乌鲁木齐市某区全民体检人群代谢综合征组分聚集性与非酒精性脂肪肝关系

古丽斯亚·海力力; 姚华; 王淑霞; 王育珊; 刘涛; 陈珍; 罗涛; 戴江红

doi:10.16462/j.cnki.zhjbkz.2019.11.012

乌鲁木齐市某区全民体检人群代谢综合征组分聚集性与非酒精性脂肪肝关系

doi: 10.16462/j.cnki.zhjbkz.2019.11.012

1.
830011 乌鲁木齐, 新疆医科大学公共卫生学院
2.
830000 乌鲁木齐, 新疆医科大学第一附属医院健康管理中心

基金项目:

国家重点研发计划项目：新疆多民族自然人群队列建设及健康随访研究 2017YFC0907203

新疆维吾尔自治区自然科学基金项目 2017D01C425

详细信息

通讯作者:
戴江红, E-mail: epi102@sina.com

中图分类号: R181
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出版历程
- 收稿日期: 2019-07-07
- 修回日期: 2019-10-05
- 刊出日期: 2019-11-10

Correlation between metabolic syndrome component aggregation and nonalcoholic fatty liver disease in a certain district of Urumqi's check-up population

1.
School of Public Health, Xinjiang Medical University, 830011, Urumqi, China
2.
Health Management Center, the First Affiliated Hospital of Xinjiang Medical University, 830000, Urumqi, China

Funds:

National key research and development plan project: Xinjiang multi-ethnic cohort study 2017YFC0907203

Xinjiang Uygur autonomous region natural science foundation project 2017D01C425

More Information

Corresponding author: DAI Jiang-hong, E-mail: epi102@sina.com

摘要

摘要: 目的通过代谢综合症评分（metabolic syndrome score，MSS）反映代谢综合症（metabolic syndrome，MetS）组分聚集性，探讨乌鲁木齐市（乌市）MetS、MSS与非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）关系。方法通过腹部B超分无NAFLD和NAFLD组，分析两组人群体格、血生化检查结果，计算MSS，采用Log-binomial回归分析模型分析MSS不同聚集性与NAFLD的关系。结果共纳入研究对象20 569例，MetS检出率为16.7，NAFLD检出率为32.4%，与NAFLD组比较，NAFLD组收缩压、舒张压、体质指数（body mass index，BMI）、腰围、空腹血糖、甘油三酯、胆固醇、低密度脂蛋白胆固醇均升高，差异均有统计学意义（P < 0.05）；调整性别、年龄、民族、文化程度后，Log-binomial回归分析模型结果显示，高BMI、高血压、高血糖、高甘油三酯和低高密度脂蛋白是NAFLD主要危险因素（PR值分别为3.194、1.331、1.623、1.981、1.254）；NAFLD的风险随MSS增加而增加，MSS0、MSS1、MSS2、MSS3和MSS4的PR值分别为3.127、4.983、6.437、7.331。结论 NAFLD的形成不是单一的肝脏脂肪堆积，而合并有血脂、血压、血糖等异常。男性MetS和NAFLD检出率高于女性，但两个代谢指标异常的女性更有可能发展成为NAFLD。BMI作为肥胖指标与NAFLD关系最强，NAFLD防治应重点关注肥胖人群。
- 代谢综合症 /
- 代谢综合症评分 /
- 非酒精性脂肪肝
Abstract: Objective The relationship between metabolic syndrome(MetS), metabolic syndrome score (MSS) and non-alcoholic fatty liver disease(NAFLD) in Urumqi was investigated by the MSS, reflecting the aggregation of MetS components. Methods The subjects were divided into non-NAFLD and NAFLD group by abdominal B ultrasound. The results of physical examination and blood biochemical examination were analyzed. The MSS was calculated and the relationship between the different aggregation of MSS and NAFLD was analyzed by Log-binomial regression. Results A total of 20 569 subjects were included in the study. The detection rate of MetS was 16.7%, the detection rate of NAFLD was 32.4%. Compared with non-NAFLD group, the systolic blood pressure, diastolic blood pressure, body mass index (BMI), waist circumference, fasting plasma glucose, triglyceride, total cholesterol, and low-density lipoprotein cholesterol were all increased in the NAFLD group, and the difference was statistically significant (P < 0.05). After adjusting for gender, age, ethnicity and education level, Log-binomial regression analysis showed high BMI, hypertension and hyperglycemia. High triglycerides and low-density lipoproteins are the main risk factors for NAFLD (PR values were 3.194, 1.331, 1.623, 1.981, 1.254, respectively); the risk of NAFLD increased corresondingly when MSS, MSS0, MSS1, MSS2, MSS3, and MSS4 increased. The PR were 3.127, 4.983, 6.437, and 7.331, respectively. Conclusions The formation of NAFLD is not a single accumulation of liver fat, combined with abnormalities such as blood lipids, blood pressure, and blood sugar. The detection rate of male MetS and NAFLD was higher than that of female, but women with two abnormal metabolic indicators were more likely to develop into NAFLD. BMI as the obesity index has the strongest relationship with NAFLD, and NAFLD prevention should focus on obese people.
- Metabolic syndrome /
- Metabolic syndrome score /
- Nonalcoholic fatty liver disease

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图 1 男、女不同代谢综合症评分NAFLD检出率变化趋势

Figure 1. Trends in the detection rate of the NAFLD in different metabolic syndrome scores among male and female

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表 1 NAFLD组与无NAFLD组一般特征[例(比例)]

Table 1. General characteristics of the NAFLD and non-NAFLD group[n(%)]

变量	总计 (n=20 569)	NAFLD组 (n=6 664)	无NAFLD组 (n=13 905)	P值
性别				< 0.001
男	7 228(35.1)	2 518(34.8)	4 710(65.2)
女	13 341(64.9)	4 146(31.1)	9 195(68.9)
年龄(岁)				< 0.001
＜45	6 099(29.7)	1 441(23.6)	4 658(76.4)
45~	6 472(31.5)	2 230(34.5)	4 242(65.5)
55~	4 769(23.2)	1 854(39.9)	2 915(61.1)
≥65	3 229(15.7)	1 139(35.3)	2 090(64.7)
民族				< 0.001
汉族	12 376(60.2)	3 822(30.9)	8 554(69.1)
维吾尔族	6 120(29.8)	2 129(34.8)	3 991(65.2)
回族	1 436(7.0)	503(35.0)	933(65.0)
其他	637(2.9)	210(33.0)	427(67.0)
文化程度				< 0.001
大学及以上	3 997(19.4)	1 103(27.6)	2 894(72.4)
高中/技校/中专	5 038(24.5)	1 662(33.0)	3 376(67.0)
初中	5 671(27.6)	1 897(33.5)	3 774(66.5)
小学	3 783(18.4)	1 260(33.3)	2 523(66.7)
文盲/半文盲	784(3.8)	260(33.2)	524(66.7)
不详	1 296(6.3)	482(37.2)	814(62.8)
SBP(mmHg)	125.6±19.2	130.5±19.4	123.2±18.7	< 0.001
DBP(mmHg)	76.9±11.3	79.6±11.5	75.6±10.9	< 0.001
BMI(kg/m²)	25.6±3.8	27.85±3.7	24.5±3.4	< 0.001
腰围(cm)	88.4±22.0	94.9±25.5	85.3±19.3	< 0.001
FPG(mmol/L)	5.5±1.7	5.82±1.9	5.3±1.4	< 0.001
TC(mmol/L)	5.0±3.7	5.28±5.3	4.88±2.5	< 0.001
TG(mmol/L)	1.7±3.6	2.1±3.4	1.55±3.6	< 0.001
HDL-C(mmol/L)	1.6±3.1	1.51±3.645	1.57±2.870	0.159
LDL-C(mmol/L)	3.1±3.6	3.14±2.445	3.02±3.995	0.022
MetS				< 0.001
MSS＜3	17 132(83.3)	4 603(26.9)	12 529(73.1)
MSS≥3	3 437(16.7)	2 061(60.0)	1 376(40.0)

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表 2 不同MSS与NAFLD关系

Table 2. Relationship between different MSS and NAFLD

MSS	NAFLD (%)	非NAFLD (%)	β	s_x^-	Wald χ²值	PR (95% CI) 值	P值
MSS0	499(9.1)	5 010(90.9)	-	-	-	1.000	-
MSS1	1 879(28.2)	4 782(71.8)	1.140	0.047	585.08	3.127(2.854~3.434)	< 0.001
MSS2	2 225(44.8)	2 737(55.2)	1.606	0.046	1 217.42	4.983(4.558~5.460)	< 0.001
MSS3	1 490(57.9)	1 082(42.1)	1.862	0.047	1 591.28	6.437(5.880~7.062)	< 0.001
MSS4	571(66.0)	294(34.0)	1.992	0.050	1 585.30	7.331(6.650~8.092)	< 0.001

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表 3 MetS组分不同聚集组合与NAFLD关系

Table 3. Relationship between different aggregation components of MetS components and NAFLD

MSS	β	s_x^-	Wald χ²值	P值	PR (95% CI) 值
MSS 0					1.000
MSS 1
高BMI	1.404	0.048	844.99	< 0.001	4.071(3.707~4.480)
高BP	0.420	0.098	18.25	< 0.001	1.521(1.248~1.835)
高FPG	0.777	0.107	52.98	< 0.001	2.175(1.751~2.662)
高TG	1.065	0.063	287.38	< 0.001	2.902(2.564~3.281)
低HDL-C	-0.422	0.174	5.87	0.015	0.656(0.457~0.906)
MSS 2
BMI+BP	1.574	0.056	803.94	< 0.001	4.824(4.327~5.379)
BMI+FPG	1.754	0.060	856.23	< 0.001	5.778(5.132~6.493)
BMI+TG	1.789	0.048	1 383.20	< 0.001	5.981(5.448~6.578)
BMI+HDL-C	1.487	0.078	366.93	< 0.001	4.425(3.785~5.133)
BP+FPG	0.452	0.202	5.02	0.025	1.571(1.023~2.265)
BP+TG	1.057	0.096	120.45	< 0.001	2.878(2.367~3.456)
BP+HDL-C	0.643	0.290	4.92	0.027	1.902(0.994~3.137)
FPG+TG	1.483	0.084	309.24	< 0.001	4.406(3.713~5.171)
FPG+HDL-C	0.171	0.547	0.10	0.755	1.186(0.307~2.834)
TG+HDL-C	1.247	0.111	127.02	< 0.001	3.480(2.771~4.280)
MSS 3
BMI+BP+FPG	1.715	0.069	622.01	< 0.001	5.554(4.840~6.339)
BMI+BP+TG	1.888	0.053	1 285.50	< 0.001	6.609(5.962~7.330)
BMI+BP+HDL-C	1.500	0.127	140.43	< 0.001	4.482(3.428~5.642)
BMI+FPG+HDL-C	1.959	0.097	412.33	< 0.001	7.091(5.756~8.427)
BMI+TG+HDL-C	1.892	0.057	1 087.33	< 0.001	6.635(5.923~7.419)
BP+FPG+TG	1.750	0.094	343.66	< 0.001	5.737(4.712~6.828)
BP+FPG+HDL-C	0.176	0.944	0.03	0.852	1.193(0.072~4.368)
FPG+TG+HDL-C	1.591	0.151	110.33	< 0.001	4.906(3.521~6.401)
BMI+FPG+TG	1.982	0.053	1 408.55	< 0.001	7.256(6.542~8.047)
BP+TG+HDL-C	0.842	0.270	9.70	0.002	2.321(1.268~3.701)
MSS 4
BMI+BP+FPG+TG	1.961	0.057	1 176.18	< 0.001	7.105(6.344~7.941)
BMI+BP+FPG+HDL-C	2.105	0.107	384.92	< 0.001	8.207(6.342~9.767)
BMI+FPG+TG+HDL-C	2.000	0.074	731.74	< 0.001	7.366(6.322~8.456)
BMI+BP+TG+HDL-C	1.954	0.071	758.37	< 0.001	7.055(6.105~8.070)
BP+FPG+TG+HDL-C	1.679	0.217	59.97	< 0.001	5.359(3.199~7.589)
BMI+BP+FPG+TG+HDL-C	2.043	0.075	749.24	< 0.001	7.715(6.597~8.858)

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表 4 MetS组分与NAFLD关系[n(%)]

Table 4. Relationship between the MetS and NAFLD in the total study population [n(%)]

变量	NAFLD	PR (95% CI) 值	P值
BMI
正常	1 502(22.5)	1.000
异常	5 162(77.5)	3.194(3.035~3.364)	< 0.001
BP
正常	4 693(70.4)	1.000
异常	1 971(29.6)	1.331(1.273~1.391)	< 0.001
FPG
正常	5 025	(75.4)1.000
异常	1 639(24.6)	1.632(1.555~1.694)	< 0.001
TG
正常	3 265(49.0)	1.000
异常	3 399(51.0)	1.981(1.905~2.059)	< 0.001
HDL-C
正常	5 676(85.2)	1.000
异常	988(14.8)	1.254(1.189~1.321)	< 0.001
注：正常BMI：BMI < 25.0 kg/m²，正常BP：SBP/DBP < 140/90 mmHg，正常FPG：FPG < 6.1 mmol/L，正常TG：TG < 1.7 mmol/L，正常HDL-C：HDL-C≥0.9 mmol/L(男)或≥1.0 mmol/L(女)。

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参考文献(12)

[1]	Abd El-Kader SM, El-Den Ashmawy EM. Non-alcoholic fatty liver disease: the diagnosis and management[J]. World J Hepatol, 2015, 7(6): 846. DOI: 10.4254/wjh.v7.i6.846.
[2]	孙蓉, 盛国滨, 高琛. 非酒精性脂肪肝的健康管理效果评价. 黑龙江医学, 2012, 36(9): 694-695. DOI: 10.3969/j.issn.1004-5775.2012.09.026. Sun R, Sheng GB, Gao C. Evaluation of health management effects of nonalcoholic fatty liver[J]. Heilongjiang Medicine, 2012, 36(9): 694-695. DOI: 10.3969/j.issn.1004-5775.2012.09.026.
[3]	中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 实用肝脏病杂志, 2018, 21(2): 177-186. DOI: 10.3969/j.issn.1672-5069.2018.02.007. Department of Fatty Liver and Alcoholic Liver Diseases, Chinese Medical Association, Department of Fatty Liver Diseases, Chinese Medical Association. Guidelines for prevention and treatment of nonalcoholic fatty liver diseases (updated 2018)[J]. Journal of Practical Hepatology, 2018, 21(2): 177-186. DOI: 10.3969/j.issn.1672-5069.2018.02.007.
[4]	Zhang Y, Zhang T, Zhang C, et al. Identification of reciprocal causality between non-alcoholic fatty liver disease and metabolic syndrome by a simplified Bayesian network in a Chinese population[J]. BMJ Open, 2015, 5(9): e008204. DOI: 10.1136/bmjopen-2015-008204.
[5]	产松苗, 欧希龙, 孙为豪, 等. 南京市梅山社区脂肪肝患病率及其危险因素回顾[J]. 世界华人消化杂志, 2016, 24(3): 420-425. DOI: 10.11569/wcjd.v24.i3.420. Chan SM, Ou XL, Sun WH, et al. Review of prevalence and risk factors of fatty liver in Meishan community of Nanjing[J]. World Chinese Journal of Digestion, 2016, 24(3): 420-425. DOI: 10.11569/wcjd.v24.i3.420.
[6]	Yoon H, Bae NY, Gi MY, et al. The association between serum ferritin and 25-hydroxy -vitamin D and metabolic syndrome in Korean women: the Korea National Health and Nutrition Examination Survey 2010-2012[J]. J Clin BiochemNutr, 2017, 61: 60-66. DOI: 10.3164/jcbn.16-115.
[7]	程桦. 代谢综合征[M]//陆再英. 内科学. 第7版. 北京: 人民卫生出版社, 2008: 811-813. Cheng H. Metabolic Syndrome[M]//Lu ZY. Internal medicine. 7th ed. Beijing: People's Medical Publishing House, 2008: 811-813.
[8]	张薇, 魏来. 非酒精性脂肪性肝病在亚洲的流行情况[J]. 中华肝脏病杂志, 2013, 21(11): 801-804. DOI: 10.3760/cma.j.issn.1007-3418.2013.11.001. Zhang W, Wei L. Prevalence of nonalcoholic fatty liver disease in Asia[J]. Chinese Journal of Hepatology, 2013, 21(11): 801-804. DOI: 10.3760/cma.j.issn.1007-3418.2013.11.001.
[9]	谢阳. B型超声在脂肪肝诊断中的应用价值[J]. 中国药物经济学, 2015, 9(8): 179-180. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYWA201508097.htm Xie Y. The value of B-mode ultrasound in the diagnosis of fatty liver[J]. Chinese Journal of Pharmaceutical Economics, 2015, 9(8): 179-180. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYWA201508097.htm
[10]	王吴. 基因遗传变异与代谢综合征的关联研究[D]. 杭州: 浙江大学, 2015. Wang W. Association study between genetic variation and metabolic syndrome[D]. Hangzhou: Zhejiang University, 2015.
[11]	Lu ZY, Shao Z, Li YL, et al. Prevalence of and risk factors for non-alcoholic fatty liver disease in a Chinese population: an 8-year follow-up study[J]. World J Gastroenterol, 2016, 22(13): 3663-3669. DOI: 10.3748/wjg.v22.i13.3663.
[12]	Bashu D, Shreena S, Anjeela B, et al. Metabolic syndrome and biochemical changes among non-alcoholic fatty liver disease patients attending a tertiary care hospital of Nepal[J]. BMC Gastroenterology, 2018, 18: 109-117. DOI: 10.1186/s12876-018-0843-6.