中青年体检人群瘦型代谢相关脂肪性肝病及其危险因素分析

doi:10.3969/j.issn.1004-583X.2025.02.005

摘要/Abstract

摘要：

目的探究中青年体检人群瘦型代谢相关脂肪性肝病(metabolic associated fatty liver disease, MAFLD)及其危险因素。方法选取2022年1月至2023年12月南充市中心医院健康管理中心的中青年体检者16 173例,收集其临床资料,探究中青年体检人群瘦型MAFLD及其危险因素。结果瘦型MAFLD患者均为男性,年龄45~59岁占比较大,体质量指数(body mass index,BMI)为20~<23 kg/m²占比较大。两组年龄、性别、BMI、血压、空腹血糖、血脂、血尿酸差异均有统计学意义(P<0.05)。瘦型MAFLD组糖代谢异常检出率为12.5%,高于瘦型非MAFLD组(P<0.001);脂代谢异常检出率为62.8%,高甘油三酯血症为33.7%,低高密度脂蛋白血症为17.6%,混合型高脂血症为18.4%,均高于瘦型非MAFLD组(P<0.001);高胆固醇血症为7.4%,低于瘦型非MAFLD组(P<0.001);尿酸代谢异常检出率为26.9%,高于瘦型非MAFLD组(P<0.001)。多因素logistic回归分析结果提示,性别、年龄、BMI、高血压病、糖代谢异常、甘油三酯、混合型高脂血症、高密度脂蛋白胆固醇、高尿酸血症为瘦型MAFLD的独立危险因素。结论加强对体检人群的早期健康宣教,针对MAFLD的危险因素采取措施,以降低MAFLD的发病率。

关键词: 非酒精性脂肪性肝病, 危险因素, 横断面研究

Abstract:

Objective To explore the metabolic-associated fatty liver disease (MAFLD) in young and middle-aged people and its risk factors. Methods From January 2022 to December 2023, clinical data of 16 173 young and middle-aged people receiving physical examinations in the Health Management Center of Nanchong Central Hospital were collected. Lean MAFLD and risk factors in them were analyzed. Results All lean MAFLD patients were male, and most of them aged 45-59 years with a body mass index (BMI) ranging from 20-23 kg/m². There were significant differences in age, gender, BMI, blood pressure, fasting plasma glucose (FPG), blood lipids and blood uric acid (UA) between the two groups (P<0.05). The detection rate of abnormal glucose metabolism in the lean MAFLD group was 12.5%, which was significantly higher than that in the lean non-MAFLD group (P<0.001). The detection rates of abnormal lipid metabolism, hypertriglyceridemia, low high density lipoprotein and mixed hyperlipidemia were 62.8%, 33.7%, 17.6% and 18.4%, respectively, which were significantly higher than those in the lean non-MAFLD group (P<0.001). Hypercholesterolemia was detected in 7.4% of lean MAFLD, which was significantly lower than that in lean non-MAFLD group (P<0.001). The detection rate of UA metabolic abnormalities was 26.9%, which was significantly higher than that of lean non-MAFLD group (P<0.001). Multivariate logistic regression analysis showed that gender, age, BMI, hypertension, abnormal glucose metabolism, triglyceride (TG), mixed hyperlipidemia, high-density lipoprotein cholesterol (HDL-C) and hyperuricemia were the independent risk factors of lean MAFLD. Conclusion Interventions on the related risk factors should be conducted as early as possible. Strengthening the early health education for the physical examination population, and taking measures against the risk factors of MAFLD are expected to reduce the incidence of MAFLD.

Key words: non-alcoholic fatty liver disease, risk factors, cross-sectional study

中图分类号:

R575.5

童明霞, 陈柯, 向小聪, 周丽峰. 中青年体检人群瘦型代谢相关脂肪性肝病及其危险因素分析[J]. 临床荟萃, 2025, 40(2): 128-132.

Tong Mingxia, Chen Ke, Xiang Xiaocong, Zhou Lifeng. Analysis of lean metabolic-associated fatty liver disease among young and middle-aged people and its risk factors[J]. Clinical Focus, 2025, 40(2): 128-132.

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https://lchc.magtechjournal.com/CN/Y2025/V40/I2/128

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参考文献 28

[1]	Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease[J]. Hepatology, 2023, 77(5): 1797-1835. doi: 10.1097/HEP.0000000000000323 pmid: 36727674
[2]	Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73(1): 202-209. doi: S0168-8278(20)30201-4 pmid: 32278004
[3]	中华医学会肝病学分会. 代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J]. 中华肝脏病杂志, 2024, 32(5): 418-434.
[4]	Ng CH, Huang DQ, Nguyen MH. Nonalcoholic fatty liver disease versus metabolic.associated fatty liver disease:Prevalence,outcomes and implications of a change in name[J]. Clin Mol Hepatol, 2022, 28(4):790-801.
[5]	宗廷妮, 戴光荣, 赵晓宇, 等. 代谢相关脂肪性肝病靶向药物治疗进展[J]. 临床荟萃, 2023, 38(4):373-376.
[6]	苏殷实, 陈源文. AGA临床实践指南更新:瘦型NAFLD的诊断和管理(专家评议)[J]. 胃肠病学和肝病学杂志, 2024, 33(3): 324-331.
[7]	Shi Y, Wang Q, Sun Y, et al. The prevalence of lean/nonobese nonalcoholic fatty liver disease: A systematic review and meta-analysis[J]. J Clin Gastroenterol, 2020, 54(4): 378-387. doi: 10.1097/MCG.0000000000001270 pmid: 31651571
[8]	Zou ZY, Wong VW, Fan JG. Epidemiology of nonalcoholic fatty liver disease in non-obese populations: Meta-analytic assessment of prevalence, genetic, metabolic and histological profiles[J]. J Dig Dis, 2020, 21(7):372-384.
[9]	Huang S, Bao Y, Zhang N, et al. Long-term outcomes in lean and non-lean NAFLD patients: A systematic review and meta-analysis[J]. Endocrine, 2024, 85(1):134-141.
[10]	中国高血压防治指南修订委员会. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1):24-56.
[11]	中华医学会糖尿病分会. 国家基层糖尿病防治管理指南(2022)[J]. 中华内科杂志, 2022, 61(3):249-262.
[12]	中国血脂管理指南修订联合专家委员会. 中国血脂管理指南(2023年)[J]. 中国循环杂志, 2023, 38(3): 237-271.
[13]	高尿酸血症相关疾病诊疗多学科共识专家组. 中国高尿酸血症相关疾病诊疗多学科专家共识[J]. 中华内科杂志, 2017, 56(3):235-248.
[14]	Kim Y, Han E, Lee JS, et al. Cardiovascular risk is elevated in lean subjects with nonalcoholic fatty liver disease[J]. Gut Liver, 2022, 16(2):290-299.
[15]	Chen N, Zhou J, Wang K, et al. Non-obese or lean non-alcoholic fatty liver disease was associated with increased risk of cancer in patients with type 2 diabetes mellitus[J]. BMI Open Diabetes Res Care, 2023, 11(1):e003066.
[16]	Nabi O, Lapidus N, Boursier J, et al. Lean individuals with NAFLD have more severe liver disease and poorer clinical outcomes(NASH-CO study)[J]. Hepatology, 2023, 8(1):279-283.
[17]	Eng PC, Forlano R, Tan T, et al. Non-alcoholic fatty liver disease in women-current knowledge and emerging concepts[J]. JHEP Rep, 2023, 5(10):100835.
[18]	杨营营, 王箴, 严颜, 等. 中国健康体检人群腹部脂肪的年龄、性别和地域分布特点[J]. 健康体检与管理, 2023, 4(2):171-175.
[19]	Gutiérrez-Cuevas J, Santos A, Armendariz-Borunda J. Pathophysiological molecular mechanisms of obesity: A link between mafld and nash with cardiovascular diseases[J]. Int J Mol Sci, 2021, 22(21):11629.
[20]	Khalid M, Alkaabi J, Khan M, et al. Insulin signal transduction perturbations in insulin resistance[J]. Int J Mol Sci, 2021, 22(16):8590.
[21]	Wei L, Ding HG. Relationship between Helicobacter pylori infection and nonalcoholic fatty liver disease: What should we expect from a meta-analysis[J]. Medicine (Baltimore), 2021, 100(31): e26706.
[22]	王晓华, 曾雅琳, 郭萃蓉. 非酒精性脂肪性肝病进展性肝纤维化患者空腹血糖受损和胰岛素抵抗调查[J]. 实用肝脏病杂志, 2022, 25(6): 812-815.
[23]	Stefan N, Cusi K. A global view of the interplay between non-alcoholic fatty liver disease and diabetes[J]. Lancet Diabetes Endocrinol, 2022, 10(4):284-296.
[24]	Yang JD, Ahmed F, Mara KC, et al. Diabetes is associated with increased risk of hepatocellular carcinoma in patients with cirrhosis from nonalcoholic fatty liver disease[J]. Hepatology, 2020, 71(3):907-916. doi: 10.1002/hep.30858 pmid: 31309602
[25]	Younossi ZM, Tampi RP, Racila A, et al. Economic and clinical burden of nonalcoholic steatohepatitis in patients with type 2 diabetes in the U.S[J]. Diabetes Care, 2020, 43(2):283-289. doi: 10.2337/dc19-1113 pmid: 31658974
[26]	Eshraghian A, Nikeghbalian S, Geramizadeh B, et al. Characterization of biopsy proven non-alcoholic fatty liver disease in healthy non-obese and lean population of living liver donors:The impact of uric acid[J]. Clin Res Hepatol Gastroenterol, 2020, 44(4):572-578.
[27]	Chen YL, Li H, Li S, et al. Prevalence of and risk factors for metabolic associated fatty liver disease in an urban population in China: A cross-sectional comparative study[J]. BMC Gastroenterol, 2021, 21(1): 212.
[28]	Ma Z, Zhang J, Kang X, et al. Hyperuricemia precedes non alcoholic fatty liver disease with abdominal obesity moderating this unidirectional relationship: Three longitudinal analyses[J]. Atherosclerosis, 2020, 311: 44-51.

组别	例数	性别[例(%)]				年龄[例(%)]				BMI[例(%)]
组别	例数	男		女		18~44岁		45~59岁		<18 kg/m²		18~<20 kg/m²		20~<23 kg/m²
瘦型非MAFLD组	15 484	4 424(28.6)		11 060(71.4)		9 065(58.5)		6 419(41.5)		603(3.9)		2 981(19.2)		11 900(76.9)
瘦型MAFLD组	689	689(100.0)		0		271(39.3)		418(60.7)		2(0.3)		29(4.2)		658(95.5)
χ²值		1 553.402				99.772				132.652
P值		<0.001				<0.001				<0.001
组别	收缩压 (mmHg)		舒张压 (mmHg)		FPG (mmol/L)		TC (mmol/L)		TG (mmol/L)		HDL-C (mmol/L)		LDL-C (mmol/L)	血UA (μmol/L)
瘦型非MAFLD组	117.85±14.92		72.21±10.27		4.85±0.92		4.89±0.94		1.12±0.72		1.55±0.35		2.72±0.77	286.78±73.20
瘦型MAFLD组	126.97±15.80		79.80±10.69		5.69±2.41		5.26±1.08		2.26±2.08		1.26±0.32		3.24±0.83	371.51±79.18
t值	-15.672		-18.960		-21.152		-9.975		-35.750		21.862		-17.419	-29.622
P值	<0.001		<0.001		<0.001		<0.001		<0.001		<0.001		<0.001	<0.001

组别	例数	性别[例(%)]				年龄[例(%)]				BMI[例(%)]
组别	例数	男		女		18~44岁		45~59岁		<18 kg/m²		18~<20 kg/m²		20~<23 kg/m²
瘦型非MAFLD组	15 484	4 424(28.6)		11 060(71.4)		9 065(58.5)		6 419(41.5)		603(3.9)		2 981(19.2)		11 900(76.9)
瘦型MAFLD组	689	689(100.0)		0		271(39.3)		418(60.7)		2(0.3)		29(4.2)		658(95.5)
χ²值		1 553.402				99.772				132.652
P值		<0.001				<0.001				<0.001
组别	收缩压 (mmHg)		舒张压 (mmHg)		FPG (mmol/L)		TC (mmol/L)		TG (mmol/L)		HDL-C (mmol/L)		LDL-C (mmol/L)	血UA (μmol/L)
瘦型非MAFLD组	117.85±14.92		72.21±10.27		4.85±0.92		4.89±0.94		1.12±0.72		1.55±0.35		2.72±0.77	286.78±73.20
瘦型MAFLD组	126.97±15.80		79.80±10.69		5.69±2.41		5.26±1.08		2.26±2.08		1.26±0.32		3.24±0.83	371.51±79.18
t值	-15.672		-18.960		-21.152		-9.975		-35.750		21.862		-17.419	-29.622
P值	<0.001		<0.001		<0.001		<0.001		<0.001		<0.001		<0.001	<0.001

组别	例数	血压			糖代谢异常	高胆固醇血症	高甘油三酯血症	混合型高脂血症	低高密度脂蛋白血症	高尿酸血症
组别	例数	正常	高血压病	血压高值	糖代谢异常	高胆固醇血症	高甘油三酯血症	混合型高脂血症	低高密度脂蛋白血症	高尿酸血症
瘦型非MAFLD组	15 484	9 179(59.3)	1 552(10.0)	4 753(30.7)	233(1.5)	2 019(13.0)	1 142(7.4)	711(4.6)	523(3.4)	1 209(7.8)
瘦型MAFLD组	689	219(31.8)	170(24.7)	300(43.5)	86(12.5)	51(7.4)	232(33.7)	127(18.4)	121(17.6)	185(26.9)
χ²值		253.626			411.090	18.782	586.779	257.205	347.105	303.690
P值		<0.001			<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	血压			糖代谢异常	高胆固醇血症	高甘油三酯血症	混合型高脂血症	低高密度脂蛋白血症	高尿酸血症
组别	例数	正常	高血压病	血压高值	糖代谢异常	高胆固醇血症	高甘油三酯血症	混合型高脂血症	低高密度脂蛋白血症	高尿酸血症
瘦型非MAFLD组	15 484	9 179(59.3)	1 552(10.0)	4 753(30.7)	233(1.5)	2 019(13.0)	1 142(7.4)	711(4.6)	523(3.4)	1 209(7.8)
瘦型MAFLD组	689	219(31.8)	170(24.7)	300(43.5)	86(12.5)	51(7.4)	232(33.7)	127(18.4)	121(17.6)	185(26.9)
χ²值		253.626			411.090	18.782	586.779	257.205	347.105	303.690
P值		<0.001			<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

因素	回归系数	标准误	Waldχ²值	P值	OR值	95%CI
因素	回归系数	标准误	Waldχ²值	P值	OR值	下限	上限
性别(女)	-19.168	267.626	0.005	<0.001	0	0	0
年龄(45~59岁)	0.323	0.093	11.954	<0.001	1.381	1.150	1.658
18 kg/m²≤BMI<20 kg/m²	0.934	0.742	1.585	0.208	2.544	0.746	15.944
20 kg/m²≤BMI<23 kg/m²	2.069	0.717	8.319	0.004	7.920	2.490	48.231
高血压病	0.432	0.122	12.509	<0.001	1.540	1.211	1.955
糖代谢异常	0.965	0.159	36.984	<0.001	2.624	1.918	3.574
脂代谢异常	0.131	0.283	0.215	0.643	1.140	0.644	1.960
高TC	0.251	0.088	8.187	0.004	1.285	1.082	1.527
高TG	1.073	0.265	16.396	<0.001	2.924	1.765	5.005
混合型高脂血症	1.082	0.287	14.200	<0.001	2.950	1.700	5.256
低HDL-C	0.318	0.153	4.323	0.038	1.374	1.016	1.850
高尿酸血症	0.485	0.103	22.185	<0.001	1.624	1.325	1.985