代谢相关脂肪性肝病肝纤维化的危险因素研究  

A study on the related factors of liver fifibrosis in metabolic associated fatty liver disease

作　　者：李树倩 周冷潇 高鹰[1] 苏海燕[1] 刘莉[1] 张卿[1] LI Shuqian;ZHOU Lengxiao;GAO Ying;SU Haiyan;LIU Li;ZHANG Qing(Health Management Center,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院健康管理中心,天津300052

出　　处：《健康体检与管理》2023年第4期325-330,336,共7页Journal of Health Examination and Management

基　　金：国家自然科学基金资助项目(72074167);天津市科技计划项目(22ZYCGSY00860)。

摘　　要：目的:研究代谢相关脂肪性肝病(MAFLD)的肝纤维化的危险因素。方法:选取2020年1月至2020年12月健康体检经超声检查诊断为脂肪肝并符合入选标准的MAFLD受检者3048例,按纤维化指数评分(FIB-4)分为MAFLD肝纤维化低风险组(FIB-4<1.3分,n=2558例)和MAFLD肝纤维化高风险组(FIB-4≥1.3分,n=490例),比较分析MAFLD肝纤维化的危险因素。结果:与MAFLD肝纤维化低风险组比较,MAFLD肝纤维化高风险组年龄更大,女性比例更高,收缩压、天冬氨酸转氨酶、总胆红素、直接胆红素、空腹血糖、糖化血红蛋白更高,合并2型糖尿病、高血压病、冠心病比例更高;与肝纤维化低风险组比较,肝纤维化高风险组体质量指数、白蛋白、丙氨酸转氨酶、γ-谷氨酰转肽酶、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、白细胞计数、红细胞计数、血红蛋白、血小板计数更低(P<0.05)。单因素Logistic回归分析显示,女性(OR=1.350,95%CI 1.096~1.662,P=0.005)、白蛋白降低(OR=0.917,95%CI 0.881~0.955,P<0.001)、白细胞计数降低(OR=0.680,95%CI 0.629~0.735,P<0.001)、血红蛋白降低(OR=0.987,95%CI0.981~0.994,P<0.001)、合并2型糖尿病(OR=1.859,95%CI 1.414~2.444,P<0.001)、合并高血压病(OR=1.818,95%CI 1.483~2.228,P<0.001)、合并冠心病(OR=2.591,95%CI 1.853~3.624,P<0.001)是MAFLD肝纤维化高风险的危险因素。多因素Logistic回归分析显示,白蛋白降低(OR=0.921,95%CI 0.882~0.962,P<0.001)、白细胞计数降低(OR=0.663,95%CI0.612~0.718,P<0.001)、合并2型糖尿病(OR=1.719,95%CI 1.281~2.305,P<0.001)、合并高血压病(OR=1.712,95%CI 1.375~2.130,P<0.001)、合并冠心病(OR=2.014,95%CI 1.401~2.896,P<0.001)是MAFLD肝纤维化高风险的独立危险因素。结论:白蛋白降低、白细胞计数降低、合并2型糖尿病、合并高血压病、合并冠心病是MAFLD肝纤维化高风险的独立危险因素。Objective:To investigate the related factors of liver fibrosis in metabolic associated fatty liver disease(MAFLD).Methods:A total of 3048 subjects who received annual physical examination at the Health Management Center,Tianjin Medical University General Hospital from January 2020 to December 2020 and met selection criterion were recruited as participants.A cross-sectional study was conducted.According to FIB-4 index,participants were divided into MAFLD with low risk of liver fibrosis group(FIB-4<1.3,n=2558)and MAFLD with high risk of liver fibrosis group(FIB-4≥1.3,n=490).The differences of clinical indicators and concomitant diseases were compared between the two groups,and the related factors of liver fibrosis in MAFLD were analyzed.Results:Age,the proportion of females,systolic blood pressure,aspartate aminotransferase,total bilirubin,direct bilirubin,fasting blood glucose,glycosylated hemoglobin,prevalence of type 2 diabetes mellitus,hypertension and coronary atherosclerotic heart disease in MAFLD with high risk of liver fibrosis group were older/higher than those in MAFLD with low risk of liver fibrosis group.Body mass index,albumin,alanine aminotransferase,γ-glutamyl transpeptidase,total cholesterol,triglyceride,low-density lipoprotein cholesterol,white blood cell count,red blood cell count,hemoglobin,platelet count in MAFLD with high risk of liver fibrosis group were lower than those in MAFLD with low risk of liver fibrosis group(P<0.05).Univariate logistic regression analysis revealed several factors to be associated with high risk of liver fibrosis in MAFLD,including females(OR=1.350,95%CI 1.096~1.662,P=0.005),reduced albumin(OR=0.917,95%CI 0.881~0.955,P<0.001),reduced white blood cell count(OR=0.680,95%CI 0.629~0.735,P<0.001),reduced hemoglobin(OR=0.987,95%CI 0.981~0.994,P<0.001),complication of type 2 diabetes mellitus(OR=1.859,95%CI 1.414~2.444,P<0.001),hypertension(OR=1.818,95%CI 1.483~2.228,P<0.001)and coronary atherosclerotic heart disease(OR=2.591,95%CI 1.853~3.624,P<0.001).Multivariate logisti

关 键 词：代谢相关脂肪性肝病 肝纤维化 危险因素 

分 类 号：R194.3[医药卫生—卫生事业管理]