Wu T, Zou Y W, Ma J D, Chen C T, Zhang X P, Lin J Z, Xu Y H, Yang K M, Zhang Q, Zou Y Y, Mo Y Q, Dai L
Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2022 May 6;56(5):574-582. doi: 10.3760/cma.j.cn112150-20210706-00647.
To investigate the characteristics of non-alcoholic fatty liver disease (NAFLD) and its associated factors in rheumatoid arthritis (RA) patients. This cross-sectional study recruited 385 RA patients [including 72 (18.7%) male and 313 (81.3%) female] who received abdominal sonographic examination from August 2015 to May 2021 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. There were 28 RA patients at 16-29 years old and 32, 80, 121, 99, 25 at 30-39, 40-49, 50-59, 60-69, ≥ 70 years old, respectively. Demographic and clinical data were collected including age, gender, history of alcohol consumption, disease duration, body mass index (BMI), waist circumference, blood pressure, RA disease activity indicators and previous medications. Logistic regression analyses were used to identify the associated factors of NAFLD in RA patients. The prevalence of NAFLD was 24.2% (93/385) in RA patients, 26.3% (21/80) in 40-49 age group and 33.1% (40/121) in 50-59 age group. There were 22.1% (85/385) and 3.6% (14/385) RA patients with overweight and obese, in which the prevalence of NAFLD was 45.9% (39/85) and 78.6% (11/14) respectively, which was 2.6 folds and 4.5 folds that of RA patients with normal BMI. Although there was no significant difference of age, gender and RA disease activity indicators between RA patients with or without NAFLD, those with NAFLD had higher proportions of metabolic diseases including obese (11.8% 1.0%), central obesity (47.3% 16.8%), hypertension (45.2% 29.8%) and type 2 diabetes mellitus (24.7% 12.0%), consistent with higher levels of total cholesterol [(5.33±1.31) mmol/L (4.73±1.12) mmol/L], triglyceride [(1.51±1.08) mmol/L (0.98±0.54) mmol/L] and low-density lipoprotein cholesterol [(3.37±0.97) mmol/L (2.97±0.78) mmol/L, all 0.05]. Multivariate logistic regression analysis showed that BMI (=1.314) and triglyceride (=1.809) were the independent factors positively associated with NAFLD in RA patients. NAFLD is a common comorbidity in RA patients, especially in those with middle-aged, overweight or obese, which is associated with high BMI or high triglyceride. Screening and management of NAFLD in RA patients especially those with overweight, obese or dyslipidemia should be emphasized.
为研究类风湿关节炎（RA）患者中非酒精性脂肪性肝病（NAFLD）的特征及其相关因素。本横断面研究纳入了2015年8月至2021年5月在中山大学孙逸仙纪念医院风湿科接受腹部超声检查的385例RA患者[包括72例（18.7%）男性和313例（81.3%）女性]。16 - 29岁的RA患者有28例，30 - 39岁、40 - 49岁、50 - 59岁、60 - 69岁、≥70岁的患者分别有32例、80例、121例、99例、25例。收集了人口统计学和临床数据，包括年龄、性别、饮酒史、病程、体重指数（BMI）、腰围、血压、RA疾病活动指标及既往用药情况。采用逻辑回归分析来确定RA患者中NAFLD的相关因素。RA患者中NAFLD的患病率为24.2%（93/385），40 - 49岁年龄组为26.3%（21/80），50 - 59岁年龄组为33.1%（40/121）。超重和肥胖的RA患者分别占22.1%（85/385）和3.6%（14/385），其中NAFLD的患病率分别为45.9%（39/85）和78.6%（11/14），分别是BMI正常的RA患者的2.6倍和4.5倍。虽然有或没有NAFLD的RA患者在年龄、性别和RA疾病活动指标方面无显著差异，但患有NAFLD的患者代谢性疾病的比例更高，包括肥胖（11.8%对1.0%）、中心性肥胖（47.3%对16.8%）、高血压（45.2%对29.8%）和2型糖尿病（24.7%对12.0%），总胆固醇[（5.33±1.31）mmol/L对（4.73±1.12）mmol/L]、甘油三酯[（1.51±1.08）mmol/L对（0.98±0.54）mmol/L]和低密度脂蛋白胆固醇[（3.37±0.97）mmol/L对（2.97±0.78）mmol/L，均P<0.05]水平也更高。多因素逻辑回归分析显示，BMI（比值比=1.314）和甘油三酯（比值比=1.809）是RA患者中与NAFLD呈正相关的独立因素。NAFLD是RA患者中常见的合并症，尤其是在中年、超重或肥胖患者中，这与高BMI或高甘油三酯有关。应强调对RA患者尤其是超重、肥胖或血脂异常患者进行NAFLD的筛查和管理。
