饮酒和代谢相关因素对代谢性脂肪肝发生重度纤维化的影响  

Influence of alcohol consumption and metabolic related factors on occurrence of significant fibrosis in metabolic fatty liver

作　　者：姜佳楠 巩艳[2] 刘唯正 张大旭 吕文平[1] JIANG Jia’nan;GONG Yan;LIU Weizheng;ZHANG Daxu;LYU Wenping(Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Health Medicine,the Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科学部,北京100853 [2]解放军总医院第二医学中心健康医学科,北京100853

出　　处：《解放军医学院学报》2023年第7期780-786,共7页Academic Journal of Chinese PLA Medical School

摘　　要：背景 一个国际专家小组建议将代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)作为更合适的术语描述代谢紊乱相关的肝病。不同于非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)的排除性诊断标准,MAFLD有自己的一套阳性标准。而脂肪肝的严重程度常用纤维化阶段来描述,活检显示轻度脂肪变性且没有NASH组织学证据的患者预后较好,重度纤维化是MAFLD患者不良结局的主要决定因素,但国内外对导致MAFLD发生重度纤维化因素的研究较少。目的 分析饮酒与代谢因素对MAFLD发生重度纤维化的影响,为指导治疗提供参考。方法 收集2011-2021年解放军总医院体检中心的病例信息。分析MAFLD与非MAFLD患者实验室指标和生活习惯等方面的差异,分析不同饮酒习惯MAFLD患者发生重度纤维化的差异。通过Logistic逻辑回归分析与MAFLD重度肝纤维化发生相关的因素。结果 共纳入体检者36 847例,平均年龄47.3岁,男性占66.4%(24 479/36 847)。MAFLD的患病率为37.1%,平均年龄47.9岁,男性占84.0%。合并一项代谢异常的MAFLD重度纤维化的患病率比不合并其他代谢异常者高(15.2%vs 0,P <0.001)。男性(OR=1.808, 95%CI:1.541~2.121, P<0.001)、高龄(OR=1.151, 95%CI:1.142~1.16, P<0.001)、饮酒(OR=1.167,95%CI:1.046~1.301,P=0.006)、患有糖尿病(OR=1.155,95%CI:1.007~1.324,P=0.040)等的体检者发生重度纤维化的风险更高。轻度饮酒组比不饮酒组肝显著纤维化的患病率高(16.5%vs 14.2%,P=0.009)。结论 代谢合并症(大腰围、高三酰甘油血症、异常的高密度脂蛋白及糖尿病)是导致MAFLD患者发生重度纤维化的独立危险因素。轻微饮酒也会导致肝重度纤维化患病率增加。Background An international panel of experts has recommended that MAFLD would be a more appropriate term to describe this liver disease associated with metabolic disorders.Unlike NAFLD,MAFLD has its own set of positive criteria for diagnosing fatty liver disease.While the severity of fatty liver is often described by fibrosis stage,patients with mild steatosis on biopsy and no histological evidence of NASH have a better prognosis,and severe fibrosis is a major determinant of adverse outcomes in patients with MAFLD.However,there are few studies on the factors leading to MAFLD's significant fibrosis at home and abroad.Objective To verify the influence of alcohol consumption and metabolic factors on MAFLD with significant fibrosis in large Chinese population.Methods The information of patients who were admitted to the Physical Examination Center of Chinese PLA General Hospital from 2011 to 2021 was collected.The clinical differences in laboratory indicators and lifestyle between MAFLD and non-MAFLD,and the differences in significant fibrosis in MAFLD with different drinking habits were analyzed.Logistic univariate and multivariate analysis of independent risk factors for MAFLD significant fibrosis were performed.Results A total of 36847 subjects were included,with a mean age of 47.3 years,and 66.4%of them(24479/36847)were male.The prevalence of MAFLD was 37.1%(13672/36847)with a mean age of 47.9 years,with male accounting for 84.0%(11478/13672).The proportion of significant fibrosis in the MAFLD patients with one metabolic abnormality was higher than that in the patients without other metabolic abnormalities(15.2%vs 0,P<0.001).Significant MAFLD fibrosis were associated with male(OR=1.808;95%CI:1.541-2.121;P<0.001),advanced age(OR=1.151;95%CI:1.142-1.16;P<0.001),drinking(OR=1.167;95%CI:1.046-1.301;P=0.006),and diabetes(OR=1.155;95%CI:1.007-1.324;P=0.040).The proportion of significant liver fibrosis was higher in the mild alcohol group than that in the non-alcohol group(16.5%vs 14.2%,P=0.009).Conclusion MAFLD with met

关 键 词：代谢性脂肪肝 肝纤维化 危险因素 代谢综合征 饮酒 

分 类 号：R575.5[医药卫生—消化系统]