摘要： 目的 探讨沈阳地区青壮年非酒精性脂肪性肝病（NAFLD）的流行趋势及其危险因素。方法 收集2014年1月至2018年12月沈阳地区东软集团45 187名职工体检资料，分析流行趋势；比较NAFLD职工（NAFLD组）与未患有NAFLD职工（非NAFLD组）各项临床指标，并根据体质量指数（BMI）水平作亚组分析；采用logistic回归分析NAFLD发病的危险因素。结果 2014年至2018年NAFLD患病率分别为29.31%、29.04%、30.67%、32.73和31.54%，呈逐年上升趋势；患者男性居多，肥胖者患病率较高。NAFLD患病人群中男性BMI值高于女性（P<0.01）。与非NAFLD组比较，NAFLD组空腹血糖（FBG）、血细胞比容（HCT）、甘油三酯（TG）、胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、血尿酸、尿素氮、肌酐均增高（均P<0.001），而红细胞平均体积（MCV）、高密度脂蛋白胆固醇（HDL-C）降低（均P<0.001）。NAFLD患病人群中与BMI<23 kg/m²患者比较，BMI ≥ 23 kg/m²患者HCT、MCV、TG、LDL-C、HDL-C、ALT、AST、ALP、GGT、血尿酸、尿素氮水平差异显著（均P<0.01）。logistic回归分析显示FBG、BMI（≥ 23 kg/m²）、ALT、ALP、GGT、TG、LDL-C、HCT、血尿酸、舒张压、胆囊结石均是NAFLD发病的独立危险因素；HDL-C、MCV、收缩压是其保护因素。结论 沈阳地区2014年至2018年青壮年NAFLD患病率总体呈上升趋势，男性和肥胖者居多。NAFLD患者中男性BMI值较女性偏高，NAFLD的发生与血糖、血压、血脂、肝功改变密切相关。

沈阳地区青壮年非酒精性脂肪性肝病的流行趋势及危险因素分析

曾子露, 关琳, 田昊宇, 张鑫赫, 孙菁, 李丹, 李异玲

中国医科大学附属第一医院消化内科, 沈阳 110001

收稿日期:2020-09-26出版日期:2021-09-30发布日期:2021-09-18
通讯作者:李异玲E-mail:LYL-72@163.com
作者简介:曾子露(1996-),女,硕士研究生.
基金资助:国家自然科学基金（81570519）


关键词: 非酒精性脂肪性肝病, 患病率, 流行趋势, 危险因素
Abstract: Objective To investigate the epidemic trend and risk factors of non-alcoholic fatty liver disease (NAFLD) in young adults in Shenyang. Methods Physical examination data of 45 187 employees of Neusoft Corporation in Shenyang from January 2014 to December 2018 were collected,and the relevant epidemic factors were analyzed. The clinical indices between the NAFLD and non-NAFLD groups were compared and analyzed. Subgroup analyses were conducted according to body mass index (BMI). The risk factors for NAFLD were analyzed using logistic regression. Results The annual prevalence rates of NAFLD from 2014 to 2018 were 29.31%,29.04%,30.67%,32.73%,and 31.54%,respectively,and showed an increasing trend year by year. Most patients were men,and the prevalence of obesity was higher. The BMI of male patients was higher than that of female patients (P<0.01). The levels of fasting blood glucose (FBG),hematocrit (HCT),triglycerides (TG),total cholesterol (TC),low-density lipid cholesterol (LDL-C),alanine transaminase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP),glutamyl transpeptidase (GGT),serum uric acid,urea nitrogen,and creatinine in the NAFLD group were significantly increased,while the levels of mean corpusular volume (MCV) and high-density lipid cholesterol (HDL-C) were lower than those in the non-NAFLD group (all P<0.001). There were significant differences in HCT,MCV,TG,LDL-C,HDL-C,ALT,AST,ALP,GGT,serum uric acid,and urea nitrogen among the patients with different BMI (all P<0.01). Logistic regression analysis showed that FBG,BMI (≥ 23 kg/m²),ALT,ALP,GGT,TG,LDL-C,HCT,serum uric acid,diastolic blood pressure,and gallstones were independent risk factors for NAFLD,while HDL-C,MCV,and systolic blood pressure were protective factors. Conclusion The prevalence of NAFLD in young adults in Shenyang from 2014 to 2018 was with an upward overall trend. Men were affected more and obesity was more prevalent. NAFLD is closely related to blood glucose,blood pressure,and blood lipid and liver function changes.
Key words: non-alcoholic fatty liver disease, prevalence, epidemic trend, risk factor
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