健康成人中非酒精性脂肪肝与腹内脂肪的相关性研究

发布时间：2018-05-16 09:42

本文选题：脂肪肝 + 定量分析　；参考：《安徽医科大学》2017年硕士论文

【摘要】：背景和目的由于非酒精性脂肪肝在我国呈逐年上升的趋势,越来越多的研究在探索它的发病机理和危险因素,非酒精性脂肪肝本身与胰岛素抵抗相关联,它甚至被认为代谢综合征在肝脏中的表现形式。例如2型糖尿病,肥胖,内脏脂肪组织,血脂异常,老龄化等都与之相关。而腹型肥胖也作为代谢综合征一个独立的高危因素,这二者之间是否具有内在的联系是本实验的研究目的。此外对于人群的选择,既往对于非酒精脂肪肝的发病机理中较多的选择是肥胖人群,但最近的研究表明非酒精性脂肪肝更多的是出现在非肥胖人群中,所以本实验旨在健康成人中来评估腹内脂肪组织同非酒精性脂肪肝的关系。方法本次实验454名中国成人(男性164人,女性290人)参与腹部低剂量CT扫描,并测量身高,体重,腰围,臀围,参与者年龄由19至63岁,平均年龄38岁。肝脏和脾脏的CT值测量是在门静脉入肝层面下完成,肝脏选取3个感兴趣区,脾脏选取两个感兴趣区,由三种指标评估肝脏脂肪浸润程度:1肝脏实质的衰减值(CTLP)2肝脏实质与脾脏衰减值之比(LSratio)3肝脏实质与脾脏衰减值之差(LSdif)。腹部定量CT(QCT)扫描数据采用Mindways QCT软件的体质成分测量功能,测得L2和L4椎体下缘水平的腹内脂肪面积(Visceral Fat Area,cm2)和总腹部脂肪面积(Total Fat Area,cm2),计算出腹部皮下脂肪面积(Subcutaneous Fat Area,cm2)。用双变量相关分析三种不同肝脏脂肪浸润指标同L2/3、L4/5椎间隙下腹内脂肪面积、腹部皮下脂肪面积和总腹部脂肪面积的相关性。单因素变量分析采用t检验,结合研究资料,将有差别的变量带入多因素分析采用Logistic回归。计算危险因素的多元校正OR值。结果在男性用三种不同指标评估非酒精性脂肪肝的影响因子中,L2/3层面下腹内脂肪面积可以作为非酒精性脂肪肝的独立危险因素。在女性中,用肝实质评价和肝脾差值评价脂肪肝的影响因子中,L2/3层面下腹内脂肪面积可作为非酒精性脂肪肝的独立危险因素。此外在男性中,CTLP、LSratio、LSdif各自同L2/3、L4/5层面下的TFA、SFA、VFA均有着较好的负相关性,分别比较LSdif与CTLP、LSratio三者同L2/3层面下腹内脂肪面积相关性(r=-0.534、r=-0.476、r=-0.500,P0.001),也比较LSdif与CTLP、LSratio同L4/5层面下腹内脂肪面积相关性(r=-0.422、r=-0.415,、r=-0.340,P0.001),发现LSdif与L2/3层面腹内脂肪面积负相关性更显著。在女性中,分别比较LSdif与CTLP、LSratio三者同L2/3层面下腹内脂肪面积相关性为(r=-0.247,r=-0.294,r=-0.211,P0.001),也比较LSdif与CTLP、LSratio同L4/5层面下腹内脂肪面积相关性(r=-0.258、r=-0.254,、r=-0.225,P0.001),发现CTLP与L2/3层面腹内脂肪面积负相关性(r=-0.294,P0.001)更密切。结论实验表明腹部内脏脂肪更多的积累,更易导致非肥胖成人人群患上非酒精性脂肪肝。其中相比较于L4/5层面下腹内脂肪,L2/3层面下腹内脂肪的积累与脂肪肝的关系更密切。
[Abstract]:Background and objective because of the increasing trend of non-alcoholic fatty liver in China, more and more studies are exploring its pathogenesis and risk factors. Non-alcoholic fatty liver itself is associated with insulin resistance. It is even thought to be the form of metabolic syndrome in the liver. For example, type 2 diabetes, obesity, visceral adipose tissue, dyslipidemia, aging, etc. Abdominal obesity is an independent risk factor for metabolic syndrome. In addition, the most common choice in the pathogenesis of non-alcoholic fatty liver is obesity, but recent studies have shown that non-alcoholic fatty liver is more common in non-obese people. The aim of this study was to evaluate the relationship between abdominal adipose tissue and non-alcoholic fatty liver in healthy adults. Methods A total of 454 Chinese adults (164 males and 290 females) were examined by low dose CT scan. Height, weight, waist circumference and hip circumference were measured. The participants' age ranged from 19 to 63 years, with an average age of 38 years. The CT values of liver and spleen were measured at portal vein level. Three regions of interest were selected for liver and two regions of interest for spleen. The attenuation value of hepatic parenchyma and spleen were evaluated by three indexes. The difference of attenuation value between hepatic parenchyma and spleen was compared with that of liver parenchyma and spleen. Mindways QCT software was used to measure the body composition. The abdominal fat area at the lower margin of L2 and L4 vertebrae was measured as visceral Fat area (cm 2) and total abdominal fat area (Total area of abdominal fat) and total area of abdominal fat (total area of abdominal fat) were calculated. The area of abdominal subcutaneous fat was calculated by subcutaneous Fat area. Bivariate correlation analysis was used to analyze the correlation between three different liver fat infiltration indexes and the subcutaneous fat area and total abdominal fat area in L2 / 3 / 4 / 5 intervertebral space. The single factor variable analysis adopts t test and combines with the research data, the different variables are brought into the multivariate analysis and the Logistic regression is adopted. The multivariate corrected OR value of risk factors was calculated. Results three different indexes were used to evaluate the influence factors of non-alcoholic fatty liver. The area of lower abdominal fat on L2 / 3 level could be used as an independent risk factor of non-alcoholic fatty liver. In women, liver parenchyma evaluation and liver-spleen difference were used to evaluate the area of lower abdominal fat in L2 / 3 level of fatty liver as an independent risk factor for non-alcoholic fatty liver. In addition, there was a good negative correlation between TFASFAVFA and L2 / 3L4 / 5 TFASFAVFA in male. The correlation between LSdif and CTLPE LSratio was compared with that of L2 / 3 in lower abdominal fat area. The negative correlation between LSdif and CTLPE LSratio in lower abdominal fat area of L4 / 5 was found to be more significant than that of LSdif and L2 / 3. The results showed that there was a more negative correlation between LSdif and the area of intraabdominal fat at L2 / 3 level, and the correlation between LSdif and CTLPE LSratio on L4 / 5 level was also more significant than that at L4 / 5 level, and the correlation between LSdif and CTLPE LSratio was higher than that on L4 / 5 level, and the correlation between LSdif and the area of intraabdominal fat at L2 / 3 level was more significant than that at L4 / 5 level. In women, the correlation between LSdif and CTLPE LSratio and the lower abdominal fat area at L2 / 3 level was found to be r-0.247r-0.294r-0.211P0.001g, and more closely compared with LSdif / CTLPV LSratio and L4 / 5 lower abdominal fat area (r-0.258r-0.254r-0.254r-0.2254r-0.2254P 0.001), and found that CTLP was more closely correlated with the area of intra-abdominal fat at L23 / L3. The negative correlation between CTLP and CTLPE LSratio was also higher than that between LSdif and CTLPE LSratio in L4 / 5 and L4 / 5 levels, and the correlation between CTLP and intra-abdominal fat area at L23 / 3 level was higher than that of CTLP and CTLPV LSratio at L4 / 5 level. Conclusion the results showed that abdominal visceral fat accumulation was more likely to lead to non-alcoholic fatty liver in non-obese adults. Compared with L4 / 5, the accumulation of subabdominal fat in L2 / 3 was more closely related to fatty liver.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575;R816.5

【相似文献】