健康体检队列人群残粒胆固醇发展轨迹与新发非酒精性脂肪性肝病的相关性研究  

Association of residual cholesterol trajectory with the risk of incident non-alcoholic fatty liver disease in a healthy physical check-up study

作　　者：孙玉婷 苗鑫蕾 唐桂敏 胡曼玲 谢霄玲 刘爽[2] 宋子萍 冷松[1] Sun Yuting;Miao Xinlei;Tang Guimin;Hu Manling;Xie Xiaoling;Liu Shuang;Song Ziping;Leng Song(Health Management Center of the Second Hospital of Dalian Medical University,Dalian 116023,China;School of Public Health,Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第二医院健康管理中心,大连116023 [2]大连医科大学公共卫生学院,大连116000

出　　处：《中华内分泌代谢杂志》2024年第12期1038-1044,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：辽宁省应用基础研究计划项目(2023JH2/101300074)。

摘　　要：目的分析健康体检队列人群残粒胆固醇(residual cholesterol,RC)的发展轨迹,探究其与新发非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)的相关性。方法回顾性选取大连医科大学附属第二医院健康管理中心2016年1月至2020年12月符合队列入组标准的2477人,建立目标人群4年RC组基轨迹模型(group-based trajectory model,GBTM)。应用Cox比例风险回归模型分析RC轨迹组与NAFLD的发病风险,用受试者工作特征(receiver operating characteristic,ROC)曲线评价该Cox模型的预测价值,进行敏感性分析验证RC与NAFLD的相关性结论的可靠性。结果确定3个亚组人群RC的变化轨迹,分别标记为RC低水平组(79.21%)、RC中水平组(19.86%)和RC高水平组(0.93%)。随访4年后,该队列NAFLD的发病率为11.99%,RC低、中、高水平组的NAFLD发病率分别为10.55%、16.46%、39.13%。各轨迹组NAFLD的4年累积发病率随着随访时间的延长而逐渐上升,且RC高水平组的累积发病率最高(χ^(2)=68.026,P<0.001)。Cox比例风险回归模型结果显示,在不同模型中,RC高水平组和RC中水平组的发病风险均高于RC低水平组;ROC曲线下面积随访第2年、3年、4年的值分别为0.777、0.778、0.720,显示RC对预测新发NAFLD有一定的价值;敏感性分析1中,剔除糖尿病、高血压、血脂异常166人后,RC与NAFLD的相关性和主分析结果保持一致;敏感性分析2中,四分位分组的Q2、Q3、Q4组的发病风险高于Q1组。结论RC高水平发展轨迹是NAFLD发病的危险因素,高水平RC值的持续上升可能是机体患NAFLD的早期信号,建议对此进行及时干预,以达到早期预防NAFLD的目的。ObjectiveTo analyze the trajectory of residual cholesterol(RC)in a healthy check-up cohort and explore its correlation with the incidence of non-alcoholic fatty liver disease(NAFLD).MethodsA total of 2477 participants who met the inclusion criteria in the Health Management Center of the Second Hospital of Dalian Medical University from January 2016 to December 2020 were retrospectively selected to establish a four-year RC trajectory model using the group-based trajectory model(GBTM),and the risk of NAFLD in the RC group was analyzed using Cox proportional hazards regression model.The predictive value of the Cox model was evaluated with a receiver operating characteristic(ROC)curve,and the reliability of the association between RC and NAFLD was verified through sensitivity analysis.ResultsThree RC trajectory subgroups were identified low-level RC(79.21%),medium-level RC(19.86%),and high-level RC(0.93%).After 4 years of follow-up,the incidence rate of NAFLD in this cohort was 11.99%,and the incidences of NAFLD in the low-,medium-,and high-RC groups were 10.55%,16.46%,and 39.13%,respectively.The cumulative incidence of NAFLD increased with follow-up with the highest rate observed in the high-level RC group(χ^(2)=68.026,P<0.001).The results of Cox proportional hazards regression model indicated that the risk of NAFLD incidence in both the high-level and medium-level RC groups was greater than that in the low-level RC group.The areas under ROC curve at the 2nd,3rd,and 4th years of follow-up were 0.777,0.778,and 0.720,respectively,suggesting that RC has certain predictive value for new-onset NAFLD.The results were consistent after excluding 166 individuals with diabetes,hypertension,or dyslipidemia.In another sensitivity analysis,higher RC quartiles(Q2,Q3,Q4)were associated with greater NAFLD risk compared to the lowest quartile(Q1).ConclusionsThe trajectory of high-level RC is a risk factor for the onset of NAFLD,and the continuous increase of high-level RC value may be an early signal of NAFLD,and timely interventio

关 键 词：健康体检队列 残粒胆固醇 非酒精性脂肪性肝病 组基轨迹模型 

分 类 号：R57[医药卫生—消化系统]