非酒精性脂肪性肝病患者的尿铅水平及其临床意义  

Levels and clinical significance of urinary lead in patients with nonalcoholic fatty liver disease

作　　者：刘亚杰 王睿林 LIU Yajie;WANG Ruilin(Department of Spleen,Stomach,Liver and Gallbladder Diseases,The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450099,China;Department of Traditional Chinese Medicine and Liver Diseases,The Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]河南中医药大学第一附属医院脾胃肝胆病科,郑州450099 [2]解放军总医院第五医学中心中医肝病科,北京100039

出　　处：《临床肝胆病杂志》2024年第9期1771-1777,共7页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81673806);中国医药教育协会科研课题(2020KTY001)。

摘　　要：目的探讨尿铅与非酒精性脂肪性肝病(NAFLD)的关系。方法选取2017—2020年美国健康和营养检查调查数据(NHANES)中年龄≥18岁的注册参与者,并排除缺乏肝脏瞬时弹性成像数据、尿铅指标及患有乙型肝炎、丙型肝炎、饮酒量显著的人群。将纳入人群(n=2492)分为NAFLD组852例,Non-NAFLD组1640例。采用高效液相色谱-电喷雾电离-串联质谱和在线固相萃取联合同位素稀释等方法定量检测尿铅水平。计量资料两组间比较采用成组t检验或Wilcoxon秩和检验;计数资料两组间比较采用χ^(2)检验或Fisher确切概率法。通过多因素Logistic回归分析、限制性立方样条函数、亚组分析、交互作用,探究尿铅与NAFLD的关联。结果NAFLD组尿铅水平高于Non-NAFLD组,差异有统计学意义(Z=-2.023,P=0.043)。调整年龄、性别、种族、婚姻、教育、家庭收入与贫困比比值、BMI、吸烟、饮酒、糖尿病、高血压、高脂血症协变量后,尿铅水平Q3组NAFLD的患病风险显著增加(比值比=1.360,95%CI:1.019~1.817,P=0.037)。尿铅与NAFLD的患病风险存在正向剂量-反应关系(P=0.047)且为非线性关系(P_(non-linear)=0.037)。尿铅与种族之间存在显著的交互作用,墨西哥裔美国人尿铅每上升1个四分位数,NAFLD的患病风险增加32.40%(比值比=1.324,95%CI:1.017~1.632,P<0.05)。结论尿铅水平与NAFLD患病风险显著相关。Objective To investigate the association between urinary lead and nonalcoholic fatty liver disease(NAFLD).Methods The participants,aged≥18 years,were selected from the 2017—2020 National Health and Nutrition Examination Survey(NHANES),with the exclusion of the participants with a lack of liver transient elastography data and urinary lead markers and those with hepatitis B,hepatitis C,and significant alcohol consumption.A total of 2492 participants were enrolled and divided into NAFLD group with 852 participants and non-NAFLD group with 1640 participants.High-performance liquid chromatographyelectrospray ionization-tandem mass spectrometry and online solid-phase extraction combined with isotope dilution were used to measure urinary lead level.The independent-samples t test or the Wilcoxon rank sum test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.Multivariate Logistic regression analysis,restricted cubic spline,subgroup analysis,and interaction analysis were used to investigate the association between urinary lead and NAFLD.Results The NAFLD group had a significantly higher urinary lead level than the non-NAFLD group(Z=-2.023,P=0.043).After adjustment of the covariates of age,sex,race,marital status,education,family income-to-poverty ratio,body mass index,smoking,drinking,diabetes mellitus,hypertension,and hyperlipidemia,there was a significant increase in the risk of NAFLD in the Q3 urinary lead group(odds ratio[OR]=1.360,95%confidence interval[CI]:1.019—1.817,P=0.037).There was a positive dose-response relationship between urinary lead and the risk of NAFLD(P=0.047),which was a non-linear relationship(P_(non-linear)=0.037).There was a significant interaction between urinary lead and race,and for every quartile increase in urinary lead,the risk of NAFLD in Mexican-Americans was increased by 32.40%(OR=1.324,95%CI:1.017—1.632,P<0.05).Conclusion Urinary lead level is significan

关 键 词：非酒精性脂肪性肝病 铅 尿 LOGISTIC模型 

分 类 号：R575.5[医药卫生—消化系统]