Tian Jianbo, Zhong Rong, Liu Cheng, Tang Yuhan, Gong Jing, Chang Jiang, Lou Jiao, Ke Juntao, Li Jiaoyuan, Zhang Yi, Yang Yang, Zhu Ying, Gong Yajie, Xu Yanyan, Liu Peiyi, Yu Xiao, Xiao Lin, Du Min, Yang Ling, Yuan Jing, Wang Youjie, Chen Weihong, Wei Sheng, Liang Yuan, Zhang Xiaomin, He Meian, Wu Tangchun, Yao Ping, Miao Xiaoping
Department of Epidemiology and Biostatistics and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, Hubei, China.
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China.
Sci Rep. 2016 Aug 3;6:31006. doi: 10.1038/srep31006.
The study aimed to assess the association between total, direct, and indirect bilirubin and nonalcoholic fatty live disease (NAFLD) risk given its high prevalence and serious clinical prognosis. Among 27,009 subjects who participated in a healthy screening program from the Dongfeng-Tongji cohort study in 2008, 8189 eligible subjects (aged 35-86 years; males, 43.95%) were ultimately enrolled. The incidence rates of NAFLD in 2013 were compared with respect to baseline bilirubin levels among subjects free of NAFLD, and the effect sizes were estimated by logistic regression analysis. During 5 years follow-up, we observed 1956 cases of newly developed NAFLD with the overall incidence of 23.88%. Direct bilirubin was presented to inversely associate with NAFLD risk. Compared with quartile 1 of direct bilirubin, the multivariable-adjusted ORs (95% CIs) for NAFLD of quartile 2 to 4 were 1.104 (0.867-1.187), 0.843 (0.719-0.989), and 0.768 (0.652-0.905), respectively, P for trend 0.002). Similarly, inverse effects of direct bilirubin on NAFLD incidence were also observed when stratified by sex and BMI. However, no significant associations were found between total, and indirect bilirubin and NAFLD risk. Direct bilirubin reduced NAFLD risk independent of possible confounders among middle-aged and elderly Chinese population, probably based on the endogenous antioxidation of bilirubin.
鉴于非酒精性脂肪性肝病（NAFLD）的高患病率和严重的临床预后，本研究旨在评估总胆红素、直接胆红素和间接胆红素与NAFLD风险之间的关联。在2008年东风-同济队列研究中参与健康筛查项目的27009名受试者中，最终纳入了8189名符合条件的受试者（年龄35-86岁；男性占43.95%）。比较了2013年无NAFLD受试者的基线胆红素水平与NAFLD发病率，并通过逻辑回归分析估计效应量。在5年的随访期间，我们观察到1956例新发生的NAFLD病例，总发病率为23.88%。直接胆红素与NAFLD风险呈负相关。与直接胆红素四分位数1相比，直接胆红素四分位数2至4的NAFLD多变量调整OR（95%CI）分别为1.104（0.867-1.187）、0.843（0.719-0.989）和0.768（0.652-0.905），趋势P值为0.002）。同样，按性别和BMI分层时，也观察到直接胆红素对NAFLD发病率的反向影响。然而，未发现总胆红素和间接胆红素与NAFLD风险之间存在显著关联。在中老年中国人群中，直接胆红素独立于可能的混杂因素降低了NAFLD风险，这可能基于胆红素的内源性抗氧化作用。
