中国非肥胖人群中高血压与新发非酒精性脂肪性肝病的关联：一项纵向队列研究
Association Between Hypertension and New-Onset Non-Alcoholic Fatty Liver Disease in Chinese Non-Obese People: A Longitudinal Cohort Study.
作者信息
Yang Dezhi, Lan Jing, Cen Ji, Han Yong, Hu Haofei
机构信息
Department of Cardiology Second Ward, Hechi People's Hospital, Hechi, People's Republic of China.
Department of Gastroenterology, Hechi People's Hospital, Hechi, People's Republic of China.
出版信息
Diabetes Metab Syndr Obes. 2023 Feb 8;16:345-363. doi: 10.2147/DMSO.S396011. eCollection 2023.
BACKGROUND
Quantification of the relationship between hypertension and non-alcoholic fatty liver disease (NAFLD) risk is limited and controversial. This study aimed to investigate the relationship between hypertension and NAFLD in non-obese Chinese and to use different methods to demonstrate that hypertension is an independent risk factor for NAFLD.
METHODS
On 16,153 nonobese individuals, a retrospective cohort study was conducted in China to examine the impact of hypertension on incident NAFLD. We compared five methods: multivariable Cox proportional-hazards regression, propensity score-matched (PSM) analysis, propensity score adjustment method (considering the propensity score as a covariate in a multivariable Cox proportional-hazard regression), and two propensity score-based weighted methods-The first one estimated the hypertension effect in the overall study population-inverse probability of treatment weights (IPTW), the other in the hypertensive population-standardized mortality ratio (SMR) weights. We also used a genetic matching (GenMatch) algorithm to match the participants for sensitive analysis.
RESULTS
Between 2010 and 2014, 16,153 participants met our inclusion criteria, including 2427 (15.03%) with hypertension. A total of 2321 (14.37%) participants developed NAFLD during the median follow-up of 2.98 years. The crude hazard ratio (HR) between hypertension and incident NAFLD was 2.05 (95% confidence interval (CI): 1.87, 2.25). The adjusted HR depended on the different methods, ranging from 1.09 (95% CI: 0.77, 1.23) for the PSM method to 2.24 (95% CI: 2.05, 2.44) for the SMR weighted analysis. Hypertensive participants with high propensity scores had a higher risk of developing NAFLD in the future. Excluding participants with propensity scores <8% yielded comparable hazard ratios with a narrower range, from 1.04 to 1.80. After adjusting for the confounding variables, the relationship also existed in the GenMatch cohort as a sensitivity analysis (HR=1.06, 95% CI 1.01-1.13).
CONCLUSION
Hypertension is a significant cause of NAFLD in Chinese adults in non-obese Chinese adults, with the hazard ratio ranging from 1.09 to 2.24.
背景
高血压与非酒精性脂肪性肝病（NAFLD）风险之间关系的量化研究有限且存在争议。本研究旨在调查非肥胖中国人群中高血压与NAFLD之间的关系，并采用不同方法证明高血压是NAFLD的独立危险因素。
方法
在中国对16153名非肥胖个体进行了一项回顾性队列研究，以检验高血压对新发NAFLD的影响。我们比较了五种方法：多变量Cox比例风险回归、倾向评分匹配（PSM）分析、倾向评分调整法（在多变量Cox比例风险回归中将倾向评分作为协变量），以及两种基于倾向评分的加权方法——第一种估计总体研究人群中的高血压效应——逆概率处理权重（IPTW），另一种估计高血压人群中的效应——标准化死亡比（SMR）权重。我们还使用遗传匹配（GenMatch）算法对参与者进行匹配以进行敏感性分析。
结果
2010年至2014年期间，16153名参与者符合我们的纳入标准，其中2427名（15.03%）患有高血压。在中位随访2.98年期间，共有2321名（14.37%）参与者发生了NAFLD。高血压与新发NAFLD之间的粗风险比（HR）为2.05（95%置信区间（CI）：1.87，2.25）。调整后的HR取决于不同方法，PSM法为1.09（95%CI：0.77，1.23），SMR加权分析为2.24（95%CI：2.05，2.44）。倾向评分高的高血压参与者未来发生NAFLD的风险更高。排除倾向评分<8%的参与者后，得到的风险比具有可比性且范围更窄，为1.04至1.80。作为敏感性分析，在调整混杂变量后，GenMatch队列中也存在这种关系（HR=1.06，95%CI 1.01 - 1.13）。
结论
在非肥胖中国成年人中，高血压是NAFLD的一个重要病因，风险比范围为1.09至2.24。
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