男性酒精性和非酒精性脂肪性肝病患者代谢异常的比较

肝脏 ›› 2021, Vol. 26 ›› Issue (1): 60-63.

男性酒精性和非酒精性脂肪性肝病患者代谢异常的比较

季蕾, 范建高, 李锋

200032 上海交通大学附属第一人民医院护理部(季蕾);上海交通大学附属新华医院消化科(范建高);复旦大学附属中山医院消化科(李锋)

收稿日期:2020-10-01 出版日期:2021-01-31 发布日期:2021-02-26
通讯作者: 李锋,Email:li.feng2@zs-hospital.sh.cn
基金资助:
国家自然科学基金(81670513),上海市青年科技启明星计划(13QA1400700),上海市卫生系统优秀青年医学人才培养计划(XYQ2013089)

Comparing the prevalence of metabolic abnormalities between male individuals with alcoholic and non-alcoholic fatty liver disease

JI Lei, FAN Jian-gao, LI Feng

Department of Gastroenterology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China

Received:2020-10-01 Online:2021-01-31 Published:2021-02-26
Contact: LI Feng,Email:li.feng2@zs-hospital.sh.cn

摘要/Abstract

摘要： 目的比较男性酒精性脂肪性肝病(AFLD)和非酒精性脂肪性肝病(NAFLD)患者中代谢异常的情况。方法上海宝钢集团股份有限公司2001年1月至2002年12月参加体检的职工中,筛选出AFLD和NAFLD患者,用多变量logistic回归模型分析体检资料,比较两组的代谢异常包括肥胖、高血压、高三酰甘油血症、高胆固醇血症和糖尿病的患病情况。此外,定义患有上面三种或三种以上代谢异常的为多元代谢异常,分析其在两组患者中的患病情况。结果最终纳入474例AFLD和764例NAFLD的男性职工。多变量分析发现,AFLD组和NAFLD组肥胖、高血压、高三酰甘油血症和糖尿病的发病率相近,但是高胆固醇血症更多见于AFLD组(OR=1.469, 95%CI 1.113~1.939, P=0.007);两组间多元代谢异常的患病率差异无统计学意义(OR=1.270, 95%CI 0.869~1.855, P=0.217)。在 < 40岁和 > 60岁的两个年龄层次人群中,多元代谢异常的患病率在AFLD组和NAFLD组差异无统计学意义(分别为54.3%比46.2%和79.6%比75.7%,均P>0.05);但是在40～60岁人群中,多元代谢异常在AFLD组的患病率高于NAFLD组(67.4%比52.6%,P=0.001)。结论男性AFLD患者和NAFLD患者均存在代谢异常。在治疗AFLD患者时,需要识别和治疗伴发的代谢异常从而改善AFLD患者的预后。

关键词: 酒精性脂肪性肝病, 非酒精性脂肪性肝病, 代谢异常, 患病率

Abstract: Objective To compare the prevalence of metabolic abnormalities between individuals with alcoholic fatty liver disease (AFLD) and with non-alcoholic fatty liver disease (NAFLD).Methods The medical records from check-ups of male employees with ultrasound-diagnosed fatty liver disease in the Bao-Steel Group (Shanghai, China) were retrospectively analyzed. The prevalence of metabolic abnormalities, including obesity, hypertension, hypertriglyceridemia, hypercholesterolemia and diabetes mellitus, were compared between the individuals with AFLD and with NAFLD by multivariate logistic regression analysis. The clustering of multiple metabolic abnormalities (CMMA) was defined as having any three or more of metabolic abnormalities mentioned above, and its prevalence was also compared between two groups.Results The male individuals with AFLD (n=474) and with NAFLD (n=764) were identified. Obesity, hypertension, hypertriglyceridemia and diabetes mellitus in the individuals with AFLD were as prevalent as with NAFLD, but hypercholesterolemia was more prevalent in AFLD (OR = 1.469, 95%CI = 1.113-1.939, P=0.007). There was no significant difference in the prevalence of CMMA between two groups (OR = 1.270, 95%CI = 0.869-1.855, P=0.217). Both in the younger than 40 years old group and in the older than 60 years old group, there was no significant difference in the prevalence of CMMA between the individuals with AFLD and with NAFLD (54.3% vs. 46.2% and 79.6% vs. 75.7%, respectively, P>0.05 for both comparisons). But in the 40~60 years old group, CMMA was more prevalent in AFLD than in NAFLD (67.4% vs. 52.6%, P=0.001).Conclusion In these male employees, individuals with AFLD are similarly metabolically unhealthy as those with NAFLD. Hence, abundant efforts should also be made to identify and manage accompanying metabolic abnormalities in the treatment of AFLD.

Key words: Alcoholic fatty liver disease, Nonalcoholic fatty liver disease, Metabolic abnormalities, Prevalence

季蕾, 范建高, 李锋. 男性酒精性和非酒精性脂肪性肝病患者代谢异常的比较[J]. 肝脏, 2021, 26(1): 60-63.

JI Lei, FAN Jian-gao, LI Feng. Comparing the prevalence of metabolic abnormalities between male individuals with alcoholic and non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2021, 26(1): 60-63.

参考文献

[1] Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology, 2016, 64: 73-84.
[2] Zhou F, Zhou J, Wang W, et al. Unexpected rapid increase in the burden of NAFLD in China from 2008 to 2018: a systematic review and Meta-analysis. Hepatology, 2019,70: 1119-1113.
[3] Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 2018, 67: 328-357.
[4] Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol, 2020, 73: 202-209.
[5] Sun K, Ren M, Liu D, et al. Alcohol consumption and risk of metabolic syndrome: a meta-analysis of prospective studies. Clin Nutr, 2014, 33: 596-602.
[6] Anuurad E, Shiwaku K, Nogi A, et al. The new BMI criteria for Asians by the regional office for the western Pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers. J Occup Health, 2003, 45: 335-343.
[7] Fan JG, Li F, Cai XB, et al. The importance of metabolic factors for the increasing prevalence of fatty liver in Shanghai factory workers. J Gastroenterol Hepatol, 2007, 22: 663-668.
[8] Li YM, Fan JG, Wang BY, et al. Guidelines for the diagnosis and management of alcoholic liver disease: update 2010. J Dig Dis, 2011, 12: 45-50.
[9] Kotronen A, Yki-Järvinen H, Männistö S, et al. Non-alcoholic and alcoholic fatty liver disease - two diseases of affluence associated with the metabolic syndrome and type 2 diabetes: the FIN-D2D survey. BMC Public Health, 2010, 10: 237.
[10] Stepanova M, Rafiq N, Younossi ZM. Components of metabolic syndrome are independent predictors of mortality in patients with chronic liver disease: a population-based study. Gut, 2010, 59: 1410-1415.
[11] Hickman IJ, Macdonald GA. Impact of diabetes on the severity of liver disease. Am J Med, 2007, 120: 829-834.
[12] Toshikuni N, Tsutsumi M, Arisawa T. Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease. World J Gastroenterol, 2014, 20: 8393-8406.
[13] Dam-Larsen S, Becker U, Franzmann MB, et al. Final results of a long-term, clinical follow-up in fatty liver patients. Scand J Gastroenterol, 2009, 44: 1236-1243.
[14] Kim HJ, Kim JH, Choe WH, et al. Alcoholic fatty liver disease elevates estimated coronary heart disease risk to levels comparable with those of nonalcoholic fatty liver disease in the Korean population: a cross-sectional study. Clin Mol Hepatol, 2014, 20: 154-161.
[15] Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation, 2005, 112: 2735-2752.
[16] Toshikuni N, Fukumura A, Hayashi N, et al. Comparison of the relationships of alcoholic and nonalcoholic fatty liver with hypertension, diabetes mellitus, and dyslipidemia. J Clin Biochem Nutr, 2013, 52: 82-88.
[17] Haflidadottir S, Jonasson JG, Norland H, et al. Long-term follow-up and liver-related death rate in patients with non-alcoholic and alcoholic related fatty liver disease. BMC Gastroenterol, 2014, 14: 166-175.