非酒精性脂肪性肝病的发病率及危险因素：一项针对城市成年斯里兰卡人的 7 年随访研究。
Incidence and risk factors for non-alcoholic fatty liver disease: A 7-year follow-up study among urban, adult Sri Lankans.
机构信息
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
出版信息
Liver Int. 2017 Nov;37(11):1715-1722. doi: 10.1111/liv.13478. Epub 2017 Jun 10.
BACKGROUND
This study investigated incidence and risk factors for NAFLD among an adult cohort with 7-year follow-up.
METHODS
The study population (age-stratified random sampling, Ragama MOH area) was screened initially in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. NAFLD was diagnosed on ultrasound criteria, safe alcohol consumption and absence of hepatitis B/C markers. Non-NAFLD controls did not have any ultrasound criteria for NAFLD. An updated case-control genetic association study for 10 selected genetic variants and NAFLD was also performed.
RESULTS
Out of 2985 of the original cohort, 2148 (72.0%) attended follow-up (1238 [57.6%] women; mean-age 59.2 [SD-7.6] years) in 2014, when 1320 (61.5%) were deemed NAFLD subjects. Out of 778 who initially did not have NAFLD and were not heavy drinkers throughout follow-up, 338 (43.4%) (221 [65.4%] women, mean-age 57.8 [SD-8.0] years) had developed NAFLD after 7-years (annual incidence-6.2%). Central obesity (OR=3.82 [95%-CI 2.09-6.99]), waist increase >5% (OR=2.46 [95%-CI 1.20-5.05]) overweight (OR=3.26 [95%-CI 1.90-5.60]), weight gain 5%-10% (OR=5.70 [95%-CI 2.61-12.47]), weight gain >10% (OR=16.94 [95%-CI 6.88-41.73]), raised plasma triglycerides (OR=1.96 [95%-CI 1.16-3.29]) and diabetes (OR=2.14 [95%-CI 1.13-4.06]), independently predicted the development of incident NAFLD in multivariate analysis. The updated genetic association study (1362-cases, 392-controls) showed replicated association (P=.045, 1-tailed) with NAFLD at a candidate locus: PNPLA3 (rs738409).
CONCLUSIONS
In this community cohort study, the annual incidence of NAFLD was 6.2%. Incident NAFLD was associated with general and central obesity, raised triglycerides and diabetes, and showed a tendency of association with PNPLA3 gene polymorphisms.
背景
本研究通过对随访 7 年的成年队列进行研究，调查非酒精性脂肪性肝病（NAFLD）的发病率和危险因素。
方法
研究人群（分层随机抽样，拉嘎马莫卫生局地区）最初于 2007 年（35-64 岁）进行筛查，并于 2014 年（42-71 岁）重新评估。两次均通过结构化访谈、人体测量、肝脏超声、生化和血清学检查进行评估。根据超声标准、安全饮酒和无乙型肝炎/丙型肝炎标志物诊断 NAFLD。非 NAFLD 对照组没有任何超声标准的 NAFLD。还对 10 个选定的遗传变异和 NAFLD 进行了更新的病例对照遗传关联研究。
结果
在最初的 2985 名队列中，有 2148 名（72.0%）参加了 2014 年的随访（女性 1238 名[57.6%]；平均年龄 59.2 [SD-7.6]岁），其中 1320 名（61.5%）被认为是 NAFLD 患者。在最初没有 NAFLD 且整个随访期间没有大量饮酒的 778 名患者中，有 338 名（43.4%）（女性 221 名[65.4%]，平均年龄 57.8 [SD-8.0]岁）在 7 年后发展为 NAFLD（年发病率为 6.2%）。中心性肥胖（OR=3.82[95%CI 2.09-6.99]）、腰围增加>5%（OR=2.46[95%CI 1.20-5.05]）、超重（OR=3.26[95%CI 1.90-5.60]）、体重增加 5%-10%（OR=5.70[95%CI 2.61-12.47]）、体重增加>10%（OR=16.94[95%CI 6.88-41.73]）、血浆甘油三酯升高（OR=1.96[95%CI 1.16-3.29]）和糖尿病（OR=2.14[95%CI 1.13-4.06]）在多变量分析中独立预测了 NAFLD 的发生。更新后的遗传关联研究（1362 例病例，392 例对照）显示候选基因座：PNPLA3（rs738409）与 NAFLD 具有复制关联（P=.045，单侧）。
结论
在这项社区队列研究中，NAFLD 的年发病率为 6.2%。新发 NAFLD 与全身和中心性肥胖、甘油三酯升高和糖尿病有关，并与 PNPLA3 基因多态性呈趋势相关。
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