基于社区老年人群比较代谢相关脂肪性肝病与非酒精性脂肪性肝病的人群差异

张爽; 刘晓慧; 王罡; 张丽; 朱云杰; 吴剑; 柳雅立; 张晶

doi:10.3969/j.issn.1001-5256.2022.03.011

基于社区老年人群比较代谢相关脂肪性肝病与非酒精性脂肪性肝病的人群差异

DOI: 10.3969/j.issn.1001-5256.2022.03.011

张爽¹,
刘晓慧¹,
王罡²,
张丽²,
朱云杰³,
吴剑³,
柳雅立^1, , ,,
张晶^1, , ,

1.
首都医科大学附属北京佑安医院脂肪性肝病诊疗中心，北京 100069
2.
北京京煤集团总医院门矿医院全科医学科，北京 102399
3.
首都体育学院运动科学与健康学院，北京 100191

基金项目:

北京慢性病防治与健康教育研究会科研项目 (BJMB0012021025002)

伦理学声明：本研究方案于2020年11月9日经由首都医科大学附属北京佑安医院伦理委员会批准，批号：京佑科伦字[2020]133号。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：张爽、刘晓慧负责课题设计，资料分析，论文撰写；王罡、张丽、朱云杰、吴剑参与收集数据，修改论文；柳雅立、张晶负责拟定写作思路，指导撰写文章及最后定稿。

详细信息

通信作者:
柳雅立，ericliudoc@ccmu.edu.cn

张晶，zjyouan@ccmu.edu.cn

计量
- 文章访问数: 444
- HTML全文浏览量: 100
- PDF下载量: 79
- 被引次数: 0
出版历程
- 收稿日期: 2021-08-03
- 录用日期: 2021-09-09
- 出版日期: 2022-03-20

Population differences of metabolic associated fatty liver disease and nonalcoholic fatty liver disease based on a community elderly population

Shuang ZHANG¹,
Xiaohui LIU¹,
Gang WANG²,
Li ZHANG²,
Yunjie ZHU³,
Jian WU³,
Yali LIU^{1
, ,
,},
Jing ZHANG^{1
, ,
,}

1.
The Third Unit, Department of Hepatology, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
2.
Department of General Practice, Menkuang Hospital, Beijing Jingmei Group General Hospital, Beijing 102399, China
3.
School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing 100191, China

Research funding:

Research Project of Beijing Research Association for Chronic Diseases Control and Health Education (BJMB0012021025002)

More Information

Corresponding author: LIU Yali, ericliudoc@ccmu.edu.cn(ORCID:0000-0002-1249-6010); ZHANG Jing, zjyouan@ccmu.edu.cn(ORCID:0000-0002-3082-8330)

摘要

摘要: 目的本研究拟比较新命名“代谢相关脂肪性肝病”(MAFLD)与旧命名“非酒精性脂肪性肝病”(NAFLD)的人群差异。方法选择2020年11月—2021年1月在北京某社区体检的65岁以上老年人群共624例进行横断面调查，收集人口学、既往史、实验室指标以及肝脏超声和弹性等指标。按照超声诊断有无脂肪肝分为2组：脂肪肝组389例，非脂肪肝组235例。正态分布的计量资料两组间比较采用独立样本t检验，非正态分布的计量资料两组间比较采用Mann-Whitney U秩和检验，计数资料两组间比较采用χ²检验。结果 389例脂肪肝患者中，387例(99.5%)符合MAFLD诊断；368例(94.6%)符合NAFLD诊断；合并大量饮酒史19例，表面抗原阳性2例。同时符合MAFLD和NAFLD诊断的患者366例，分别占MAFLD和NAFLD患者的94.6%和99.5%。与非脂肪肝组相比，MAFLD组的BMI(t=-11.228)、腰围(Z=-8.532)、臀围(Z=-6.449)、腰臀比(Z=-5.708)、ALT(Z=-5.027)、AST(Z=-2.880)、PLT(t=-3.623)、TG(Z=-8.489)、空腹血糖(Z=-3.516)、HbA1c(Z=-2.884)、稳态模型计算胰岛素抵抗指数(Z=-0.394)、超敏C反应蛋白(Z=-4.912)、控制衰减参数(t=13.744)、肝硬度值(Z=-7.69)均增加，差异均有统计学意义(P值均＜0.05)，而HDL- C(t=6.348，P＜0.001)水平下降。同时，MAFLD患者合并更多的代谢相关疾病，如超重、肥胖、中心性肥胖、血脂异常、高血压(χ²值分别为9.978、65.472、36.571、9.797、5.128，P值均＜0.05)。在MAFLD组中，30.7%的患者为非肥胖脂肪肝(BMI ≥25 kg/m²)，11.1%为瘦人脂肪肝(BMI＜23 kg/m²)；与肥胖MAFLD患者相比，非肥胖MAFLD患者年龄(Z=-3.042)、BMI(Z=-15.705)、腰围(Z=-9.589)、臀围(Z=-10.275)、稳态模型计算胰岛素抵抗指数(Z=-2.081)、控制衰减参数(t=-3.468)、肝硬度值(Z=-3.630)、NFS(t=-4.433)更低(P值均＜0.05)。根据肝硬度值进行判断，进展期肝纤维化占MAFLD人群的3.6%，不能排除进展期肝纤维化占10%。结论在老年人群中，MAFLD的诊断基本能够覆盖NAFLD人群，在类似人群中基本可以直接替代NAFLD的概念。但是在其他人群中的应用尚有待进一步研究。
- 代谢相关脂肪性肝病 /
- 非酒精性脂肪性肝病 /
- 医院, 社区 /
- 横断面研究
Abstract: Objective To investigate the population differences of the newly named "metabolic associated fatty liver disease" (MAFLD) and the former name "nonalcoholic fatty liver disease" (NAFLD). Methods From November 2020 to January 2021, a cross-sectional survey was conducted among 624 elderly individuals aged above 65 years in a community in Beijing, China, and related data were collected, including demographic data, past history, laboratory markers, liver ultrasound, and liver elasticity. According to the presence or absence of fatty liver based on ultrasonic diagnosis, the individuals were divided into fatty liver group with 389 individuals and non-fatty liver group with 235 individuals. The independent samples t-test was used for comparison of normally distributed continuous data between the two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between the two groups; the chi-square test was used for comparison of categorical data between the two groups. Results Among the 389 patients with fatty liver, 387(99.5%) were diagnosed with MAFLD and 368(94.6%) were diagnosed with NAFLD, and there were 19 patients with a history of heavy alcohol consumption and 2 with positive surface antigen. A total of 366 patients met the diagnostic criteria for both MAFLD and NAFLD, accounting for 94.6% of the MAFLD patients and 99.5% of the NAFLD patients. Compared with the non-fatty liver group, the MAFLD group had significant increases in body mass index (BMI) (t=-11.228, P < 0.05), waist circumference (Z=-8.532, P < 0.05), hip circumference (Z=-6.449, P < 0.05), waist-hip ratio (Z=-5.708, P < 0.05), alanine aminotransferase (Z=-5.027, P < 0.05), aspartate aminotransferase (Z=-2.880, P < 0.05), platelet count (t=-3.623, P < 0.05), triglyceride (Z=-8.489, P < 0.05), fasting blood glucose (Z=-3.516, P < 0.05), HbA1c (Z=-2.884, P < 0.05), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (Z=-0.394, P < 0.05), high-sensitivity C-reactive protein (Z=-4.912, P < 0.05), controlled attenuation parameter (CAP) (t=13.744, P < 0.05), and liver stiffness measurement (LSM) (Z=-7.69, P < 0.05), as well as a significant reduction in high-density lipoprotein cholesterol (HDL-C) (t=6.348, P < 0.001). Meanwhile, MAFLD patients had more metabolic associated diseases, such as overweight, obesity, central obesity, dyslipidemia, and hypertension (χ²=9.978, 65.472, 36.571, 9.797, and 5.128, all P < 0.05). In the MAFLD group, 30.7% of the patients had non-obese fatty liver disease (BMI < 25 kg/m²), and 11.1% had lean fatty liver disease (BMI < 23 kg/m²); compared with the obese MAFLD patients, the non-obese MAFLD patients had significantly lower age (Z=-3.042, P < 0.05), BMI (Z=-15.705, P < 0.05), waist circumference (Z=-9.589, P < 0.05), hip circumference (Z=-10.275, P < 0.05), HOMA-IR (Z=-2.081, P < 0.05), CAP (t=-3.468, P < 0.05), LSM (Z=-3.630, P < 0.05), and NAFLD fibrosis score (t=-4.433, P < 0.05). According to LSM value, advanced liver fibrosis accounted for 3.6% of the MAFLD population, and 10% of the MAFLD population could not be excluded for advanced liver fibrosis. Conclusion The diagnosis of MAFLD can basically cover the NAFLD population in the elderly people, and it is supposed that MAFLD can almost directly replace the concept of NAFLD in similar populations. However, further studies are needed to investigate its application in other populations.
- Metabolic Associated Fatty Liver Disease /
- Non-alcoholic Fatty Liver Disease /
- Hospitals, Community /
- Cross-Sectional Studies

HTML全文

图 1 患者筛选流程图

下载: 全尺寸图片幻灯片

表 1 MAFLD和非脂肪肝的临床特征比较

指标	MAFLD组(n=387)	非脂肪肝组(n=235)	统计值	P值
年龄(岁)	68.0(66.0~72.0)	69.0(67.0~74.0)	Z=-2.474	0.030
男性[例(%)]	135(34.9)	102(43.4)	χ²=4.501	0.034
BMI(kg/m²)	26.6±3.0	24.1±2.5	t=-11.228	＜0.001
腰围(cm)	90.0(86.3~97.0)	86.0(81.0~90.0)	Z=-8.532	＜0.001
臀围(cm)	100.0(95.0~105.0)	96.0(92.0~100.0)	Z=-6.449	＜0.001
腰臀比	0.91(0.89~0.94)	0.89(0.87~0.92)	Z=-5.708	＜0.001
ALT(U/L)	21.0(16.0~28.0)	18.0(14.0~23.0)	Z=-5.027	＜0.001
AST(U/L)	19.0(16.0~23.8)	18.0(14.0~21.0)	Z=-2.880	0.004
TBil(μmol/L)	15.0(11.4~18.6)	14.5(11.4~18.3)	Z=-1.452	0.147
SCr(μmol/L)	64.0(54.0~75.0)	65.0(54.0~75.0)	Z=-0.233	0.816
BUN(mmol/L)	5.3(4.4~6.7)	5.3(4.4~6.7)	Z=-0.207	0.836
PLT(×10⁹/L)	232.5±55.9	215.6±56.4	t=-3.623	＜0.001
TG(mmol/L)	1.6(1.2~2.2)	1.2(0.9~1.6)	Z=-8.489	＜0.001
TC(mmol/L)	4.8(4.1~5.7)	4.7(4.0~5.6)	Z=-0.920	0.358
HDL-C(mmol/L)	1.2±0.2	1.3±0.3	t=6.348	＜0.001
LDL-C(mmol/L)	3.4(2.7~4.1)	4.2(2.5~3.9)	Z=-1.418	0.156
FBG(mmol/L)	6.4(5.8~7.7)	6.1(5.5~7.2)	Z=-3.516	＜0.001
HbA1c(%)	6.2(5.8~6.9)	5.9(5.6~6.6)	Z=-2.884	0.004
HOMA-IR	3.3(2.2~5.1)	2.0(1.4~3.5)	Z=-0.394	＜0.001
hs-CRP(mg/L)	1.6(0.9~3.1)	1.0(0.5~1.8)	Z=-4.912	＜0.001
CAP¹⁾(dB/m)	294.9±44.5	238.1±45.1	t=13.744	＜0.001
LSM¹⁾(kPa)	5.4(4.3~6.7)	4.1(3.5~5.3)	Z=-7.690	＜0.001
注：1)因肝弹性检测有一定的失败率，在MAFLD组中，有CAP和LSM结果的为318例；在非脂肪肝组中，有CAP和LSM结果的为185例。

下载: 导出CSV

表 2 MAFLD患者合并代谢相关疾病情况

组别	MAFLD组(n=387)	非脂肪肝组(n=235)	χ²值	P值
超重[例(%)]	76(19.6)	72(30.6)	9.978	0.002
肥胖[例(%)]	268(69.3)	84(35.7)	65.472	＜0.001
中心性肥胖[例(%)]	324(83.7)	145(61.7)	36.571	＜0.001
糖尿病[例(%)]	157(40.6)	89(37.9)	0.380	0.538
血脂异常[例(%)]	282(72.9)	142(60.4)	9.797	0.002
高血压[例(%)]	288(74.4)	154(65.5)	5.128	0.024
冠心病[例(%)]	113(29.2)	67(28.5)	0.021	0.886
脑卒中[例(%)]	50(12.9)	33(14.0)	0.180	0.672
肾功能不全[例(%)]	10(2.6)	4(1.7)	0.513	0.474

下载: 导出CSV

表 3 肥胖和非肥胖MAFLD比较

指标	非肥胖MAFLD组(n=119)	肥胖MAFLD组(n=268)	统计值	P值
年龄(岁)	67.0(66.0~71.0)	69.0(67.0~73.0)	Z=-3.042	0.002
男性[例(%)]	44(37.0)	91(34.0)	χ²=0.331	0.565
BMI(kg/m²)	23.9(22.6~24.5)	27.6(26.2~29.3)	Z=-15.705	＜0.001
腰围(cm)	87.0(82.0~90.0)	93.0(89.0~98.0)	Z=-9.589	＜0.001
臀围(cm)	95.0(90.0~98.0)	102.0(98.0~106.0)	Z=-10.275	＜0.001
腰臀比	0.91(0.88~0.93)	0.91(0.89~0.94)	Z=-1.535	0.125
ALT(U/L)	21.0(16.0~28.0)	21.0(16.0~28.0)	Z=-0.603	0.547
AST(U/L)	18.0(14.0~23.0)	19.0(16.0~24.0)	Z=-1.835	0.067
TBil(μmol/l)	15.6(11.2~18.5)	14.8(11.5~18.7)	Z=-0.082	0.934
SCr(μmol/L)	66.5±19.5	66.4±17.2	t=0.077	0.938
BUN(mmol/L)	5.1(4.3~6.8)	5.4(4.4~6.7)	Z=-0.552	0.581
PLT(×10⁹/L)	231.9±50.5	233.0±58.3	t=-0.174	0.862
TG(mmol/L)	1.6(1.2~2.3)	1.7(1.2~2.1)	Z=-0.269	0.788
TC(mmol/L)	4.9(4.0~5.7)	4.8(4.2~5.5)	Z=-0.126	0.900
HDL-C(mmol/L)	1.2±0.3	1.1±0.2	t=1.255	0.210
LDL-C(mmol/L)	3.4(2.7~4.0)	3.4(2.7~4.1)	Z=-0.161	0.872
FBG(mmol/L)	6.3(5.6~7.8)	6.5(5.8~7.7)	Z=-1.106	0.269
HbA1c(%)	6.1(5.7~6.5)	6.2(5.8~6.9)	Z=-1.310	0.190
HOMA-IR	3.1(1.9~4.2)	3.5(2.2~6.3)	Z=-2.081	0.037
Hs-CRP(mg/L)	1.5(0.6~2.5)	1.8(1.0~3.2)	Z=-1.781	0.075
CAP¹⁾(dB/m)	281.9±51.7	301.8±38.4	t=-3.468	0.001
LSM¹⁾(kPa)	4.8(4.2~5.8)	5.7(4.7~7.1)	Z=-3.630	＜0.001
FIB-4	1.27(1.01~1.50)	1.33(1.04~1.68)	Z=-1.710	0.087
NFS	-1.35±0.85	-0.76±1.08	t=-4.433	＜0.001
注：1)在非肥胖MAFLD组中，有CAP和LSM结果的为102例；在肥胖MAFLD组中，有CAP和LSM结果的为216例。

下载: 导出CSV

表 4 MAFLD肝纤维化分布

评分标准	排除F3	不能排除F3	≥F3	F4
LSM¹⁾[例(%)]	274(86.1)	32(10.0)	11(3.6)	1(0.3)
FIB-4²⁾[例(%)]	283(89.0)	30(9.4)	5(1.6)
NFS³⁾[例(%)]	261(82.2)	38(11.9)	19(5.9)
注：1)LSM＜8.0排除F3；8.0≤LSM＜11不能排除F3，需行肝穿刺活检评估肝纤维化状态；11≤LSM＜15诊断F3；LSM≥15诊断F4；2)FIB-4＜2.0排除F3；2.0≤FIB-4≤3.25不能排除F3；FIB-4＞3.25诊断F3；3)NFS＜0.12排除F3；0.12≤NFS≤0.675不能排除F3；NFS＞0.675诊断F3。

下载: 导出CSV

参考文献(10)

[1]	ESLAM M, SANYAL AJ, GEORGE J. MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease[J]. Gastroenterology, 2020, 158(7): 1999-2014. e1. DOI: 10.1053/j.gastro.2019.11.312.
[2]	LIN S, HUANG J, WANG M, et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world[J]. Liver Int, 2020, 40(9): 2082-2089. DOI: 10.1111/liv.14548.
[3]	ESLAM M, NEWSOME PN, SARIN SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73(1): 202-209. DOI: 10.1016/j.jhep.2020.03.039.
[4]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Consensus on the diagnosis and therapy of hepatic fibrosis(2019)[J]. J Clin Hepatol, 2019, 35(10): 2163-2172. DOI: 10.3969/j.issn.1001-5256.2019.10.007. 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 肝纤维化诊断及治疗共识(2019年)[J]. 临床肝胆病杂志, 2019, 35(10): 2163-2172. DOI: 10.3969/j.issn.1001-5256.2019.10.007.
[5]	NEWSOME PN, CRAMB R, DAVISON SM, et al. Guidelines on the management of abnormal liver blood tests[J]. Gut, 2018, 67(1): 6-19. DOI: 10.1136/gutjnl-2017-314924.
[6]	NAN Y, AN J, BAO J, et al. The Chinese Society of Hepatology position statement on the redefinition of fatty liver disease[J]. J Hepatol, 2021, 75(2): 454-461. DOI: 10.1016/j.jhep.2021.05.003.
[7]	WONG VW, WONG GL, WOO J, et al. Impact of the new definition of metabolic associated fatty liver disease on the epidemiology of the disease[J]. Clin Gastroenterol Hepatol, 2021, 19(10): 2161-2171. e5. DOI: 10.1016/j.cgh.2020.10.046.
[8]	YAMAMURA S, ESLAM M, KAWAGUCHI T, et al. MAFLD identifies patients with significant hepatic fibrosis better than NAFLD[J]. Liver Int, 2020, 40(12): 3018-3030. DOI: 10.1111/liv.14675.
[9]	YE Q, ZOU B, YEO YH, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: A systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2020, 5(8): 739-752. DOI: 10.1016/S2468-1253(20)30077-7.
[10]	LI YY, XIE ZY. Advances in the etiology and treatment of non-obese nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2021, 37(2): 452-457. DOI: 10.3969/j.issn.1001-5256.2021.02.043. 李洋洋, 谢正元. 非肥胖型非酒精性脂肪性肝病的病因及治疗进展[J]. 临床肝胆病杂志, 2021, 37(2): 452-457. DOI: 10.3969/j.issn.1001-5256.2021.02.043.