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上海市成人脂肪肝患病率及其危险因素流行病学调查

Epidemiological survey of prevalence of fatty liver and its risk factors in a genera] adult population of Shanghai

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【作者】 范建高朱军李新建李锐戴菲宋晓敏陈兰李锋陈世耀

【Author】 FAN Jian-gao, ZHU Jun, LI Xin-jian, LI Rui, DAI Fei, SONG Xiao-min, CHEN Lan, LI Feng, CHEN Shi-yao. Fatty Liver Research Center, Shanghai First People’s Hospital, Jiaotong University, Shanghai 200080, China

【机构】 上海交通大学附属第一人民医院脂肪肝诊治中心上海市疾病预防控制中心慢性病科上海第二医科大学公共卫生学院杨浦区中心医院防保科复旦大学附属中山医院循证医学中心 200080200080

【摘要】 目的 明确上海市成人脂肪肝的患病率及其主要危险因素。 方法 通过随机多级分层整群抽样对杨浦区和浦东新区各4个居委会16岁以上居民进行调查,内容涉及问卷咨询、体格检查、75 g葡萄糖耐量试验、血脂检测、以及肝脏实时超声检查。 结果 3175名成人完成调查,约占上海市人口的2.26/10000。其中男性1218名,女性1957名,平均年龄(52.4±15.1)岁。B超共检出脂肪肝661例,占20.82%,其中酒精性、可疑酒精性、非酒精性脂肪肝分别占3.48%、4.08%及92.43%。经年龄和性别调整后,上海市成人脂肪肝患病率为17.29%,酒精性脂肪肝、可疑酒精性脂肪肝、非酒精性脂肪肝患病率分别为0.79%、1.15%、15.35%。无论是男性还是女性,脂肪肝患病率均随年龄增长而增加,50岁之前男性脂肪肝患病率显著高于女性(x2=13.934,P<0.01),而50岁以后女性脂肪肝患病率显著高于男性(x2=4.146,P<0.05)。脂肪肝组年龄、体重指数(BMI)、腰围、血压、空腹及餐后血糖、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、肥胖、糖尿病、高血压病、血脂异常和胆石症患病率等均显著高于对照组,高密度脂蛋白胆固醇(HDL-C)水平以及文化程度显著低于对照组。多元回归分析显示:男性、文化程度、腰围、BMI、HDL-C、TG、空腹血糖水平、糖尿病、?

【Abstract】 Objective To investigate the prevalence and major risk factors of fatty liver among adult residents in Shanghai. Methods A cross-sectional survey with multiple-stage stratified cluster and random sampling was performed. All residents aged 16 and above were invited to participate in the survey; they came from four communities of Yangpu District and Pudong New District. Questionnaire, physical examination, serum lipid-profile, and 75 gram oral glucose tolerance test and ultrasonographic examination of liver were undertaken. Analysis of data was performed through SPSS 11.0 for Windows statistical package. Results A total of 3175 residents took part in the survey, which was 75% of adult residents of the investigated communities and 2.26/10 000 of Shanghai municipal residents. Of the 3175, 1218 were males and 1957 were females. The mean age of the participants was 52.4±15.1 years and ranged from 16~88 years. Fatty liver was detected with ultrasound examination in 661 participants (20.82%), among which 3.48% had alcoholic fatty liver, 4. 08% had suspected alcoholic fatty liver, and 92.43% had nonalcoholic fatty liver. The age-adjusted, sex-adjusted prevalence of fatty liver in Shanghai adult residents was 17.29%, the prevalence of alcoholic fatty liver, suspicious alcoholic fatty liver, and nonalcoholic fatty liver in Shanghai adult residents were 0.79%, 1.15%, and 15.35%, respectively. The prevalence of fatty liver was increased with aging in males and in females. Among participants younger than 50 years old,the prevalence of fatty liver in males was significantly higher than that in females (x2 =13.934, P < 0.01), but in participants older than 50 years the case was just the opposite, higher in females (x2 = 4.146, P < 0.05). The mean age (years), body mass index (BMI), waist circumference, blood pressure, fasting and two hour serum glucose level, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and the presence of obesity, diabetes mellitus, hypertension, dyslipidemia, and gallstones in the fatty liver group was significantly higher than those in the group without fatty liver (all P < 0.001), but the high-density lipoprotein cholesterol (HDL-C) level and the educational level were both lower in the fatty liver group (P < 0.001 and 0.05, respectively). Logistic regression analysis demonstrated that the prevalence of fatty liver was only positively correlated to nine risk factors, including male sex, educational level, waist circumference, BMI, fasting glucose level, HDL-C, TG, hypertension and diabetes mellitus. In heavy drinkers, obesity increased the risk for fatty liver by 4.8-fold (95% CI 1.4-16.6, P = 0.0141), but heavy drinking only increased the risk for fatty liver 1.5-fold (95% CI 0.9-2.6, P = 0.1685). Conclusions There is a high prevalence of fatty liver among adult residents in Shanghai, and nonalcoholic fatty liver is the major type. Metabolic disorders such as obesity and diabetes mellitus, hypertension and hyperlipidemia are more closely associated with fatty liver than heavy drinking in Shanghai.

【关键词】 脂肪肝; 流行病学; 患病率; 危险因素;

【Key words】 Fatty liver; Epidemiological survey; Prevalence; Risk factors;

【分类号】R575.5;R181.13;R195.4;

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