非糖尿病成人中非酒精性脂肪性肝病和糖化血红蛋白的关系  

Correlation between nonalcoholic fatty liver disease and glycosylated hemoglobin in non-diabetic adults

作　　者：李培瑛 陈明明 余馨妍 LI Pei-ying;CHEN Ming-ming;YU Xin-yan(Health Management Center,Second Affiliated Hospital of Zhejiang University Medical College,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院健康管理中心,310009 [2]浙江大学医学院附属第二医院全科医学科,310009

出　　处：《中国实用医药》2022年第27期58-61,共4页China Practical Medicine

摘　　要：目的 探讨非糖尿病成人中非酒精性脂肪性肝病(NAFLD)与正常范围内糖化血红蛋白(HbA1c)水平的关系。方法 2916例非糖尿病成人,根据研究人群HbA1c水平的四分位数间距分为Quartile 1(Q1)组(HbA1c≤5.4%, 736例)、Quartile 2 (Q2)组(HbA1c 5.5%~5.6%, 757例)、Quartile3(Q3)组(HbA1c 5.7%~5.8%, 666例)、Quartile 4 (Q4)组(HbA1c 5.9%~6.4%, 757例)。比较四组的一般情况、生化指标及NAFLD患病率,采用Logistic回归分析评估不同HbA1c水平与NAFLD的关系。结果 2916例非糖尿病成人中, NAFLD患者共1135例,占比38.9%。四组中随着HbA1c水平升高,年龄、男性占比、收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、空腹胰岛素(FPI)、胰岛素抵抗指数(HOMA-IR)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血清尿酸(SUA)、C反应蛋白(CRP)水平逐渐增加,差异有统计学意义(P<0.05);而高密度脂蛋白胆固醇(HDL-C)水平随着HbA1c水平的升高呈逐渐降低趋势,差异有统计学意义(P<0.05)。Q1、Q2、Q3、Q4组的NAFLD患病率分别为25.7%、30.9%、44.3%和55.1%,随着HbA1c水平的升高,NAFLD患病率逐渐升高,差异具有统计学意义(P<0.05)。根据HbA1c水平四分位数间距分组,在Model1(未校正)、Model 2(校正性别和年龄)和Model 3(校正性别、年龄和BMI)中,以Q1组作为参照组,随着HbA1c水平的升高, NAFLD的患病风险逐渐升高,差异具有统计学意义(P<0.05)。在Model 4(校正年龄、性别、BMI、SBP、DBP、TG、TC、HDL-C、LDL-C、SUA、CRP和HOMA-IR)中, Q4组与Q1组比较, NAFLD患病的OR(95%CI)为1.430 (1.042, 1.962),差异具有统计学意义(P<0.05)。将HbA1c作为计量数据时,在Model 4中NAFLD患病的OR(95%CI)为1.860(1.290, 2.681),差异具有统计学意义(P<0.05)。结论 在非糖尿病成人中, HbA1c水平在正常范围内升高是发生NAFLD的独立危险因素。Objective To discuss the correlation between nonalcoholic fatty liver disease(NAFLD and glycosylated hemoglobin(HbA1c) in non-diabetic adults. Methods A total of 2916 non-diabetic adults were divided into Quartile 1(Q1) group(HbA1c ≤5.4%, 736 cases), Quartile 2(Q2) group(HbA1c 5.5%-5.6%,757 cases), Quartile 3(Q3) group(HbA1c 5.7%-5.8%, 666 cases), and Quartile 4(Q4) group(HbA1c 5.9%-6.4%,757 cases) according to the interquartile spacing of HbA1c levels. The general data, biochemical parameters and prevalence of NAFLD were compared among the four groups. Logistic regression analysis was used to evaluate the correlation between different levels of HbA1c and NAFLD. Results Among the 2916 non-diabetic adults, there were 1135 patients with NAFLD, accounting for 38.9%. As HbA1c levels increased in the four groups, age, male proportion, systolic blood pressure(SBP), diastolic blood pressure(DBP), body mass index(BMI), total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), fasting plasma glucose(FPG), fasting proinsulin(FPI), homeostasis model assessment-insulin resistance(HOMA-IR), glutamate transaminase(ALT),aspartate aminotransferase(AST), serum uric acid(SUA), and C-reactive protein(CRP) levels gradually increased with statistically significant differences(P<0.05). The level of high-density lipoprotein cholesterol(HDL-C)decreased gradually with the increase of HbA1c level, and the difference was statistically significant(P<0.05). The prevalence of NAFLD in Q1, Q2, Q3 and Q4 groups were 25.7%, 30.9%, 44.3% and 55.1%, respectively. With the increase of HbA1c level, the prevalence of NAFLD gradually increased, and the difference was statistically significant(P<0.05). According to the quartile spacing grouping of HbA1c levels, in Model 1(uncorrected),Model 2(corrected for gender and age) and Model 3(corrected for gender, age and BMI), with the Q1 group as the reference group, the risk of NAFLD increased gradually with increasing HbA1c levels, and the difference was statistically significa

关 键 词：非酒精性脂肪性肝病 糖化血红蛋白 非糖尿病 

分 类 号：R575.5[医药卫生—消化系统]