非肥胖型非酒精性脂肪性肝病显著纤维化的影响因素分析  

Risk factor analysis of significant liver fibrosis in the non-obese non-alcoholic fatty liver disease patients

作　　者：赵欣宇 孔媛媛[1] 赵新颜[2] 王宇[2] 段维佳[2] 王晓明[2] 王民[2] 贾继东[2] 尤红[2] 王倩怡[2] ZHAO Xin-yu;KONG Yuan-yuan;ZHAO Xin-yan(Clinical Epidemiology&EBM Unit,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China;Liver Research Center,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院临床流行病学与循证医学研究室,北京100050 [2]首都医科大学附属北京友谊医院肝病中心,国家消化系统疾病临床医学研究中心,北京100050

出　　处：《临床和实验医学杂志》2022年第14期1497-1500,共4页Journal of Clinical and Experimental Medicine

基　　金：北京市属医院科研培育计划(编号:PX2022001);首都卫生发展科研专项重点公关项目(编号:首发2022-1-2021);北京市医院管理局消化协同中心重点项目子课题(编号:XXZ0304)。

摘　　要：目的探索非肥胖型非酒精性脂肪性肝病(NAFLD)患者发生显著纤维化的影响因素。方法以2016年1月至2018年6月于首都医科大学附属北京友谊医院经肝活检确诊的非肥胖型NAFLD(体重指数<25 kg/m ^(2))患者为研究对象,回顾性收集其临床资料、实验室检查及病理资料,依据脂肪变性、活动度和纤维化(SAF)/脂肪肝进展抑制(FLIP)系统进行肝脏病理组织学评价,肝纤维化分期≥2定义为显著纤维化。基于非条件Logistic回归,分别构建单因素和多因素模型,计算不同影响因素的比值比(OR)和95%可信区间(CI),分析非肥胖型NAFLD患者显著纤维化的影响因素。结果本研究共纳入76例经肝活检病理证实的非肥胖型NAFLD患者,平均年龄为(51.7±12.7)岁,其中男性13例(17.1%)。按照是否患有显著纤维化分组,显著纤维化患者组42例患者,占比为55.3%;无显著纤维化患者组34例,占比为44.7%。与无显著纤维化组相比,显著纤维化组患者的男性人群占比较低,空腹血糖、天门冬氨酸氨基转移酶(AST)和总胆汁酸水平较高,差异均有统计学意义(P<0.05);两组血压、血脂、总胆汁酸、尿酸等指标比较,差异均无统计学意义(P>0.05)。单因素Logistic回归分析结果显示:性别(OR=0.29,95%CI:1.29~6.63,P=0.010)、空腹血糖(OR=2.32,95%CI:1.19~4.51,P=0.013)、AST(OR=1.03,95%CI:1.01~1.05,P=0.011)和总胆汁酸(OR=1.19,95%CI:1.02~1.38,P=0.024)与非肥胖型NAFLD患者显著纤维化相关。进一步进行多因素危险因素筛选,最终显示空腹血糖(OR=2.92,95%CI:0.08~1.05,P=0.060)和AST(OR=1.03,95%CI:1.00~1.06,P=0.022)升高是非肥胖型NAFLD患者显著纤维化的危险因素。结论非肥胖型NAFLD中有相当比例的患者伴有显著肝纤维化,空腹血糖水平和血清AST升高是非肥胖型NAFLD显著纤维化的独立危险因素。Objective To analyze the risk factors for significant fibrosis in non-obese NAFLD patients.Methods The non-obese NAFLD patients(body mass index<25 kg/m ^(2))confirmed by liver biopsy between January 2016 and June 2018 in Beijing Friendship Hospital,Capital Medical University were enrolled.Their clinical,laboratory and histological data were retrospectively collected.Histopathological evaluation of liver was based on the steatosis,activity and fibrosis(SAF)/fatty liver progression inhibition(FLIP)system,stage of liver fibrosis≥2 was defined as significant fibrosis.Using unconditional Logistic regression,the odds ratios(OR)and 95%confidence intervals(CI)were calculated,to explore the risk factors of significant fibrosis in non-obese NAFLD patients.Results A total of 76 non-obese NAFLD patients confirmed by liver biopsy were enrolled in this study,with an average age of(51.7±12.7)years,thirteen(17.1%)patients were males and 42(55.3%)were with significant fibrosis.According to the status of significant fibrosis,there were 42 patients with significant fibrosis,accounting for 55.3%,and 34 patients without significant fibrosis,accounting for 44.7%.Compared with the non-significant fibrosis group,the proportion of males in the significant fibrosis group was lower,and the levels of fasting blood glucose,aspartic transaminase(AST)and total bile acids were higher,and the differences were statistically significant(P<0.05).There was no significant difference in bile acid,uric acid and other indicators(P>0.05).Univariate logistic model showed that gender(OR=0.29,95%CI:1.29-6.63,P=0.010),fasting blood glucose(OR=2.32,95%CI:1.19-4.51,P=0.013),AST(OR=1.03,95%CI:1.01-1.05,P=0.011)and total bile acids(OR=1.19,95%CI:1.02-1.38,P=0.024)were associated with significant fibrosis in non-obese NAFLD patients.Furthermore,multivariate logistic model showed that increased fasting blood glucose(OR=2.92,95%CI:0.08-1.05,P=0.060)and AST(OR=1.03,95%CI:1.00-1.06,P=0.022)were risk factors for significant fibrosis in non-obese NAFLD patients.Conc

关 键 词：非肥胖型非酒精性脂肪性肝病 肝纤维化 危险因素 

分 类 号：R575.5[医药卫生—消化系统]