Fan Jian-Gao, Li Fen, Cai Xiao-Bo, Peng Yong-De, Ao Qing-Hong, Gao Yan
Center for Fatty Liver, Shanghai First People's Hospital, Jiaotong University, Shanghai, China.
J Gastroenterol Hepatol. 2007 Jul;22(7):1086-91. doi: 10.1111/j.1440-1746.2006.04781.x.
Nonalcoholic fatty liver disease (NAFLD) is considered to be the liver component of metabolic syndrome. However, the impact of NAFLD on metabolic syndrome is unclear. The aim of this study was to explore the influence of NAFLD on the development of metabolic disorders.
Patients with NAFLD and an age, sex, and occupation-matched control group were recruited from employees of Bao-Steel Group (Shanghai, China) who had received medical check-ups biennially between 1995 and 2002. Anthropometric and laboratory data, and incidence of metabolic disorders were assessed at baseline and at follow-up of at least 4 years. SPSS 11.5 was used for statistical analysis.
The study consisted of 358 patients (326 men and 32 women) and 788 matched controls (711 men and 77 women) with a similar mean age of 39.0 years and median follow-up of 6 years. At the end of follow-up, incidence of obesity (47.6% vs 19.5%), hypertension (69.6% vs 16.3%), hypertriglyceridemia (39.1% vs 16.3%), hypercholesterolemia (24.5% vs 17.3%), impaired fasting glucose (IFG) (25.1% vs 11.6%), diabetes mellitus (20.3% vs 5.2%) and multiple metabolic disorders (MMD) (56.3% vs 16.3%) were significantly higher in the fatty liver group than the control group. Interestingly, the mean alanine aminotransferase (ALT) level in patients with fatty liver significantly decreased at follow-up compared with baseline (28.56 +/- 18.86 vs 31.51 +/- 18.34 U/L, P < 0.05). To separate the effects of obesity from fatty liver, the subjects were re-classified according to the presence of obesity and fatty liver at baseline. The incidence of hypertension (61.1% vs 41.3%), hypertriglyceridemia (38.1% vs 15.0%), hypercholesterolemia (29.9% vs 16.6%), IFG (21.3% vs 10.0%) and diabetes (11.1% vs 4.3%) were significantly higher in the fatty liver group without obesity (n = 84) than in the group with without fatty liver or obesity (n = 614). In addition, the incidence of hypertension (72.9% vs 57.4%), hypertriglyceridemia (39.4% vs 22.7%) and diabetes (23.2% vs 8.4%) was higher in the group with fatty liver and obesity (n = 274) than in the group with obesity alone (n = 174).
The presence of NAFLD might predict the development of metabolic disorders due to insulin resistance, rather than obesity itself. ALT levels decreased over time in patients with fatty liver.
非酒精性脂肪性肝病（NAFLD）被认为是代谢综合征的肝脏组成部分。然而，NAFLD对代谢综合征的影响尚不清楚。本研究旨在探讨NAFLD对代谢紊乱发展的影响。
从宝钢集团（中国上海）的员工中招募NAFLD患者及年龄、性别和职业匹配的对照组，这些员工在1995年至2002年期间每两年接受一次体检。在基线和至少4年的随访中评估人体测量和实验室数据以及代谢紊乱的发生率。使用SPSS 11.5进行统计分析。
该研究包括358例患者（326例男性和32例女性）和788例匹配的对照组（711例男性和77例女性），平均年龄相似，为39.0岁，中位随访时间为6年。随访结束时，脂肪肝组肥胖（47.6%对19.5%）、高血压（69.6%对16.3%）、高甘油三酯血症（39.1%对16.3%）、高胆固醇血症（24.5%对17.3%）、空腹血糖受损（IFG）（25.1%对11.6%）、糖尿病（20.3%对5.2%）和多重代谢紊乱（MMD）（56.3%对16.3%）的发生率显著高于对照组。有趣的是，与基线相比，脂肪肝患者的平均丙氨酸转氨酶（ALT）水平在随访时显著降低（28.56±18.86对31.51±18.34 U/L，P<0.05）。为了区分肥胖与脂肪肝的影响，根据基线时肥胖和脂肪肝的存在情况对受试者进行重新分类。无肥胖的脂肪肝组（n = 84）高血压（61.1%对41.3%）、高甘油三酯血症（38.1%对15.0%）、高胆固醇血症（29.9%对16.6%）、IFG（21.3%对10.0%）和糖尿病（11.1%对4.3%）的发生率显著高于无脂肪肝或肥胖的组（n = 614）。此外，有脂肪肝和肥胖的组（n = 274）高血压（72.9%对57.4%）、高甘油三酯血症（39.4%对22.7%）和糖尿病（23.2%对8.4%）的发生率高于仅肥胖组（n = 174）。
NAFLD的存在可能预示着由于胰岛素抵抗而非肥胖本身导致的代谢紊乱的发展。脂肪肝患者的ALT水平随时间下降。
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