探讨非酒精性脂肪肝病(NAFLD)的相关危险因素及其与代谢综合征(MS)的关系。

研究对象为2013年9—12月在西安市第九医院参加体检，并排除酒精、药物、肝炎等可能导致的脂肪肝，共4 615例资料完整的西安铁路职工。根据腹部超声是否有脂肪肝分为NAFLD组和正常组。比较两组对象的血压、人体质量指数(BMI)、腰臀比、空腹血糖、空腹胰岛素及胰岛素抵抗指数(HOMA-IR)、血脂、肝功、肾功等指标，以及两组间代谢综合征及其组分的检出率。全部数据采用SPSS 13.0统计软件进行分析，各项观察指标多组间比较用单因素方差分析、两组间比较用t检验，MS检出率等计数资料用χ²检验。

4 615名铁路职工，检出NAFLD患者1 848例，检出率为40.04%；其中女性职工总数1 373名，检出NAFLD患者520例，检出率为37.87%；男性职工总数3 242名，检出NAFLD患者1 327例，检出率为40.93%，男性检出率略高，但两者比较差异无统计学意义(χ²＝0.39，P>0.05)。年轻职工NAFLD检出率低于中老年职工；NAFLD组与正常组比较，年龄[(50.78±12.51)岁，(47.22±14.61)岁，t＝－3.24，P<0.05]、BMI[(26.23±3.02)kg/m²，(22.40±2.62)kg/m²，t＝－16.32，P<0.05]、腰臀比(0.91±0.09，0.85±0.09，t＝－8.21，P<0.05)，收缩压[(127.69±18.29)mmHg，(118.32±16.93)mmHg，t＝－6.54，P<0.05](1 mmHg＝0.133 kPa)、舒张压[(84.82±11.21)mmHg，(78.32±9.31)mmHg，t＝－7.84，P<0.05]、空腹血糖[(5.38±1.84)mmol/L，(4.69±1.03)mmol/L，t＝－5.89，P<0.05]、空腹胰岛素[(10.93±4.97)μU/ml，(6.04±2.85)μU/ml，t＝－2.99，P<0.05]、HOMA-IR[0.89±0.20，0.47±0.16，t＝－2.61，P<0.05]、胆固醇[(5.00±1.07)mmol/L，(4.59±0.85)mmol，t＝－5.24，P<0.05]、甘油三酯[(2.37±1.59)mmol/L，(1.45±0.96)mmol/L，t＝－7.22，P<0.05]、谷丙转氨酶[(38.17±19.35)U/L，(22.92±14.83)U/L，t＝－8.52，P<0.05]、尿酸[(364.54±84.39)μmol/L，(333.74±84.63)μmol/L，t＝－4.44，P<0.05]水平高于正常组，差异有统计学意义；NAFLD组代谢综合征(30.95%，21.94%)、中心性肥胖(41.40%，30.36%)、高血压(52.60%，43.73%)、高甘油三酯(49.35%，32.42%)、高血糖(13.80%，6.69%)的检出率高于正常组，差异有统计学意义(P<0.05)。

肥胖、高血压、高血糖、高血脂、高尿酸是NAFLD的危险因素，NAFLD患者有更高的代谢综合征检出率。

To analyze the risk factors of non-alcoholic fatty liver disease(NAFLD) and their relationship with metabolic syndrome(MS) in Xi′an railway workers.

From september 2013 to December 2013, five thousand cases of Xi′an railway workers were selected for evaluating the risk factors of NAFLD.The causes of fatty liver disease such as hepatitis, alcohol and drugs were excluded.Four thousand six hundred and fifteen workers were divided into NAFLD group and normal group by the results of abdominal ultrasound.The blood pressure, body mass index(BMI), waist-hip ratio, blood glucose, insulin and homeostasis madel assessment of insulin resistance (HOMA-IR), lipids, transaminase, uric acid and the prevalence of the metabolic syndrome were compared between the two groups.

There were one thousand eight hundred and forty-eight NAFLD cases(40.04%) in all cases.The detection rate of NAFLD was 37.87% in women, and 40.93% in men.The detection rate of NAFLD in young workers was lower than that in older workers.The age[(50.78±12.51)years, (47.22±14.61)years, t=-3.24, P<0.05], BMI[(26.23±3.02)kg/m², (22.40±2.62)kg/m², t=-16.32, P<0.05], waist-hip ratio(0.91±0.09, 0.85±0.09, t=-8.21, P<0.05), systolic pressure(SBP)[(127.69±18.29)mmHg, (118.32±16.93)mmHg, t=-6.54, P<0.05], diastolic pressure(DBP)[(84.82±11.21)mmHg, (78.32±9.31)mmHg, t=-7.84, P<0.05], blood glucose[(5.38±1.84)mmol/L, (4.69±1.03)mmol/L, t=-5.89, P<0.05], insulin[(10.93±4.97)μU/ml, (6.04±2.85)μU/ml, t=-2.99, P<0.05], HOMA-IR[0.89±0.20, 0.47±0.16, t=-2.61, P<0.05], cholesterol [(5.00±1.07)mmol/L, (4.59±0.85)mmol, t=-5.24, P<0.05], triglyceride[(2.37±1.59)mmol/L, (1.45±0.96)mmol/L, t=-7.22, P<0.05], alanine aminotransferase[(38.17±19.35)U/L, (22.92±14.83)U/L, t=-8.52, P<0.05], uric acid[(364.54±84.39)μmmol/L, (333.74±84.63)μmol/L, t=-4.44, P<0.05] levels in the NAFLD patients were significantly higher than those in normal group.Nevertheless, the prevalences of MS(30.95%, 21.94%) and its components [central obesity(41.40%, 30.36%), hypertension(52.60%, 43.73%), hypertriglyceridemia(49.35%, 32.42%), hyperglycemia(13.80%, 6.69%)] were significantly higher in the NAFLD patients.

Obesity, hypertension, hyperglycemia, hypertriglyceridemia, hyperuricemia are risk factors of NAFLD, and the detection rate of MS is higher in NAFLD patients.