65 years in a community in Beijing,China,and related data were collected,including demographic data,past history,laboratory markers,liver ultrasound,and liver elasticity.According to the presence or absence of fatty liver based on ultrasonic diagnosis,the individuals were divided into fatty liver group with 389 individuals and non-fatty liver group with 235 individuals.The independent samples t-test was used for comparison of normally distributed continuous data between the two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between the two groups;the chi-square test was used for comparison of categorical data between the two groups.Results Among the 389 patients with fatty liver,387(99.5%)were diagnosed with MAFLD and 368(94.6%)were diagnosed with NAFLD,and there were 19 patients with a history of heavy alcohol consumption and 2 with positive surface antigen.A total of 366 patients met the diagnostic criteria for both MAFLD and NAFLD,accounting for 94.6%of the MAFLD patients and 99.5%of the NAFLD patients.Compared with the non-fatty liver group,the MAFLD group had significant increases in body mass index(BMI)(t=-11.228,P<0.05),waist circumference(Z=-8.532,P<0.05),hip circumference(Z=-6.449,P<0.05),waist-hip ratio(Z=-5.708,P<0.05),alanine aminotransferase(Z=-5.027,P<0.05),aspartate aminotransferase(Z=-2.880,P<0.05),platelet count(t=-3.623,P<0.05),triglyceride(Z=-8.489,P<0.05),fasting blood glucose(Z=-3.516,P<0.05),HbA1c(Z=-2.884,P<0.05),Homeostasis Model Assessment of Insulin Resistance(HOMA-IR)(Z=-0.394,P<0.05),high-sensitivity C-reactive protein(Z=-4.912,P<0.05),controlled attenuation parameter(CAP)(t=13.744,P<0.05),and liver stiffness measurement(LSM)

关 键 词：代谢相关脂肪性肝病 非酒精性脂肪性肝病 医院 社区 横断面研究 

分 类 号：R57[医药卫生—消化系统]