代谢综合征各组分与非酒精性脂肪肝发生的回顾性巢式病例对照研究

目的 研究天津市体检人群非酒精性脂肪肝（NAFLD）自然新发情况及与基线代谢综合征各组分指标间的关系。方法 采取回顾性巢式病例对照研究，收集2011年（基线）和2013年均在天津市第一中心医院健康体检中心接受体检的3 842人的体检结果，包括体格检查、生化指标测定结果、饮酒史、用药史及B超诊断结果等。分析基线（2011年）无脂肪肝人群到2013年NAFLD自然新发情况，并采用主成分改进的Logistic回归分析基线代谢综合征各组分指标与新发NAFLD间的关联性。结果 基线无NAFLD的1 226人中2年内有224人新发生NAFLD，累积发病率为18.30%，根据全国2010年人口普查人口结构进行标化，年均标化发病率为8.17%，其中男性为10.91%，女性为5.36%；单因素分析显示:新发NAFLD组基线体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、空腹血糖（FBG）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、极低密度脂蛋白胆固醇（VLDL-C）、丙氨酸转氨酶（ALT）与尿酸（UA）水平均高于对照组，高密度脂蛋白胆固醇（HDL-C）水平低于对照组（P ＜0.05）；主成分改进的Logistic回归进行多因素分析显示:基线BMI（OR = 1.211）、TG（OR = 1.446）、LDL-C（OR = 1.216）、UA（OR = 1.001）是NAFLD发生的独立危险因素，HDL-C（OR = 0.394）是独立保护因素。结论 在天津市体检人群中，基线MS各组分指标与NAFLD的发生密切相关，并且基线BMI、TG、LDL-C、UA是NAFLD发生的独立危险因素，HDL-C是独立保护因素，可以认为NAFLD是代谢综合征在肝脏的表现。

A retrospective nested case-control study on correlation between components of metabolic syndrome and non-alcoholic fatty liver disease

Objective The aim of this study was to investigate the nature incidence of NAFLD and the relationship with baseline components of metabolic syndrome (MS) in a representative sample of the health check-up population in Tianjin. Methods The retrospective nested case-control study was performed in 3842 subjects who participated in health examination in the health examination center of Tianjin First Center Hospital in 2011 and 2013. Data for physical examination, biochemistry indexes, alcohol consumption, medical history and B-ultrasonic test were collected. The population without NAFLD in 2011 and occurrence of NAFLD in 2013 were analyzed. The principal component transformational logistic regression analysis was used to analyze the relationship of baseline components of metabolic syndrome (MS) and occurrence of NAFLD. Results In 2013, 224 subjects suffered newly NAFLD among 1226 without baseline NAFLD in 2011, and the cumulative incidence was 18.30%. The average annual standardized incidence was 8.17% ( 10.91% for males and 5.36% for females) according to the Chinese population census in 2010. Univariate analysis showed that the baseline BMI、SBP、DBP、FBG、TG、LDL-C、VLDL-C、ALT and UA in new NAFLD group were significantly higher than control group, and the level of HDL-C was lower in new NAFLD group（P＜0.05）. With the principal component transformational logistic regression analysis, the results showed that risk factors for NAFLD were baseline BMI (OR=1.211)、TG (OR=1.446)、LDL-C (OR=1.216)and UA (OR=1.001), and the protective factor was baseline HDL-C (OR=0.394). Conclusion The baseline components of metabolic syndrome (MS) were closely related to the occurrence of NAFLD in the health examination population of Tianjin. The elevated baseline BMI、TG、LDL-C、UA 、HDL-C were independent predictors for NAFLD occurrence and NAFLD should be served as the manifestation of MS in liver.