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中国成年人健康体检中无创诊断的肝脂肪变性与慢性肾脏病之间的关联

Association between non-invasively diagnosed hepatic steatosis and chronic kidney disease in Chinese adults on their health check-up.

作者信息

Zeng Jing, Sun Chao, Sun Wan Lu, Chen Guang Yu, Pan Qin, Yan Shi Yan, Xu Zheng Jie, Chen Yuan Wen, Fan Jian Gao

机构信息

Department of Gastroenterology, Center for Fatty Liver, Xin Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

J Dig Dis. 2017 Apr;18(4):229-236. doi: 10.1111/1751-2980.12465.

Abstract

OBJECTIVE

To explore the association between chronic kidney disease (CKD), graded by the estimated glomerular filtration rate (eGFR), and non-alcoholic fatty liver disease (NAFLD) using controlled attenuation parameter (CAP) and fatty liver index (FLI) values in Chinese adults undergoing routine health examinations.

METHODS

A total of 731 adult participants without diabetes mellitus or significant alcohol consumption who underwent routine health examinations were included. Their eGFR, CAP, FLI and abdominal ultrasonography results were assessed.

RESULTS

The prevalence of ultrasound-diagnosed NAFLD and CKD (eGFR <60 mL/min per 1.73 m ) was 36.1% and 6.6%, respectively. CKD was more common in NAFLD patients than in those without (10.6% vs 4.3%, P < 0.001). The CAP and FLI values were significantly higher in the NAFLD group than in those without, but the change in the eGFR was negligible between the two groups. eGFR was negatively correlated with CAP (r = -0.189, P = 0.003) and FLI values (r = -0.130, P = 0.045). Moreover, eGFR was significantly lower in participants with CAP >292 dBm or FLI ≥60 than in those with CAP <238 dBm or FLI <30, respectively (both P < 0.05). The CAP value (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.091-1.108, P = 0.021) was an independent risk factor for CKD.

CONCLUSIONS

A diagnosis of hepatic steatosis is related to an increased risk of CKD among non-alcoholic and non-diabetic Chinese adults regardless of whether the diagnosis was acquired via ultrasound, CAP or FLI. Increased hepatic lipid content may contribute to CKD development.

摘要

目的

在中国接受常规健康检查的成年人中,利用受控衰减参数(CAP)和脂肪肝指数(FLI)值,探讨根据估计肾小球滤过率(eGFR)分级的慢性肾脏病(CKD)与非酒精性脂肪性肝病(NAFLD)之间的关联。

方法

纳入731名接受常规健康检查、无糖尿病或大量饮酒史的成年参与者。评估他们的eGFR、CAP、FLI及腹部超声检查结果。

结果

超声诊断的NAFLD和CKD(eGFR<60ml/(min·1.73m²))患病率分别为36.1%和6.6%。CKD在NAFLD患者中比在非NAFLD患者中更常见(10.6%对4.3%,P<0.001)。NAFLD组的CAP和FLI值显著高于非NAFLD组,但两组间eGFR的变化可忽略不计。eGFR与CAP(r = -0.189,P = 0.003)和FLI值(r = -0.130,P = 0.045)呈负相关。此外,CAP>292dBm或FLI≥60的参与者的eGFR分别显著低于CAP<238dBm或FLI<30的参与者(均P<0.05)。CAP值(比值比[OR]1.099,95%置信区间[CI]1.091 - 1.108,P = 0.021)是CKD的独立危险因素。

结论

对于非酒精性、非糖尿病的中国成年人,无论肝脂肪变性诊断是通过超声、CAP还是FLI获得,其均与CKD风险增加相关。肝脏脂质含量增加可能促使CKD的发生发展。

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