Analysis of liver dysfunction and its influencing factors in middle-aged and elderly people in Hainan Province
-
摘要:
目的 了解海南省中老年人的肝功能异常检出情况，并探讨相关影响因素。 方法 利用2020年“海南自然人群慢性病前瞻性队列研究”中的基线调查数据，选取海南省35~＜75岁的常住居民共5 826人作为研究对象，采用问卷调查和血生化检测中的肝功能指标：丙氨酸氨基转移酶(alanine aminotransferase, ALT)，天冬氨酸氨基转移酶(aspartate aminotransferase, AST)及γ-谷氨酰转移酶(γ-glutamyltransferase, GGT)描述肝功能异常的检出率及分布特征。采用χ2检验和二元logistic回归分析模型对肝功能异常相关因素进行分析。 结果 5 826名研究对象中肝功能异常检出率为22.6%(1 318/5 826)。性别、民族、年龄、地理位置、学历、职业、烟酒习惯、患有慢性病、服用药物、居住地及睡眠满意度与肝功能异常差异均有统计学意义(均P < 0.05)。多因素logistic回归分析模型显示男性(OR=5.239, 95% CI：4.189~6.552)、黎族(OR=3.510, 95% CI：2.233~5.517)、高龄(OR=1.015, 95% CI：1.006~1.024)、服用药物(OR=1.717, 95% CI：1.284~2.295)、农村居民(OR=1.931, 95% CI：1.570~2.375)、吸烟[偶尔吸烟比不吸烟(OR=1.503, 95% CI：1.210~1.866)；经常吸烟比不吸烟(OR=1.606, 95% CI：1.330~1.940)]、饮酒[偶尔饮酒比不饮酒(OR=2.127, 95% CI：1.733~2.611)；经常饮酒比不饮酒(OR=3.123, 95% CI：2.493~3.915)]是肝功能异常的主要危险因素。 结论 海南省肝功能异常整体检出率较高，高龄、男性、黎族、服用药物、农村地区、吸烟和饮酒是肝功能异常的主要危险因素，建议加强海南省少数民族地区老年人的健康教育。 Abstract:Objective The aim of this study is to assess the prevalence of liver dysfunction among middle-aged and elderly people in Hainan and identify its associated factors. Methods This study is based on the baseline survey from the "Prospective Cohort Study of Chronic Diseases in Hainan Natural Population" in 2020, comprising 5 826 permanent residents aged 35- < 75 years in Hainan. Liver dysfunction prevalence and distribution data were collected via questionnaire surveys, and liver dysfunction indicators: alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyltransferase (GGT) were obtained through blood biochemical tests. The related factors of liver dysfunction were analyzed by χ2 test and binary logistic regression analysis model. Results Among 5 826 subjects, the prevalence of liver dysfunction was 22.6% (1 318/5 826). There were statistic significant differences between liver dysfunction and variables such as gender, nationality, age, geographical location, education level, occupation, smoking and drinking habits, chronic disease status, drug intake, place of residence, and sleep satisfaction (all P < 0.05). Multivariate logistic regression showed that being male (OR=5.239, 95% CI: 4.189-6.552), belonging to Li nationality (OR=3.510, 95% CI: 2.233-5.517), being elderly (OR=1.015, 95% CI: 1.006-1.024), drug intake (OR=1.717, 95% CI: 1.284-2.295), rural residents (OR=1.931, 95% CI: 1.570-2.375), smoking [occasional versus non-smoking, 1.503 (1.210-1.866); regular versus non-smoking, 1.606 (1.330-1.940)], drinking [occasional versus non-drinking, 2.127 (1.733-2.611); regular versus non-drinking, 3.123 (2.493-3.915)] were main risk factors of liver dysfunction. Conclusions The prevalence of liver dysfunction is notably high among residents aged 35-74 years in Hainan. The main risk factors are age, gender, ethnicity (Li), drug intake, residing in rural areas, and habits of smoking and drinking. It is suggested to amplify health education efforts among the elderly and ethnic minority regions in Hainan Province. -
Key words:
- Liver dysfunction /
- Hainan Province /
- Risk factors /
- Cross-sectional study
-
表 1 肝功能异常检出率的单因素分析[例数(占比/%)]
Table 1. Univariate analysis of detection rate of abnormal liver function (population/%)
变量 总人数 肝功能正常人数 肝功能异常人数 χ2/Z值 P值 变量 总人数 肝功能正常人数 肝功能异常人数 χ2/Z值 P值 年龄/岁[M(P25, P75)] 47(36, 58) 46(36, 56) 49(35, 63) 10.135 < 0.001 西部地区 1 177 929(79.0) 248(21.0) 性别 862.906 < 0.001 南部地区 959 745(77.7) 214(22.3) 男 2 821 1 714(60.8) 1 107(39.2) 北部地区 1 838 1 465(79.8) 373(20.2) 女 3 005 2 794(93.0) 211(7.0) 服用药物 29.864 < 0.001 民族 63.872 < 0.001 否 5 531 4 318(78.1) 1 213(21.9) 汉族 5 699 4 447(78.0) 1 252(22.0) 是 295 190(64.5) 105(35.5) 黎族 127 61(48.0) 66(52.0) 患有慢性病 21.82 < 0.001 居住地区 71.197 < 0.001 否 4 944 3 879(78.5) 1 065(21.5) 城市 5 025 3 981(79.2) 1 044(20.8) 是 882 629(71.4) 253(28.6) 农村 801 527(65.8) 274(34.2) 吸烟 609.601 < 0.001 文化程度 14.672 < 0.001 不吸烟 3 680 3 236(88.0) 444(12.0) 初中及以下 2 600 1 970(75.8) 630(24.2) 偶尔吸烟 737 463(62.9) 274(37.1) 高中 2 522 1 952(77.4) 570(22.6) 经常吸烟 1 409 809(57.5) 600(42.5) 高中以上 704 586(83.3) 118(16.7) 饮酒 468.139 < 0.001 职业 37.221 < 0.001 不饮酒 2 436 2 253(92.5) 183(7.5) 体力劳动 3 266 2 594(79.5) 672(20.5) 偶尔饮酒 2 392 1 617(67.7) 775(32.3) 脑力劳动 1 880 1 456(77.5) 424(22.5) 经常饮酒 998 638(64.0) 360(36.0) 其他 680 458(67.4) 222(32.6) 睡眠满意度 12.576 < 0.001 地理位置 15.025 < 0.001 好 2 382 1 897(79.7) 485(20.3) 中部地区 1 621 1 179(72.8) 442(27.2) 中 2 672 2 037(76.3) 635(23.7) 东部地区 231 190(82.3) 41(17.7) 差 772 574(74.4) 198(25.6) 
下载: 导出CSV
表 2 变量赋值情况
Table 2. Variable assignment
变量 赋值 自变量 性别 女性=0，男性=1 民族 汉族=0，黎族=1 文化程度 初中及以下=0，高中=1，高中以上=2 职业 体力劳动(工人、生产、销售、服务人员)=0，脑力劳动(行政、管理、技术人员)=1，其他(待业、下岗、退休人员)=2 地理位置 中部地区(琼中黎族苗族自治县、白沙黎族自治县、屯昌县、保亭黎族苗族自治县、五指山市)=0，东部地区(琼海市、定安县、文昌市)=1，西部地区(昌江黎族自治县、东方市、乐东黎族自治县、儋州市)=2，南部地区(三亚市、陵水黎族自治县、万宁市)=3，北部地区(临高县、澄迈县、海口市)=4 服用药物 否=0，是=1(过去1年内服用过各种降压、降血糖、降脂药物及中草药者) 患有慢性病 否=0，是=1(已经被医院确诊为高血压、糖尿病、痛风等慢性病的病人) 吸烟 不吸(从不吸烟者)=0，偶尔吸(过去1年已经戒烟或每周吸烟次数 < 7次者)=1，经常吸(过去1年每周吸烟次数≥7次者)=2 饮酒 不饮酒(从未喝酒者)=0，偶尔饮酒(过去1年内每周饮酒次数 < 7次者)=1，经常饮酒(过去1年内每周饮酒次数≥7次者)=2 居住地区 城镇=0，农村=1 睡眠满意度 由受试者对自己过去1周内的睡眠质量进行自评：好=0，中=1，差=2 因变量 肝功能异常 否=0，是=1(ALT>40 U/L或AST>40 U/L或GGT>58 U/L)[7] 注：1. ALT: 丙氨酸氨基转移酶。2. AST：天冬氨酸氨基转移酶。3. GGT: γ-谷氨酰转移酶。
下载: 导出CSV
表 3 影响肝功能异常的多因素logistic回归分析
Table 3. Multivariate logistic regression analysis of abnormal liver function
影响因素 β sx Wald值 OR值(95% CI) P值 影响因素 β sx Wald值 OR值(95% CI) P值 年龄/岁 南部地区 0.017 0.110 0.023 1.017(0.820~1.261) 0.879 35~＜75 0.015 0.005 10.118 1.015(1.006~1.024) 0.001 北部地区 -0.245 0.097 6.238 0.783(0.647~0.947) 0.012 性别 服用药物 女 1.000 否 1.000 男 1.656 0.114 210.756 5.239(4.189~6.552) < 0.001 是 0.541 0.148 13.327 1.717 (1.284~2.295) < 0.001 民族 吸烟 汉族 1.000 不吸烟 1.000 黎族 1.256 0.231 29.627 3.510(2.233~5.517) < 0.001 偶尔吸烟 0.407 0.110 13.603 1.503(1.210~1.866) < 0.001 文化程度 经常吸烟 0.474 0.096 24.235 1.606(1.330~1.940) < 0.001 初中及以下 1.000 饮酒 高中 -0.300 0.083 12.879 0.741(0.629~0.873) < 0.001 不饮酒 1.000 高中以上 -0.362 0.144 6.274 0.696(0.525~0.924) 0.012 偶尔饮酒 0.755 0.105 52.049 2.127(1.733~2.611) < 0.001 职业 经常饮酒 1.139 0.115 97.929 3.123(2.493~3.915) < 0.001 体力劳动 1.000 居住地区 脑力劳动 0.208 0.091 5.275 1.231(1.031~1.470) 0.022 城市 1.000 其他 0.359 0.115 9.699 1.433(1.143~1.796) 0.002 农村 0.658 0.106 38.761 1.931(1.570~2.375) < 0.001 地理位置 睡眠满意度 中部地区 1.000 好 1.000 东部地区 -0.43 0.205 4.384 0.651(0.435~0.973) 0.036 中 0.179 0.078 5.209 1.196(1.026~1.395) 0.022 西部地区 -0.144 0.105 1.888 0.866(0.705~1.063) 0.169 差 0.279 0.115 5.878 1.322(1.055~1.658) 0.015
下载: 导出CSV
-
[1] Tomedi LE, Roeber J, Landen M. Alcohol consumption and chronic liver disease mortality in new Mexico and the United States, 1999-2013[J]. Public Health Rep, 2018, 133(3): 287-293. DOI: 10.1177/0033354918766890. [2] Marcellin P, Kutala BK. Liver diseases: a major, neglected global public health problem requiring urgent actions and large-scale screening[J]. Liver Int, 2018, 38(Suppl 1): 2-6. DOI: 10.1111/liv.13682. [3] 董华, 王定彬, 华婧, 等. 2016年海南省肿瘤登记地区恶性肿瘤发病与死亡分析[J]. 实用肿瘤学杂志, 2021, 35 (4): 344-350. DOI: 10.11904/j.issn.1002-3070.2021.04.010.Dong H, Wang DB, Hua J, et al. Analysis for the incidence and death of malignant tumors in Hainan cancer registry, 2016[J]. Pract Oncol J, 2021, 35(4): 344-350. DOI: 10.11904/j.issn.1002-3070.2021.04.010. [4] 颜有萱, 陈俊财, 林柳婷, 等. 基于海南省队列BMI与睡眠时长和睡眠质量关系的横断面研究[J]. 中华疾病控制杂志, 2022, 26(4): 406-411. DOI: 10.16462/j.cnki.zhjbkz.2022.04.008.Yan YX, Chen JC, Lin LT, et al. A cross-section study of the correlations between BMI and sleep duration or sleep quality based on Hainan cohort study[J]. Chin J Dis Control Prev, 2022, 26(4): 406-411. DOI: 10.16462/j.cnki.zhjbkz.2022.04.008. [5] 陈俊财, 颜有萱, 林柳婷, 等. 海南省35~74岁人群超重肥胖流行特征与相关危险因素的研究[J]. 基层医学论坛, 2021, 25(19): 2665-2667. DOI: 10.19435/j.1672-1721.2021.19.001.Chen JC, Yan YX, Lin LT, et al. Epidemiological characteristics and risk factors of overweight and obesity in population aged 35-74 in Hainan Province[J]. Med Forum, 2021, 25(19): 2665-2667. DOI: 10.19435/j.1672-1721.2021.19.001. [6] 于宏亮, 刘峰, 王建瑞. 血清ALT、AST及HBV-DNA水平联合检测在慢性乙型肝炎患者诊断中的应用及相关生物学行为的评价[J]. 实验与检验医学, 2017, 35 (5): 760-762. DOI: 10.3969/j.issn.1674-1129.2017.05.045.Yu HL, Liu F, Wang JR. Application of combined detection of serum ALT, AST and HBV-DNA levels in the diagnosis of patients with chronic hepatitis B and evaluation of related biological behaviors[J]. Exp Lab Med, 2017, 35(5): 760-762. DOI: 10.3969/j.issn.1674-1129.2017.05.045. [7] 李庆林, 王涵, 张晓红, 等. 倒班和睡眠时间对钢铁工人肝功能异常的影响[J]. 中华疾病控制杂志, 2021, 25(11): 1347-1353. DOI: 10.16462/j.cnki.zhjbkz.2021.11.020.Li QL, Wang H, Zhang XH, et al. Effects of rotating night shift work and sleep duration on liver dysfunction among steelworkers[J]. Chin J Dis Control Prev, 2021, 25(11): 1347-1353. DOI: 10.16462/j.cnki.zhjbkz.2021.11.020. [8] 李继猛, 孔学云, 官玉红. 健康工人效应的调查分析[J]. 职业与健康, 2009, 25(17): 1812-1814. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJK200917013.htmLi JM, Kong XY, Guan YH. Investigation and analysis on the effect of healthy workers[J]. Occupation and Health, 2009, 25(17): 1812-1814. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJK200917013.htm [9] 宋丹丹, 许茹, 黄杰庭, 等. 海南黎族人群乙肝感染情况与风险因素分析[J]. 中国免疫学杂志, 2018, 34(6): 892-896. DOI: 10.3969/j.issn.1000-484X.2018.06.018.Song DD, Xu R, Huang JT, et al. Analysis of HBV infection and risk factors among Li minority in Hainan[J]. Chin J Immunol, 2018, 34(6): 892-896. DOI: 10.3969/j.issn.1000-484X.2018.06.018. [10] 惠宇, 陈碧玉, 黄小玲, 等. 海南省2011-2019年乙肝流行趋势与特征分析[J]. 中国热带医学, 2022, 22(5): 412-417. DOI: 10.13604/j.cnki.46-1064/r.2022.05.04.Hui Y, Chen BY, Huang XL, et al. Analysis of the epidemiological trend and characteristics of hepatitis B in Hainan, 2011-2019[J]. China Tropical Medicine, 2022, 22(5): 412-417. DOI: 10.13604/j.cnki.46-1064/r.2022.05.04. [11] 许茹, 宋丹丹, 王敏, 等. 海南省白沙县黎族和汉族1992年后出生人群的HBV流行病学研究[J]. 中国输血杂志, 2019, 32(6): 538-542. DOI: 10.13303/j.cjbt.issn.1004-549x.2019.06.007.Xu R, Song DD, Wang M, et al. Comparison the HBV seroprevalence between the Li & Han ethnic individuals who were born after 1992 in Baisha County, Hainan Province, China[J]. Chin J Blood Transfus, 2019, 32(6): 538-542. DOI: 10.13303/j.cjbt.issn.1004-549x.2019.06.007. [12] 孙莲英, 曾昭长, 陈海云, 等. 海南省人群乙型肝炎血清流行病学调查研究[J]. 中国热带医学, 2007, 7(2): 182-184, 189. DOI: 10.3969/j.issn.1009-9727.2007.02.002.Sun LY, Zeng ZC, Chen HY, et al. Sero-epidemiological survey of hepatitis B in different populations in Hainan Province[J]. China Tropical Medicine, 2007, 7(2): 182-184, 189. DOI: 10.3969/j.issn.1009-9727.2007.02.002. [13] 陈碧玉, 曾雪霞, 李俊, 等. 海南省公共场所顾客乙肝病毒感染状况及其防治知识态度行为影响因素[J]. 中国热带医学, 2019, 19(8): 738-742. DOI: 10.13604/j.cnki.46-1064/r.2019.08.06.Chen BY, Zeng XX, Li J, et al. Infection status and influencing factors for knowledge-attitude-practice of hepatitis B among customers in public service place in Hainan[J]. China Tropical Medicine, 2019, 19(8): 738-742. DOI: 10.13604/j.cnki.46-1064/r.2019.08.06. [14] Hallsworth K, Thoma C, Moore S, et al. Non-alcoholic fatty liver disease is associated with higher levels of objectively measured sedentary behaviour and lower levels of physical activity than matched healthy controls[J]. Frontline Gastroenterol, 2015, 6(1): 44-51. DOI: 10.1136/flgastro-2014-100432. [15] 李晓芸, 唐洁婷. 药物性肝损伤的流行病学[J]. 临床肝胆病杂志, 2021, 37(11): 2510-2514. DOI: 10.3969/j.issn.1001-5256.2021.11.002.Li XY, Tang JT. Epidemiology of drug-induced liver injury[J]. J Clin Hepatol, 2021, 37(11): 2510-2514. DOI: 10.3969/j.issn.1001-5256.2021.11.002. [16] 杜长臻, 陈文, 王湘君, 等. 海南黎族传统黎药发展与传承研究[J]. 内江科技, 2021, 42(9): 111, 96. https://www.cnki.com.cn/Article/CJFDTOTAL-KJNJ202109062.htmDu CZ, Chen W, Wang XJ, et al. Research on the development and inheritance of traditional Li medicine of Li nationality in Hainan[J]. Nei Jiang Sci Technol, 2021, 42(9): 111, 96. https://www.cnki.com.cn/Article/CJFDTOTAL-KJNJ202109062.htm [17] Di Ciaula A, Bonfrate L, Krawczyk M, et al. Synergistic and detrimental effects of alcohol intake on progression of liver steatosis[J]. Int J Mol Sci, 2022, 23(5): 2636. DOI: 10.3390/ijms23052636. [18] Wahlang B, Gripshover TC, Gao H, et al. Associations between residential exposure to volatile organic compounds and liver injury markers[J]. Toxicol Sci, 2021, 185(1): 50-63. DOI: 10.1093/toxsci/kfab119. [19] Altamirano J, Bataller R. Cigarette smoking and chronic liver diseases[J]. Gut, 2010, 59(9): 1159-1162. DOI: 10.1136/gut.2008.162453. [20] 黄坚强, 陈军, 谭琰. 海南地区黎、汉族人群患酒精性肝病的相关因素分析和临床疗效分析比较[J]. 海南医学院学报, 2011, 17(9): 1175-1178. DOI: 46-1049/r.20110726.1112.024.Huang JQ, Chen J, Tan Y. Relevant factors and clinical treatment of alcoholic liver disease between Li minority and Han people[J]. J Hainan Med Univ, 2011, 17(9): 1175-1178. DOI: 46-1049/r.20110726.1112.024. [21] 孙铭繁, 吴梦曼, 林昆. 潮汕地区居民吸烟及饮酒情况调查[J]. 汕头大学医学院学报, 2020, 33(4): 242-246. DOI: 10.13401/j.cnki.jsumc.2020.04.013.Sun MF, Wu MM, Lin K. lnvestigation on smoking and alcohol drinking among residents in Chaoshan area[J]. J Shantou Univ Med Coll, 2020, 33(4): 242-246. DOI: 10.13401/j.cnki.jsumc.2020.04.013. [22] Okamura T, Hashimoto Y, Hamaguchi M, et al. Short sleep duration is a risk of incident nonalcoholic fatty liver disease: a population-based longitudinal study[J]. J Gastrointestin Liver Dis, 2019, 28(1): 73-81. DOI: 10.15403/jgld.2014.1121.281.alc. [23] Imaizumi H, Takahashi A, Tanji N, et al. The association between sleep duration and non-alcoholic fatty liver disease among Japanese men and women[J]. Obes Facts, 2015, 8(4): 234-242. DOI: 10.1159/000436997. -
