脂肪肝危险因素与脂肪肝严重程度的相关因素分析

非酒精性脂肪性肝病是指除外酒精和其他明确损伤因素所致的,以弥漫性肝细胞大泡性脂肪变为主要特征的临床病理综合征.随着肥胖和糖尿病患病率的增加,脂肪肝已成为我国常见的慢性肝病之一,它通常与肥胖,胰岛素抵抗和内脏脂肪的堆积相关[1].此外,非酒精性脂肪性肝病还被认为是以内脏型肥胖、糖尿病、血脂异常和高血压为特征的代谢综合征的临床表现之一[2].内脏脂肪堆积是代谢综合征一个非常重要的危险因素[3].本研究旨在探讨成人内脏脂肪量及其他人体测量指标与脂肪肝及其严重程度的关系,分析脂肪肝的危险因素及影响其严重程度的相关因素,为脂肪肝的防治提供参考.     

脂肪肝相关危险因素的评估

目的: 探讨脂肪肝的危险因素, 寻求简洁适用的脂肪性肝病流行病学调查的筛查方法.方法: 收集成人健康体检者1654例, 排除恶性肿瘤、病毒性肝炎标志物阳性、慢性胰腺炎、严重肾功损伤、急性感染或创伤、长期激素应用者, 均接受人体学测量(身高、体质量、血压)、生化及免疫学检查(肝功、血糖、血脂、血尿酸、肾功、病毒标志物)及超声检查. 将资料建立SPSS13.0数据库, 进行χ2检验、Logistic回归分析及协变量分析.结果: 1654例研究对象中, 男性901例(54.5%),女性753例(45.5%), 年龄22-90(平均年龄51.34±14.14)岁, 其中超声检出脂肪肝624例(37.7%). 多元回归分析显示年龄、甘油三酯、低密度脂蛋白胆固醇、血糖、UA、体质量指数、收缩压是脂肪肝的危险因素, 其中高密度脂蛋白胆固醇(HDL-C)是脂肪肝的保护因素. 空腹血糖调节受损(IFG)组及糖尿病组较血糖正常组相比脂肪肝患病风险分别增加了1.6、2.8倍( P<0.001); 超质量、Ⅰ度肥胖、Ⅱ度肥胖组与正常体质量组相比脂肪肝患病风险分别增加了1.7、1.9、9.1倍( P<0.001).结论: 糖代谢紊乱、高尿酸血症、高血压、肥胖及血脂异常增加了脂肪肝的患病风险. 脂肪肝指数的适用性还需要进一步的研究证实.     

脂肪肝危险因素Logistic回归分析

目的调查、分析我市城镇成年人群脂肪肝的患病率、发展趋势，同时试对脂肪肝危险因素进行Logistic回归分析，以进一步探求防治措施。方法通过询问病史、生活史及既往史，测量身高、体重、血压，检测血脂、血尿酸、血糖、胰岛素、肝功能、华支睾吸虫抗体、肝脏B超等，收集2003-2005年连续3年来在我科健康普查的11956名成人的临床资料，进行临床医学统计处理和分析。结果我市城镇成年人群脂肪肝患病率呈逐年上升趋势（由14．11％→16．33％→20．76％），其中以20～39岁患病率上升较明显，患病率随年龄增长而上升，脂肪肝患者中肝功能异常率为28．5％，饮酒、肥胖、高甘油三酯血症、高胆固醇血症、糖尿病或糖耐量异常、高尿酸血症、高血压、华支睾吸虫病均为脂肪肝的危险因素，其中脂肪肝各危险因素按危险风险大小顺序排列如下：饮酒〉肥胖〉高甘油三酯血症〉高胆固醇血症〉糖尿病或糖耐量异常〉高尿酸血症〉高血压〉华支睾吸虫病。结论中山市城镇成年人群近3年来脂肪肝患病率呈上升趋势，并随着年龄增长而上升，有呈年轻化的趋势，而且与华支睾吸虫病发病呈相关性。     

武汉水果湖地区脂肪肝的流行现状及危险因素分析

目的 研究脂肪肝及脂肪性肝炎在武汉水果湖地区的流行趋势、现状与危险因素.方法 回顾性收集武汉大学中南医院体检中心武汉市水果湖地区机关、学校、企业事业单位职员7247人,平均年龄（43.25±13.63）岁,男性4253人,女性2994人.测定体重指数、空腹血糖、丙氨酸氨基转移酶、胆固醇和甘油三脂等指标,并进行血压检测及腹部B超检查.结果 武汉水果湖地区体检人员检出脂肪肝1779例（24.5%）,其中男性1347例（75.7%）,女性432例（24.3%）.脂肪肝随年龄上升而上升,男性50～60岁患病率最高,女性60～70岁最高.脂肪肝随体重指数上升而上升,超重者及肥胖者1584人（89.0%）,其中肥胖者1226人（68.9%）.脂肪肝伴发高血压病者520例（29.2%）,空腹血糖大于6.1 mmol/L者447例（25.1%）,高血脂症者1128例（63.4%）.脂肪性肝炎发病率为4.9%.结论 城市脂肪肝发病率男性明显大于女性,60岁以后女性发病率大于男性.超重及肥胖、男性、增龄、高血压、高丙氨酸氨基转移酶、高脂血症、糖代谢紊乱等为脂肪肝危险因素.     

合并脂肪肝对急性胰腺炎严重程度的影响

目的 通过对比急性胰腺炎（AP）合并脂肪肝及不合并脂肪肝患者的临床及影像资料,评价合并脂肪肝对AP严重程度的影响。方法 收集2017年12月—2020年5月于内蒙古科技大学包头医学院第一附属医院收治的328例AP患者的临床资料,根据AP患者是否存在脂肪肝分为AP合并脂肪肝组（FLAP）和非合并脂肪肝组（NFLAP）。比较两组患者的一般资料、实验室检查指标及合并既往慢性病等参数之间的差异。分类变量以χ²检验进行组间的比较,连续性变量采用t检验或Mann-Whitney U检验进行数据的比较。采用Pearson 线性相关分析连续性变量之间的相关性;采用Spearman 等级相关分析等级变量之间的相关性。采用多因素logistic回归分析和卡方检验的方法分别评价中重度AP发生的影响因素及可能的风险预测指标。结果 在328例纳入研究的AP患者中,FLAP患者133例（40.55%）,NFLAP患者195例（59.45%）。AP的主要病因为高脂血症（42.1%）,其次为胆石症（39.3%）。FLAP患者的平均年龄显著低于NFLAP[（41.32±11.43）岁vs （54....     

761例成人脂肪肝患者的患病情况调查及相关危险因素分析

目的了解脂肪肝在本组成人中的患病情况及探讨脂肪肝发生的相关危险因素。方法对2009年在我院进行体检的3481名各类体检人员的体检资料进行统计,对比分析,内容包括健康咨询、空腹血糖、肝功能、血脂等指标及肝脏B超检查等。结果体检人员中检出脂肪肝患者761例(21.86%),经年龄和性别调整后,本组成人脂肪肝发生率21.6%。酒精性脂肪肝、可疑酒精性脂肪肝、非酒精性脂肪肝发生率分别为0.67%、0.83%和20.01%。脂肪肝发生率均随年龄增长而增加,50岁之前男性脂肪肝发生率显著高于女性。而50岁以后男女脂肪肝发生率相当。单因素分析显示,脂肪肝组的年龄、体重指数、腰围、腰臀比、舒张压、空腹血糖、甘油三酯、胆固醇、丙氨酸转氨酶均比非脂肪肝组显著为高。多元问归分析显示:甘油三酯、腰围、腰臀比、空腹血糖、体重指数、舒张压、丙氨酸转氨酶、年龄和男性等指标是脂肪肝的危险因素。结论成人脂肪肝发生率高,主要为非酒精性脂肪肝。高脂血症、超重及肥胖、糖尿病、高血压、高丙氨酸转氨酶、年龄、男性等为脂肪肝的危险因素。     

乌鲁木齐地区汉族成人脂肪肝及其相关危险因素的多元回归分析

目的了解乌鲁木齐地区机关汉族成人脂肪肝的临床特点及其相关危险因素。方法对机关工作的汉族健康体检者进行问卷调查、生化、肝脏超声检查等相关资料进行单因素和多因素logistic回归分析。结果脂肪肝患病率为26.8%,其中非酒精性脂肪肝患病率18.1%,酒精性脂肪肝患病率8.7%,男女脂肪肝患病率差异无显著性。单因素分析显示,非酒精性脂肪肝与年龄、胆固醇、甘油三酯、血糖、体重指数、腰围/臀围比值、吸烟、高脂饮食相关(P0.05);酒精性脂肪肝与年龄、胆固醇、饮酒相关(P0.05)。经多元回归分析,脂肪肝危险因素依次为TG、BMI、高脂饮食、TC。结论非酒精性脂肪肝的患病率与TG、BMI、TC、高脂饮食密切相关,饮酒是酒精性脂肪肝的独立危险因素,上述相关因素可作为预防和治疗脂肪肝的依据。     

老年脂肪肝的临床特点及相关危险因素

目的　探讨老年脂肪肝的独立危险因素及其临床特点。方法　回顾性分析 1 92例老年脂肪肝和 2 2 1例非老年脂肪肝病人的临床资料 ,并随机抽取非脂肪肝的老年患者 82例作为对照组。对老年脂肪肝组和对照组的血脂等变量进行回归分析 ,比较老年脂肪肝和非老年脂肪肝的临床特点和肝功能的改变。结果　酗酒 (OR =36 678)、体重指数 (OR =2 0 795)、甘油三酯 (OR =2 70 2 )、2型糖尿病 (OR =2 569)和空腹血糖 (OR=1 836)与老年脂肪肝的形成有关。老年脂肪肝组高血压、冠心病的发生率高于非老年脂肪肝组 ,而肥胖、高脂血症、乙型与丙型肝炎病毒感染的比例显著低于非老年脂肪肝组。老年脂肪肝组ALT升高的比例 (2 1 9% )显著低于非老年脂肪肝组 (39 4% ) ,A/G <1 5的比例 (2 6 0 % )高于非老年脂肪肝组 (1 5 4% )。结论　酗酒、肥胖、高甘油三酯血症、2型糖尿病和空腹血糖升高为老年患者发生脂肪肝的独立危险因素。老年脂肪肝患者更易合并高血压和冠心病。老年脂肪肝患者的肝功能改变以慢性损害多见。     

北京地区体检人群脂肪肝患病率及危险因素分析

目的了解北京市体检人群脂肪肝的患病率,分析其危险因素。方法对我院健康体检的14018名人员中脂肪肝患者的体重指数、血压、血脂、血糖、肝功能等检测结果与非脂肪肝组进行对比分析。结果脂肪肝的检出率为35.64％,男性明显高于女性,约是女性的1.63倍。男性脂肪肝的高发年龄是41-60岁,女性是61-70岁。脂肪肝组的腰围、体重指数、舒张压、血脂（TG、LDL-C、HDL-C）、血糖、血红蛋白、γ-谷氨酰基转移酶及丙氨酸氨基转移酶水平与非脂肪肝组比较差异均有显著性。脂肪肝组中肥胖、血脂异常、高血压、糖尿病的检出率显著高于非脂肪肝组（P〈0.05）。两组间乙肝病毒感染的比例无差异。结论肥胖、糖尿病、血脂异常、高血压是脂肪肝发病的危险因素。减轻体重和维持正常的血糖、血脂、血压水平是防治脂肪肝的重要措施。     

非酒精性脂肪肝与冠心病危险因素的相关性分析

目的探讨非酒精性脂肪肝（NAFLD）与冠心病危险因素之间的关系。方法从我院2008年5月—2010年3月间门诊就诊和健康体检者中,抽取患及未患非酒精性脂肪肝患者各86例,分析其与年龄、腰围（WI）、体重指数（BMI）、血压、谷丙转氨酶（ALT）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（GLU）、尿酸（UA）之间的关系。结果 NAFLD组有较高的ALT、TG、LDL-C、GLU、UA水平,与非NAFLD组比较,差异有统计学意义（P〈0.01）;NAFLD组合并冠心病和高血压的患病率明显高于非NAFLD组,差异有统计学意义（P〈0.05）。WI、BMI、高血压、高三酰甘油血症、高低密度脂蛋白血症、高血糖与脂肪肝关系密切,OR分别为7.795（P〈0.01）、5.782（P〈0.01）、1.673（P〈0.05）、3.575（P〈0.01）、3.871（P〈0.01）、2.396（P〈0.01）。结论非酒精性脂肪肝与肥胖、高血压、高三酰甘油血症、高低密度脂蛋白血症、高血糖等冠心病的危险因素有相关性。     

The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is closely associated with the metabolic syndrome. AIM: We evaluated the association among the metabolic syndrome, visceral fat accumulation, and the severity of fatty liver with a new scoring system of ultrasonographic findings in apparently healthy Japanese adults. METHODS: Subjects consisted of 94 patients who received liver biopsy and 4,826 participants who were selected from the general population. Two hepatologists scored the ultrasonographic findings from 0 to 6 points. We calculated Cohen's kappa of within-observer reliability and between-observer reliability. We evaluated the predictive value of the score by the area under a conventional receiver operating characteristic curve (AUC). RESULTS: Within-observer reliability was 0.95 (95% CI 0.93-0.97, P<0.001) and between-observer reliability was 0.95 (95% CI 0.93-0.97, P<0.001). The AUC to diagnose NAFLD was 0.980. The sensitivity was 91.7% (95% CI 87.0-95.1, P<0.001) and the specificity was 100% (95% CI 95.4-100.0, P<0.001). The AUC to diagnose visceral obesity was 0.821. The sensitivity was 68.3% (95% CI 51.9-81.9, P=0.028) and the specificity was 95.1% (95% CI 86.3-99.0, P<0.001). Adjusted odds ratio of the score for the metabolic syndrome was 1.37 (95% CI 1.26-1.49, P<0.001). CONCLUSIONS: The scoring system with abdominal ultrasonography could provide accurate information about hepatic steatosis, visceral obesity, and the metabolic syndrome in apparently healthy people who do not consume alcohol.     

脂质蓄积指数、内脏脂肪指数对非酒精性脂肪性肝病的预测价值

目的探讨脂质蓄积指数（LAP）和内脏脂肪指数（VAI）与非酒精性脂肪性肝病（NAFLD）的相关性,并评估其对NAFLD患病风险的预测价值。方法随机纳入2018年9月—2019年5月北京中日友好医院的708例体检受试者,分为NAFLD组（n=426）和非NAFLD组（n=282）,比较两组间LAP、VAI及相关生化指标差异。计量资料符合正态分布的2组间比较采用t检验,不符合正态分布者2组间比较采用Mann-Whitney U秩和检验。计数资料2组间比较采用χ²检验。应用Spearman进行相关性分析。然后将LAP、VAI根据四分位数水平分为四组（L1～L4;V1～V4）,比较各组间NAFLD的分布情况,采用logistic回归分析计算不同LAP、VAI水平NAFLD的发生风险,绘制不同性别和体质量亚组LAP、VAI、腰围（WC）、体质量指数（BMI）预测NAFLD的ROC曲线,以评估各指标对NAFLD的预测诊断价值。结果 NAFLD组受试者的年龄、男性、吸烟史占比以及LAP、VAI、WC、BMI、收缩压（SBP）、舒张压（DBP）、ALT、AST、总胆固醇（TC）、...     

Relationship between nonalcoholic fatty liver disease prevalence and visceral fat in obese adolescents

BACKGROUND: Visceral adiposity is the major risk factor for paediatric nonalcoholic fatty liver disease. AIMS: Determine the prevalence of nonalcoholic fatty liver disease according to the visceral fat quartile. SUBJECTS: 181 obese adolescents including 113 girls (16.58+/-1.56 years) and 68 boys (16.87+/-1.62 years) were evaluated. METHODS: The inclusion criteria were obesity and post-pubertal stage of Tanner. Visceral fat of obese adolescents was distributed in quartiles after ultrasound nonalcoholic fatty liver disease diagnosis. RESULTS: Nonalcoholic fatty liver disease prevalence was 45.30%. It was observed that 62.07% and 76.47% of girls and boys with nonalcoholic fatty liver disease were found in the 4th quartile. In a multivariate logistic analysis it was observed that only visceral fat remained statistically significant, every 1cm increase in visceral fat was associated with a 1.97 fold (95% CI 1.06-3.66) in boys and 2.08 fold (95% CI 1.38-3.13) in girls increased risk to develop nonalcoholic fatty liver disease. Indeed it was verified a positive correlation between visceral fat, body mass index, insulin levels, homeostasis model assessment insulin resistance index and steatosis degree. CONCLUSIONS: Our findings suggested that the expansion of visceral fat was a determinant factor to increase nonalcoholic fatty liver disease prevalence and the visceral fat measured by ultrasound might be a good predictor to identify risk for nonalcoholic fatty liver disease in obese adolescents. It was confirmed by a stronger correlation between visceral fat and body mass index.     

Relationship between visceral fat accumulation and hypertension in obese men

PURPOSE: Visceral-fat (VF) accumulation is suggested to be a major contributor to such cardiovascular-disease risk factors as hypertension (H), glucose intolerance (G), and hyperlipidemia (L). We have devised a simple way of estimating VF accumulation, and investigated the relationship between VF and hypertension in obese men. METHODS: First, CT scan was used to measure VF area in the umbilical region in 108 obese men. Then the umbilical-region circumference (C) was measured with a tape measure and abdominal skinfold thickness (S) with a skinfold caliper. The data obtained with a model formula (VFe = alphaC2 - betaCS + gamma) and actual VF area were compared, and three coefficients, alpha, beta, and gamma, were calculated by means of multivariate analysis. Next, in 354 male company employees, VFe was estimated using this model formula, and cardiovascular risk factors were investigated. RESULTS: The formula for estimating VF (cm2) was VFe = 0.03C2 - 0.36CS - 47 (correlation coefficient; r = 0.72). Discriminant analysis between the merely obese group (O) and thegroup complicated by multiple cardiovascular risk factors (O, H, G, and L) determined a VFe-cutoff value of 120 cm2. Its discriminant sensitivity/specificity values were significantly higher than those based on body mass index (BMI) (cutoff value of 27 kg/m2) (p < 0.05). Hypertensive obese (HO) men with high VFe value (> 120 cm2) had a higher frequency of other risk factors (G or L: 86%). CONCLUSION: VFe is considered useful in estimating VF accumulation, and seems more effective than BMI for predicting multiple cardiovascular risk factors (VF syndrome) in obese hypertensive men.     

腹部内脏脂肪与冠状动脉狭窄的关系

目的:探讨冠心病患者腹部内脏脂肪与冠状动脉狭窄程度的关系。方法:选自2007-11-2009-03在我院经冠状动脉造影证实为冠心病的206患者为研究对象。记录身高、体重、腰围、血压等,检测受试者的血脂、空腹血糖、尿酸、肾功能等指标,采用定量Gensini积分评价患者冠状动脉狭窄的程度,同时应用超声测量腹部内脏脂肪厚度(visceral fat thick ness,VFT),根据VFT值将患者分为低、中、高值3组。结果:与低值组比较,中、高值组患者腰围、体质指数较大,TG明显增高,HDL-C水平显著降低。随着腹部内脏脂肪厚度的增加,Gensini积分明显增大。Gensini积分与年龄、腰围、体质指数、TG、LDL-C、VFT呈正相关,与HDL-C呈负相关。多元回归分析显示年龄,LDL-C、糖尿病和VFT是冠状动脉狭窄的独立危险因素,但是校正腰围后VFT不再有统计学意义。结论:冠心病患者VFT与冠状动脉狭窄呈明显正相关,VFT测量可以作为冠心病患者危险评估的有用指标。     

Relationship between visceral fat accumulation and physical fitness in Japanese women

OBJECTIVE: To investigate the link between visceral fat (V) accumulation and physical fitness. DESIGN: Cross-sectional clinical investigation study. SUBJECTS: Twenty-eight overweight Japanese women with abdominal obesity (abdominal obesity) (body mass index, BMI>or=25, visceral fat area>or=100 cm2) aged 38-65 years (BMI 29.5+/-3.3 kg/m2) were enrolled in this study. They were compared with age and sex matched 28 normal weight subjects (BMI<25, visceral fat area<100 cm2) and 28 overweight subjects without abdominal obesity (overweight) (BMI>or=25, visceral fat area<100 cm2). Measurements: Fat distribution was evaluated by visceral fat and subcutaneous fat (S) areas measured by computed tomography (CT) scanning at umbilical level. Anthropometric parameters, aerobic exercise level, muscle strength, flexibility and blood examination were also investigated. RESULTS: Anthropometric and body composition parameters were significantly higher in abdominal obesity subjects than those in normal weight subjects. BMI, waist circumference, waist hip ratio and visceral fat (V) area were also significantly higher than those in overweight subjects. Reduced oxygen uptake at ventilatory threshold (VT), lowering weight bearing index (WBI), and elevation of blood enzymes were noted in abdominal obesity subjects. There were significant relationships between oxygen uptake at VT and visceral fat area, and also between oxygen uptake at VT and WBI. CONCLUSION: Reduced aerobic exercise level and WBI are characteristic and visceral fat may play an important role for the etiology in Japanese women with abdominal obesity.     

冠心病患者腹部内脏脂肪厚度与冠状动脉狭窄程度的关系

目的探讨冠心病患者腹部内脏脂肪厚度（VFT）与冠状动脉狭窄程度的关系。方法对158例冠心病患者的冠状动脉狭窄（CAS）程度进行Gemini积分,应用超声测量VFT。结果与低值组比较,中、高值组患者腰围、体重指数、甘油三酯（TG）明显增高,高密度脂蛋白胆固醇（HDL-C）显著降低。随着VFT增加,Gensini积分明显增大。Gensini积分与年龄、腰围、体重指数、TG、低密度脂蛋白和胆固醇呈正相关,与HDL—C呈负相关。校正年龄、性别、腰围后,VFT仍然与Gensini积分相关,但进一步校正其他心血管危险因素后不再明显。结论VFT与冠状动脉狭窄程度关系密切。