摘要
目的分析非酒精性脂肪性肝病(NAFLD)的预后及与预后相关的因素,探讨NAFLD患者肝脏功能恢复的质量。方法纳入2003年某单位接受体检的459名受试者,其中诊断为NAFLD 154例,非脂肪性肝病的正常人群(健康组)305例,2009年对同一受试人群再次进行随访。观察6年后该人群体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、血脂、肝功能、血尿酸(UA)及腹部超声检查的变化,比较两组人群的预后,以及与预后相关的(危险或保护)因素。结果 6年后再次检测该研究人群时,之前诊断为NAFLD的154例患者中,有38例超声下脂肪肝消失(男、女分别为13例和25例),其余116例仍为NAFLD(男、女分别为50例和66例);健康组的305例受试者中有91例新发NAFLD(男、女分别为47例和44例),其余214例受试者仍保持健康状态(男、女分别为75例和139例)。原有NAFLD患者例数6年间减少了24.7%(38/154),原来没有NAFLD的正常人群6年间新出现了29.8%(91/305)。NAFLD发生率由原来的33.6%(154/459)增加到45.1%(207/459),6年增加了11.5%。6年前男性NAFLD的高峰年龄位于40～49岁,女性位于60岁以上;6年后男女高峰年龄相同(50～59岁)。新增的NAFLD患者中男性在40～59岁为高峰,女性比男性晚10年左右;NAFLD消失的患者中,男性在50岁以后居多,女性半数以上在60岁以后。新增加的NAFLD患者除HDL-C外,其他代谢综合征(MS)组分发生率与持续存在的NAFLD患者基本相同,但是FBG增高的发生率在持续存在的NAFLD中更高;腹部超声检查NAFLD转归的患者,除HDL-C外,其他MS组分与持续无NAFLD受试者相比,差异有统计学意义(P<0.05)。新近发生的NAFLD与持续存在NAFLD患者间所有生化指标和MS组分无明显差异(P>0.05);NAFLD已经消失的患者中,BMI、SBP、甘油三酯、总胆固醇、ALT、FBG、UA水平均高于非NAFLD受试者(P<0.05)。结论 NAFLD的发生或消失与性别、年龄、肝脏酶学和MS组分密切相关,影像学NAFLD消退并不意味着功能的完全恢复,应该重视NAFLD患者肝脏功能恢复的质量。
Objective To investigate the prognosis of non-alcoholic fatty liver disease（NAFLD） and its related factors and explore the recovered quality of liver function. Methods A total of 459 subjects from one company who underwent health check-up in 2003 were enrolled in the study. 154 of them were diagnosed as NAFLD, while the rest 305 without NAFLD were included in the health group, then they were all followed up in 2009. We observed the levels of BMI, SBP, DBP, FBG, serum lipids, liver enzymes, uric acid（UA）and the results of abdominal ultrasonic examination after 6 years for all subjects, then compared the prognosis of the two groups and investigated prognosis related factors （risk factors or protective factors）. Results During the 6 years follow-up, 38 subjects of 154 in NAFLD group improved and revealed a normal liver appearance under ultrasonic examination （13males and 25 females）, while the other 116 subjects still had NAFLD（50 males and 66 females）. In health group, 91 subjects developed to NAFLD（47 males and 44 females）, and 214 subjects remained healthy（75 males and 139 females）. The number of original NAFLD was reduced by 24. 7% （38/154） during 6 years and 29.8 % of the health group newly developed to NAFLD（91/305）simultaneously. Overall, the incidence of NAFLD increased from 33.6 % （154/459） to 45.1% （207/459）, growing by 11.5 %. In 2003 the peak age of NAFLD in men was 40-49 years old, in women was more than 60 years old; in 2009 the peak age in both sexes were similar（ 50-59 years old）. The peak age of the newly developed NAFLD group in men was 40-59 years old, and about a decade older than in women. Similarly, in the group of NAFLD disappeared, most men were beyond 50 years old, and more than half of women were aged more than 60 years. The incidence of metabolic syndrome（MS）components （but not in HDL-C）was basically the same between the newly developed NAFLD and the persistent NAFLD, but the level of FBG is higher in the persistent NAFLD. There was a significant difference between the persistent NAFLD and NAFLD disappeared under ultrasonic examination in the levels of components of MS except for HDL-C （P 〈 0. 05）. The newly developed NAFLD and the persistent NAFLD had no obvious difference in the levels of all biochemical indices and MS components （P 〉 0. 05 ） ; The subjects of NAFLD disappeared had higher average levels than those remained for Health status in BMI, SBP, TG, TC, AI.T, FBG and UA（P〈0.05）. Conclusion The occurrence and disappearance of NAFLD are highly associated with gender, age and MS. The regression of NAFLD in imaging is not equal to functional recovery, which we should pay more attention to.
出处
《肝脏》
2012年第7期474-478,共5页
Chinese Hepatology
基金
辽宁省教育厅基金资助项目(2009A809)
关键词
非酒精性脂肪性肝病
代谢综合征
预后
生化指标
Non-alcoholic fatty liver disease
Metabolic syndrome
Prognosis
Biochemical indicator
