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非酒精性脂肪性肝病患者发病和预后的影响因素分析
Prevalence of nonalcoholic fatty liver disease and its prognostic factors
文章发布日期:2016年02月06日  来源:  作者:倪曼曼,张颖秋,陈岳祥,等  点击次数:1412次  下载次数:343次

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【摘要】:目的探讨非酒精性脂肪性肝病(NAFLD)的患病情况、自然史、死亡原因及相关影响因素。方法选取2011年1月1日-12月31日在上海长征医院和上海85医院进行体检且自2011年起每年在上海长征医院或上海85医院随访的离退休老干部及部分单位职员,最终共纳入833例,2011年12月31日前确诊NAFLD的为NAFLD组(n=459),无肝脏及胆道系统疾病的为对照组(n=374)。收集患者临床资料,包括身高、体质量、收缩压、舒张压及血生化检查,是否有糖尿病、高脂血症、心脑血管疾病、恶性肿瘤等疾病,吸烟及饮酒情况,死亡对象明确其死亡时间和死亡原因。分析该研究人群NAFLD患病情况、自然病程、发病危险因素及预后影响因素。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,采用多因素二元Logistic回归分析NAFLD发病危险因素,多分类Logistic回归分析NAFLD病情加重、减轻的影响因素。结果NAFLD组中男性NAFLD患病比例高于女性(580% vs 46.7%, χ2=4.962,P=0.026)。NAFLD组BMI、收缩压、舒张压、ALT、空腹血糖、血尿酸、甘油三酯(TG)、男性患者、吸烟、高血压病、糖尿病、代谢综合征、新发糖尿病、新发代谢综合征比例均明显高于对照组(P值均<0.05),高密度脂蛋白胆固醇明显低于对照组(t=-9.818,P<0.001)。对照组374例患者中新发NAFLD 64例(17.1%),男性与女性新发率比较差异无统计学意义(18% vs 15%, χ2=0.349,P>0.05); BMI[优势比(OR)=1304,95%可信区间(95%CI):1153~1474,P<0001]和TG(OR=1509,95%CI: 1.080~2.166, P=0.016)是新发NAFLD的独立危险因素。随访终点发现NAFLD组235例(51.2%)病情稳定、40例(87%)改善、144例(31.4%)消退、40例(8.7%)加重。BMI升高患者NAFLD加重风险增加(OR=1.163,95%CI: 1.028~1316, P=0.016);而BMI(OR=0.849, 95%CI: 0.781~0.923,P<0.001)和血尿酸(OR=0997,95%CI:0995~1000,P=0038)水平下降是NAFLD的保护因素。NAFLD组死亡10例(恶性肿瘤5例、心脑血管疾病2例),对照组死亡6例(恶性肿瘤2例,无心脑血管疾病),两组死亡风险差异无统计学意义(P>0.05)。结论体检者中NAFLD预后相对较好,BMI、TG和血尿酸是其预后影响因素。NAFLD主要死因为恶性肿瘤和心脑血管疾病,而不是终末期肝病。
【Abstract】:ObjectiveTo investigate the prevalence, natural history, and causes of death of nonalcoholic fatty liver disease (NAFLD), as well as related influencing factors. MethodsA total of 833 retired cadres and staff members who underwent physical examination in Shanghai Changzheng Hospital and Shanghai 85 Hospital of the PLA from January 1 to December 31, 2011 and received follow-up visits in either hospital every year since 2011 were enrolled as study subjects, and were divided into NAFLD group (459 patients who were diagnosed with NAFLD before December 31, 2011) and control group (374 patients without liver or biliary diseases). The patients′ clinical data were collected, including body height, body weight, systolic pressure, diastolic pressure, blood biochemical parameters, presence or absence of diabetes, hyperlipidemia, cerebrovascular and cardiovascular diseases, and malignant tumor, and smoking and drinking, and the death time and causes of death were clarified for the patients who died. The prevalence and natural course of NAFLD and related risk factors and prognostic factors were analyzed in this population. The t-test was applied for comparison of continuous data between groups, the chi-square test was applied for comparison of categorical data between groups, the multivariate binary logistic regression was applied to analyze the risk factors for the pathogenesis of NAFLD, and the multinomial logistic regression was applied to analyze the influencing factors for aggravation or alleviation of NAFLD. ResultsThe patients in NAFLD group accounted for 55.1% of all subjects, and the proportion of male patients was higher than that of female patients (580% vs 46.7%, χ2=4.962, P=0.026). Compared with the control group, the NAFLD group had significantly higher body mass index (BMI), systolic pressure, diastolic pressure, alanine aminotransferase (ALT), fasting blood glucose, serum uric acid, and triglyceride (TG), a significantly higher proportion of male patients, and significantly higher proportions of patients with hypertension, diabetes, metabolic syndrome, newly-onset diabetes, and newly-onset metabolic syndrome (all P<0.05), as well as a significantly lower high-density lipoprotein cholesterol level (t=-9.818, P<0.001). Of all 374 patients in the control group, 64 (171%) had newly-onset NAFLD, and the incidence rate of newly-onset NAFLD showed no significant difference between male and female patients (18% vs 15%, χ2=0.349, P>0.05); BMI and TG were the independent risk factors for newly-onset NAFLD (OR=1304, 95%CI: 1.153-1.474, P<0.001; OR=1.509, 95%CI: 1.080-2.166, P=0.016). At the end of follow-up in NAFLD group, 235 patients (51.2%) achieved a stable disease, 40 (8.7%) achieved improvement, 144 (31.4%) achieved remission, and 40 (8.7%) experienced aggravation. The increase in BMI increased the risk of aggravation of NAFLD (OR=1.163, 95%CI: 1.028-1.316, P=0.016), while reductions in BMI and serum uric acid were the protective factors against NAFLD (OR=0.849, 95%CI: 0.781-0923, P<0.001; OR=0.997, 95%CI: 0.995-1.000, P=0.038). Ten patients in NAFLD group died (including 5 patients with malignant tumor and 2 patients with cerebrovascular and cardiovascular diseases), and 6 patients in the control group died (including 2 patients with malignant tumor, no patients with cerebrovascular and cardiovascular diseases), and the risk of death showed no significant difference between the two groups (P>0.05). ConclusionThe prognosis of NAFLD is relatively good in people who underwent physical examination, and BMI, TG, and serum uric acid are the factors affecting the prognosis of such patients. The major causes of death in NAFLD patients are malignant tumor and cerebrovascular and cardiovascular diseases, rather than end-stage liver disease.
【关键字】:脂肪肝;预后;危险因素
【Key words】:fatty liver; prognosis; risk factors
【引证本文】:倪曼曼, 张颖秋, 陈岳祥, 等. 非酒精性脂肪性肝病患者发病和预后的影响因素分析[J]. 临床肝胆病杂志, 2016, 32(3): 453-458.

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