临床肝胆病杂志2025，Vol.41Issue(4)：643-649,7.DOI:10.12449/JCH250408
北京市体检人群代谢相关脂肪性肝病的患病率、影响因素和纤维化风险分层分析
Prevalence,influencing factors,and fibrosis risk stratification of metabolic dysfunction-associated fatty liver disease in the health check-up population in Beijing,China
摘要
Abstract
Objective To identify the patients with metabolic dysfunction-associated fatty liver disease(MAFLD)among the health check-up population,and to perform stratified management of patients with the low,medium,and high risk of advanced fibrosis based on noninvasive fibrosis scores.Methods A cross-sectional study was conducted among 3 125 individuals who underwent physical examination in Beijing Physical Examination Center from December 2017 to December 2019,and they were divided into MAFLD group with 1 068 individuals and non-MAFLD group with 2 057 individuals.According to BMI,the MAFLD group was further divided into lean MAFLD group(125 individuals with BMI<24 kg/m2)and non-lean MAFLD group(943 individuals with BMI≥24 kg/m2).Indicators including demographic data,past history,laboratory examination,and liver ultrasound were compared between groups.Fibrosis-4(FIB-4)score,NAFLD fibrosis score(NFS),aspartate aminotransferase-to-platelet ratio index(APRI),and BARD score were calculated for the patients in the MAFLD group to assess the risk of advanced fibrosis.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.A logistic regression analysis was used to investigate the influence of each indicator in MAFLD.Results Compared with the non-MAFLD group,the MAFLD group had significantly higher age(Z=-9.758,P<0.05),proportion of male patients(χ2=137.555,P<0.05),and levels of body weight(Z=-27.987,P<0.05),BMI(Z=-32.714,P<0.05),waist circumference(Z=-31.805,P<0.05),hip circumference(Z=-26.342,P<0.05),waist-hip ratio(Z=-28.554,P<0.05),alanine aminotransferase(ALT)(Z=-25.820,P<0.05),aspartate aminotransferase(AST)(Z=-16.894,P<0.05),gamma-glutamyl transpeptidase(GGT)(Z=-25.069,P<0.05),alkaline phosphatase(Z=-12.533,P<0.05),triglyceride(Z=-27.559),total cholesterol(Z=-7.833,P<0.05),low-density lipoprotein cholesterol(LDL-C)(Z=-8.222,P<0.05),and uric acid(UA)(Z=-20.024,P<0.05),as well as a significantly higher proportion of patients with metabolic syndrome(MetS)(χ2=578.220,P<0.05),significantly higher prevalence rates of hypertension(χ2=241.694,P<0.05),type 2 diabetes(χ2=796.484,P<0.05),and dyslipidemia(χ2=369.843,P<0.05),and a significant reduction in high-density lipoprotein cholesterol(HDL-C)(Z=23.153,P<0.001).The multivariate logistic regression analysis showed that male sex(odds ratio[OR]=1.45,95%confidence interval[CI]:1.203-1.737),ALT(OR=1.05,95%CI:1.046-1.062),LDL-C(OR=1.23,95%CI:1.102-1.373),and comorbidity with MetS(OR=5.97,95%CI:4.876-7.316)were independently associated with MAFLD.Compared with the non-lean MAFLD group,the lean MAFLD group had significantly higher age(Z=3.736,P<0.05)and HDL-C(Z=2.679,P<0.05)and significant reductions in the proportion of male patients(χ2=28.970,P<0.05),body weight(Z=-14.230,P<0.05),BMI(Z=-18.188,P<0.05),waist circumference(Z=-13.451,P<0.05),hip circumference(Z=-13.317,P<0.05),ALT(Z=-4.519,P<0.05),AST(Z=-2.258,P<0.05),GGT(Z=-4.592,P<0.05),UA(Z=-4.415,P<0.05),the proportion of patients with moderate or severe fatty liver disease or MetS(χ2=42.564,P<0.05),and the prevalence rates of hypertension(χ2=12.057,P<0.05)and type 2 diabetes(χ2=3.174,P<0.05).Among the patients with MAFLD,10 patients(0.9%)had an FIB-4 score of>2.67,4 patients(0.4%)had an NFS score of>0.676,8 patients(0.7%)had an APRI of>1,and 551 patients(51.6%)had a BARD score of≥2.Conclusion There is a relatively high prevalence rate of MAFLD among the health check-up population in Beijing,but with a relatively low number of patients with a high risk of advanced fibrosis,and such patients need to be referred to specialized hospitals for liver diseases.关键词
代谢相关脂肪性肝病/患病率/影响因素分析/纤维化/北京Key words
Metabolic Dysfunction-Associated Fatty Liver Disease/Prevalence/Root Cause Analysis/Fibrosis/Beijing引用本文复制引用
郭海清,李明亮,刘峰,张晶..北京市体检人群代谢相关脂肪性肝病的患病率、影响因素和纤维化风险分层分析[J].临床肝胆病杂志,2025,41(4):643-649,7.基金项目
北京市属医院科研培育计划项目(PX2023061) （PX2023061）
2021年度院内中青年人才孵育项目(YNKTXF2021003) Beijing Municipal Administration of Hospitals Incubating Program(PX2023061) （YNKTXF2021003）
Scientific Research Project of Beijing Youan Hospital(YNKTXF2021003) （YNKTXF2021003）
