肺功能下降与非酒精性脂肪性肝病发病风险的相关性：一项纵向队列研究。
Decreased lung function is associated with risk of developing non-alcoholic fatty liver disease: A longitudinal cohort study.
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
PLoS One. 2019 Jan 23;14(1):e0208736. doi: 10.1371/journal.pone.0208736. eCollection 2019.
BACKGROUND
Decreased lung function is associated with non-alcoholic fatty liver disease (NAFLD), based on linking mechanisms such as insulin resistance and systemic inflammation However, its association with the risk of developing NAFLD is unclear. Our aim was to investigate whether baseline lung function is associated with incident NAFLD in middle-aged healthy Koreans.
METHODS
A cohort study of 96,104 subjects (mean age: 35.7 years) without NAFLD were followed up from 2002 to 2015. NAFLD was diagnosed by ultrasound after the exclusion of other possible causes of liver diseases. Baseline percent predicted forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%) were categorized in quartiles. Adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) (using the highest quartile as reference) were calculated for incident NAFLD at follow-up, controlling for covariates and potential confounders.
RESULTS
During 579,714.5 person-years of follow-up, 24,450 participants developed NAFLD (incidence rate, 42.2 per 1,000 person-years). The mean follow-up period was 5.9±3.4 years. Regardless of smoking history, the risk for incident NAFLD increased with decreasing quartiles of FEV1 (%) and FVC (%) in a dose-response manner (p for trend<0.001). In never smokers, the aHRs (95% CIs) for incident NAFLD were 1.15 (1.08-1.21), 1.11 (1.05-1.18), and 1.08 (1.02-1.14) in quartiles 1-3 for FEV1 (%) and 1.12 (1.06-1.18), 1.11 (1.05-1.18), and 1.09 (1.03-1.15) in quartiles 1-3 for FVC (%), compared with the highest quartile reference. Similar inverse association was present in smoke-exposed subjects (aHR for incident NAFLD were 1.14, 1.21, 1.13 and 1.17, 1.11, 1.09 across FEV1(%) and FVC(%) quartile in increasing order, respectively).
CONCLUSIONS
Reduced lung function was a risk factor for incident NAFLD in a large middle-aged Korean cohort with over half a million person-years of follow-up.
背景
非酒精性脂肪性肝病（NAFLD）与肺功能下降有关，其关联机制包括胰岛素抵抗和全身炎症等。然而，肺功能与 NAFLD 发病风险之间的关系尚不清楚。本研究旨在探讨中年韩国健康人群中，基线肺功能与 NAFLD 发病的关系。
方法
这是一项队列研究，共纳入 96104 名无 NAFLD 的受试者（平均年龄：35.7 岁），随访时间从 2002 年至 2015 年。NAFLD 通过超声检查排除其他可能导致肝脏疾病的原因后进行诊断。将基线时预测的 1 秒用力呼气量百分比（FEV1%）和用力肺活量百分比（FVC%）按四分位数进行分类。以最高四分位数为参考，采用调整后的风险比（aHR）及其 95%置信区间（CI）来计算随访期间 NAFLD 的发病情况，并对协变量和潜在混杂因素进行校正。
结果
在 579714.5 人年的随访期间，24450 名参与者发生了 NAFLD（发病率为 42.2/1000 人年）。平均随访时间为 5.9±3.4 年。无论吸烟史如何，FEV1（%）和 FVC（%）四分位数越低，NAFLD 发病风险呈剂量反应性增加（趋势检验 P<0.001）。在从不吸烟者中，与 FEV1（%）最高四分位数相比，第 1-3 四分位数的 aHR（95%CI）分别为 1.15（1.08-1.21）、1.11（1.05-1.18）和 1.08（1.02-1.14），而 FVC（%）第 1-3 四分位数的 aHR（95%CI）分别为 1.12（1.06-1.18）、1.11（1.05-1.18）和 1.09（1.03-1.15）。在暴露于烟雾的受试者中也存在类似的反比关系（NAFLD 发病的 aHR 分别为 1.14、1.21、1.13 和 1.17、1.11、1.09，随着 FEV1（%）和 FVC（%）四分位数的升高而升高）。
结论
在一项超过 50 万人年随访的大型韩国中年队列中，肺功能下降是 NAFLD 发病的一个危险因素。
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