肥胖及其变化对中国华北新发NAFLD成年男性患者心血管疾病发病风险的影响

doi:10.16352/j.issn.1001-6325.2022.05.021

基础医学与临床 ›› 2022, Vol. 42 ›› Issue (5): 788-794.doi: 10.16352/j.issn.1001-6325.2022.05.021

肥胖及其变化对中国华北新发NAFLD成年男性患者心血管疾病发病风险的影响

胡诗琪¹, 蓝彦琦¹, 吴寿岭², 王晓墨¹, 陈朔华², 汪国栋^2*, 王丽^1*

1.中国医学科学院基础医学研究所北京协和医学院基础学院流行病与卫生统计学系,北京 100005;
2.开滦总医院心内科,河北唐山 063000

收稿日期:2022-01-17 修回日期:2022-03-23 出版日期:2022-05-05 发布日期:2022-04-28
通讯作者: * liwang@ibms.pumc.edu.cn;wgd201204@163.com
基金资助:
中国医学科学院医学与健康科技创新工程项目(2016-I2M-3-001,2019-I2M-2-007)

Effect of obesity and obesity trajectories on the risk of cardiovascular diseases in adult male with incident NAFLD in Northern China

HU Shi-qi¹, LAN Yan-qi¹, WU Shou-ling², WANG Xiao-mo¹, CHEN Shuo-hua², WANG Guo-dong^2*, WANG Li^1*

1. Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences CAMS, School of Basic Medicine PUMC, Beijing 100005;
2. Department of Cardiology, Kailuan General Hospital, Tangshan 063000, China

Received:2022-01-17 Revised:2022-03-23 Online:2022-05-05 Published:2022-04-28
Contact: * liwang@ibms.pumc.edu.cn;wgd201204@163.com

摘要/Abstract

摘要： 目的探讨肥胖及短期肥胖变化对新发非酒精性脂肪性肝病(NAFLD)成年患者心血管疾病(CVDs)发病风险的影响。方法以2006—2013年开滦队列研究中首次诊断为NAFLD且无既往CVDs史的成年男性(18~59岁)为研究对象,采用Kaplan-Meier法分别基于体质量指数(BMI)和腰围(WC)描述肥胖及其短期(1~4年)不同变化状态组的CVDs发病率;采用竞争风险Cox模型比较肥胖及其不同短期变化状态组发生CVDs的风险差异。结果共纳入观察者8 591人,经过中位9.41年的随访,共发生CVDs 349例。按基线腰围划分的非肥胖组和肥胖组10年CVDs的累积发病率分别为3.3%和4.3%(log-rank检验, P＜0.05),但校正了死亡的竞争风险以及其他协变量后,发病风险差异无统计学意义;与基于BMI定义的肥胖CVDs发病率结果相似。进一步分析短期体质量变化发现,基于BMI定义的持续非肥胖组、增重组、减重组与持续肥胖组的8年CVDs累积发病率分别为2.8%、3.6%、4.2%和3.3%(log-rank检验, P＞0.05);在校正多因素的竞争风险模型中,与持续非肥胖组相比,增重组CVDs发病风险增高了57%(HR:1.57;95% CI:1.03~2.38;P＜0.05),进一步校正基线BMI后结论不变(HR:1.56; 95% CI:1.02~2.37; P＜0.05)。结论成年男性NAFLD患者短期BMI或WC增加会增高CVDs发生风险,科学合理控制体质量对早期NAFLD患者的心血管疾病预防十分重要。

关键词: 肥胖, 非酒精性脂肪性肝病, 心血管疾病, 队列研究

Abstract: Objective To investigate the baseline and effect of obesity and obesity trajectories on cardiovascular diseases(CVDs) in adult male with incident non-alcoholic fatty liver disease(NAFLD). Methods Adult men with newly diagnosed NAFLD and without CVDs in the Kailuan cohort study from 2006—2013 were enrolled. The subjects were divided into the nonobese group and obese group according to the definition of body mass index(BMI) or waist circumference (WC), then further divided by the obesity trajectories at the first follow-up (1-4 years). Kaplan-Meier method was used to estimate the incidence rate of CVDs for each subgroup. In addition, the Fine and Gray competing risk Cox regression model was used to compare CVDs risk in NAFLD with different baseline or trajectories in obesity measures after 1-4 years of NAFLD diagnosis. Results A total of 8 591 incident NAFLD patients were included. During a median follow-up of 9.41 years, 349 cases were found with CVDs. The 10-year cumulative incidence rates of CVDs were 3.3% and 4.3% in the nonobese and obese groups according to the definition of waist circumference, respectively (log-rank test, P＜0.05). However, the significance disappeared after adjusting the competing risk of death and other covariates. Similar results were observed based on the definition of BMI. Also, further analysis was conducted for the association trajectories in obesity measures and CVDs. The 8-year cumulative incidence rates of CVDs were 2.8%, 3.6%, 4.2%, and 3.3% in the constantly nonobese group, nonobese-obese, obese-nonobese, and constantly obese group, respectively (log-rank test, P＞0.05). Compared to the subjects with constantly nonobese defined by BMI, those who transition from nonobese to obese increased the CVDs risk by 57% (hazard ratio [HR]:1.57; 95% CI:1.03~2.38; P＜0.05). The conclusion remained even after adjusting baseline BMI (HR:1.56; 95% CI:1.02~2.37; P＜0.05). Conclusions Short-term weight gain in men with incident NAFLD led a higher CVDs risk, suggesting the importance of weight control in preventing CVDs once NAFLD occurrence.

Key words: obesity, non-alcoholic fatty liver disease, cardiovascular diseases, cohort study

中图分类号:

R181.3

胡诗琪, 蓝彦琦, 吴寿岭, 王晓墨, 陈朔华, 汪国栋, 王丽. 肥胖及其变化对中国华北新发NAFLD成年男性患者心血管疾病发病风险的影响[J]. 基础医学与临床, 2022, 42(5): 788-794.

HU Shi-qi, LAN Yan-qi, WU Shou-ling, WANG Xiao-mo, CHEN Shuo-hua, WANG Guo-dong, WANG Li. Effect of obesity and obesity trajectories on the risk of cardiovascular diseases in adult male with incident NAFLD in Northern China[J]. Basic & Clinical Medicine, 2022, 42(5): 788-794.

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肥胖及其变化对中国华北新发NAFLD成年男性患者心血管疾病发病风险的影响

Effect of obesity and obesity trajectories on the risk of cardiovascular diseases in adult male with incident NAFLD in Northern China

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