金昌队列人群非酒精性脂肪肝发病的影响因素分析

霍艳蓓; 白亚娜; 张德生; 常晓宇; 尹春; 把玉佩; 王玉峰; 甘婷; 丁皎; 李娜; 张文玲; 程宁

Abstract

霍艳蓓,白亚娜,张德生,常晓宇,尹春,把玉佩,王玉峰,甘婷,丁皎,李娜,张文玲,程宁.金昌队列人群非酒精性脂肪肝发病的影响因素分析[J].Chinese journal of Epidemiology,2021,42(3):493-498

金昌队列人群非酒精性脂肪肝发病的影响因素分析

Analysis on influencing factors for nonalcoholic fatty liver disease in Jinchang cohort

Received:April 28, 2020

DOI：10.3760/cma.j.cn112338-20200428-00668

KeyWord: 非酒精性脂肪肝 Cox回归分析队列研究

English Key Word: Non-alcoholic fatty liver disease Cox regression analysis Cohort study

FundProject:兰州大学“一带一路”专项（2018ldbrzd008）

Author Name	Affiliation	E-mail
Huo Yanbei	Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
Bai Yana	Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
Zhang Desheng	Workers'Hospital of Jinchuan Group, Jinchang 737100, China
Chang Xiaoyu	Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
Yin Chun	Workers'Hospital of Jinchuan Group, Jinchang 737100, China
Ba Yupei	Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
Wang Yufeng	Workers'Hospital of Jinchuan Group, Jinchang 737100, China
Gan Ting	Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
Ding Jiao	Workers'Hospital of Jinchuan Group, Jinchang 737100, China
Li Na	Workers'Hospital of Jinchuan Group, Jinchang 737100, China
Zhang Wenling	Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
Cheng Ning	School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China	chengn@lzu.edu.cn

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Abstract:

目的了解金昌队列人群非酒精性脂肪肝（NAFLD）发病的影响因素，为NAFLD的预防和控制提供科学依据。方法以金昌队列基线未患脂肪肝且符合纳入标准的20 051人为研究对象，通过前瞻性队列研究及Cox回归分析探讨NAFLD发病影响因素，并用限制性立方样条法研究相关生化指标与NAFLD发病风险的剂量反应关系。结果 NAFLD发病密度为42.37/1 000人年，多因素Cox回归分析显示，职业为工人与技术人员（工人：HR=0.84，95%CI：0.70~0.99；技术人员：HR=0.73，95%CI：0.56~0.95）、饮茶（正在饮：HR=0.86，95%CI：0.78~0.94；过去饮：HR=0.52，95%CI：0.31~0.86）、体育锻炼（偶尔：HR=0.79，95%CI：0.68~0.91；经常：HR=0.60，95%CI：0.52~0.69）、体重较轻（HR=0.10，95%CI：0.05~0.22）、奶类及奶制品摄入>300 ml/d（HR=0.78，95%CI：0.71~0.87）、HBV感染（HR=0.77，95%CI：0.60~0.99）是NAFLD的保护因素；职业为内勤服务人员（HR=1.84，95%CI：1.46~2.31）、家庭人均月收入≥2 000元（2 000~元：HR=1.32，95%CI：1.04~1.66；≥5 000元：HR=1.72，95%CI：1.11~2.66）、文化程度为本科及以上（HR=1.35，95%CI：1.03~1.76）、超重（HR=2.31，95%CI：2.08~2.55）、肥胖（HR=3.95，95%CI：3.42~4.56）、空腹血糖受损（HR=1.31，95%CI：1.17~1.47）、糖尿病（HR=1.53，95%CI：1.30~1.80）、TC升高（HR=1.37，95%CI：1.24~1.52）、TG升高（HR=1.79，95%CI：1.62~1.98）、HDL-C降低（HR=1.29，95%CI：1.14~1.45）、ALT升高（HR=1.13，95%CI：1.01~1.26）和高脂饮食（HR=1.24，95%CI：1.11~1.40）是NAFLD的危险因素，TC、TG、HDL-C、ALT、FPG与NAFLD发病呈良好的剂量反应关系。结论职业、文化程度、家庭人均月收入、饮茶、体育锻炼、BMI、FPG、血脂、ALT、HBV、饮食与NAFLD发病有关。

English Abstract:

Objective To explore the influencing factors for non-alcoholic fatty liver disease (NAFLD) in Jinchang cohort, and provide scientific basis for the prevention and control of NAFLD. Methods A total of 20 051 patients without fatty liver at baseline survey and met the inclusion criteria in Jinchang cohort were selected as study subjects. Prospective cohort study and Cox regression analysis were used to investigate the influencing factors for NAFLD, and the dose-response relationship between related biochemical indicators and NAFLD risk was studied by restricted cubic spline method. Results The incidence of NAFLD was 42.37/1 000 person years. Multivariate Cox regression analysis showed that being worker and technical personnel (being worker:HR=0.84,95%CI:0.70-0.99;being technical personnel:HR=0.73,95%CI:0.56-0.95), tea drinking (current drinking:HR=0.86,95%CI:0.78-0.94;previous drinking:HR=0.52,95%CI:0.31-0.86), exercise (occasionally:HR=0.79, 95%CI:0.68-0.91;frequently:HR=0.60,95%CI:0.52-0.69), low body weight (HR=0.10, 95%CI:0.05-0.22), daily intake of dairy products >300 ml/day (HR=0.78, 95%CI:0.71-0.87) and HBV infection (HR=0.77, 95%CI:0.60-0.99) were the protective factors for NAFLD, while being internal or office workers (HR=1.84, 95%CI:1.46-2.31), income ≥ 2 000 yuan (2 000-yuan:HR=1.32, 95%CI:1.04-1.66; ≥ 5 000 yuan:HR=1.72, 95%CI:1.11-2.66), bachelor degree or above (HR=1.35,95%CI:1.03-1.76), overweight (HR=2.31, 95%CI:2.08-2.55), obesity (HR=3.95, 95%CI:3.42-4.56), impaired fasting blood glucose (HR=1.31, 95%CI:1.17-1.47), diabetes (HR=1.53, 95%CI:1.30-1.80), increased TC (HR=1.37,95%CI:1.24-1.52), increased TG (HR=1.79,95%CI:1.62-1.98), decreased HDL-C (HR=1.29, 95%CI:1.14-1.45), increased ALT (HR=1.13, 95%CI:1.01-1.26) and high-fat diet (HR=1.24, 95%CI:1.11-1.40) were the risk factors for NAFLD. Moreover, TC, TG, HDL-C, ALT and FPG all showed good dose-response relationship with the incidence of NAFLD. Conclusion Occupation, education level, income level, tea drinking, exercise, BMI, FPG, blood lipid, ALT, HBV infection and diet were related to the incidence of NAFLD.

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