论文部分内容阅读
目的探讨非酒精性脂肪肝(NAFLD)对慢性肾脏病(CKD)发病的影响。方法以山东大学附属省立医院健康体检中心接受常规健康体检的人群建立回顾性队列。队列人群为2005~2010年期间体检3次及以上并且在首次体检无CKD者。应用t检验、χ2检验比较基线有无NAFLD两组人群的特征,应用Kaplan-Meier法分别估计基线有无NAFLD两组人群CKD的累计发病率,Log-rank检验用于比较其差异。单因素Cox用于探索CKD发生风险与相关因素如人口统计学特征、生化指标等的关系,应用多元Cox回归模型控制混杂因素后,分析NAFLD与CKD的关联。结果研究队列包含10 775人,共随访34 878人年(平均3.24±0.99年/人)。研究期间,CKD共发生1 068例,发病密度为30.62/1 000人年。基线有NAFLD组CKD的累计发病率显著高于无NAFLD组(22.76%vs 12.07%,P<0.01)。多因素Cox回归模型中,调整年龄、性别、体质量指数(BMI)、收缩压、空腹血糖、甘油三酯、高密度脂蛋白、血红蛋白、血小板压积、是否患高血压、是否患糖尿病、是否患代谢综合征及有无冠心病病史后,HR值为1.20(95%CI:1.05~1.38,P=0.01)。结论调整多种已知的CKD危险因素后,NAFLD与CKD发病的关系仍具有统计学差异,说明NAFLD为CKD发病的独立危险因素。该结果对CKD的预防有重要意义。
Objective To investigate the effect of non-alcoholic fatty liver disease (NAFLD) on the pathogenesis of chronic kidney disease (CKD). Methods A retrospective cohort was established in the population undergoing routine physical examination in the Provincial Health Check-up Center of Shandong Provincial Hospital. The cohort was physically examined three times or more between 2005 and 2010 and had no CKD on the first physical examination. The t-test and χ2 test were used to compare the characteristics of the two groups with or without NAFLD. Kaplan-Meier method was used to estimate the cumulative incidence of CKD in both groups with or without NAFLD. Log-rank test was used to compare the differences. Univariate Cox was used to explore the relationship between the risk of CKD and related factors such as demographic characteristics and biochemical indexes. After using multivariate Cox regression model to control confounding factors, the association between NAFLD and CKD was analyzed. Results The cohort consisted of 10 775 cohorts of 34 878 person-years (mean, 3.24 ± 0.99 year / person). During the study, CKD occurred in a total of 1 068 cases with a disease density of 30.62 / 1000 person-years. The cumulative incidence of CKD in patients with NAFLD at baseline was significantly higher than those without NAFLD (22.76% vs 12.07%, P <0.01). Multivariate Cox regression model adjusted for age, gender, body mass index (BMI), systolic blood pressure, fasting blood glucose, triglycerides, high density lipoprotein, hemoglobin, platelet pressure, whether suffering from hypertension, whether diabetes, whether The HR value was 1.20 (95% CI: 1.05-1.38, P = 0.01) after suffering from metabolic syndrome and the history of coronary heart disease. Conclusions After adjusting for a variety of known CKD risk factors, the relationship between NAFLD and CKD is still statistically significant, indicating that NAFLD is an independent risk factor for CKD. This result is of great significance for the prevention of CKD.