维生素D与非酒精性脂肪性肝病的相关性研究

发布时间：2018-06-17 00:27

本文选题：维生素D + 非酒精性脂肪性肝病　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的目前维生素D被认为是一种类固醇激素,不仅具有经典的调节钙磷代谢的作用,亦具有抗炎、抗感染及免疫调节等功能。已知维生素D缺乏参与多种疾病的发生、发展过程,而维生素D缺乏与非酒精性脂肪性肝病(NAFLD)发病关系的的临床研究资料较少,且研究结果尚存在分歧,本课题拟采用病例对照研究探讨维生素D缺乏与NAFLD之间的相关性。方法纳入2013年4-6月来我院门诊健康体检的1150例人群为研究对象。首先建立NAFLD病史资料调查表,通过问卷调查收集研究对象一般情况,包括性别、年龄、民族、学历、职业、吸烟史、饮酒史、服药史、NAFLD病程及其他代谢性疾病史,体格检查收集身高、体重、腹围、心率、血压等指标,并计算体质量指数(BMI)。所有研究对象均检测血清白蛋白、总胆红素、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(AKP)、谷氨酰转肽酶(GGT)、乳酸脱氢酶(LDH)、血尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、空腹血糖(FPG)、总胆固醇(TCH)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血钙和血磷等生化指标。酶联免疫吸附法检测乙肝表面抗原和丙型肝炎病毒抗体。上腹部肝脏超声检查筛查脂肪肝,并做出轻度、中度、重度肝脏脂肪变性严重程度的评定。依照纳入和排除标准,最终纳入符合NAFLD诊断标准的患者104例,及同期体检人群中年龄、性别相匹配的健康对照98例。放免法检测血清25-羟维生素D[25(OH)D]浓度。采用两独立样本t-检验、χ2检验、ANOVA分析、多元logistic回归分析等统计学方法分析血清25(OH)D浓度与NAFLD之间的相关性。结果NAFLD组与对照组临床变量相比,BMI、腹围、血压、ALT、AST、GGT、LDH、UA、TG、TCH、LDL-C、HDL-C、FPG等参数的差异均有统计学意义(P0.001或P0.05);NAFLD组与对照组的年龄、性别、AKP、Cr、血清25(OH)D浓度(20.87±6.73 vs.21.63±8.22 ng/ml,P=0.474)以及钙、磷水平差异无统计学意义(P0.05),且血清25(OH)D浓度15ng/ml与≥15ng/ml的状态在两组间的差异亦无统计学意义(P均0.05)。年龄、性别、BMI的分层研究显示,≤30岁NAFLD组25(OH)D浓度低于对照组,差异有统计学意义(16.85±7.56 vs.22.23±5.78ng/ml,P=0.04),且NAFLD组25(OH)D缺乏(15ng/ml)的比例高于对照组(χ2=6.679,OR=13.71,95%C.I.1.38~136.21,P=0.025);BMI≤25kg/m2的NAFLD组25(OH)D缺乏(15ng/ml)的比例高于对照组(χ2=3.734,OR=4.97,95%C.I.2.27~10.89,P0.001)。在30-50岁与50岁的年龄层中,25(OH)D缺乏在NAFLD组与对照组中的比例差异无统计学意义(P0.05),在性别以及BMI25kg/m2的分层中,25(OH)D缺乏在两组中的差异亦无统计学意义(P0.05)。根据25(OH)D四分位数对整体研究样本分层研究显示,各组间年龄、性别、体质量指数、ALT、AST、AKP、GGT、LDH、UA、Cr、TCH、LDL-C等参数的差异无统计学意义(P0.05);各组间NAFLD发生率的差异亦无统计学意义(P0.05)。HDL-C、空腹血糖及甘油三酯的水平在各组间的差异有统计学意义,在最低25(OH)D四分位数HDL-C的数值最低(P0.001);在最高的25(OH)D四分位数空腹血糖的水平最低(P=0.02),在最高的25(OH)D四分位数也显示了甘油三酯的水平最高(P=0.02)。超声判定的轻度、中度与重度肝脂肪变各组间25(OH)D浓度差异无统计学意义(F=0.419,P=0.740);且各组间发生25(OH)D15ng/ml的例数或发生25(OH)D30ng/ml的例数差异均无统计学意义(χ2=3.844,P=0.279;χ2=2.143,P=0.516)。多元logistic回归分析显示,整体样本中BMI、TG是NAFLD的危险因素;BMI≤25kg/m2群体多元logistic回归分析校正年龄、性别、TG、TCH、HDL-C、LDL-C、GLU、UA等混杂因素后显示,25(OH)D与NAFLD相关(OR=1.16,95%C.I.1.03~1.3,P=0.032);多元回归分析显示,超声判定的肝脂肪变严重程度与UA、TCH、年龄相关,与25(OH)D浓度无明显关联。结论维生素D缺乏可能是≤30岁年轻人和正常体质量指数的NAFLD患者发病的危险因素。
[Abstract]:Aim at present, vitamin D is considered as a steroid hormone, which not only has the function of regulating calcium and phosphorus metabolism, but also has the functions of anti-inflammatory, anti infection and immunoregulation. It is known that vitamin D deficiency is involved in the occurrence and development of various diseases and the relationship between vitamin D deficiency and non-alcoholic fatty liver disease (NAFLD). There are few research data and there are still differences in the results of the study. A case control study is intended to study the correlation between vitamin D deficiency and NAFLD. Methods the study was taken in the outpatient health check-up of our hospital in 4-6 months in 2013 as the research object. First, a questionnaire on the medical history of NAFLD was established, and a questionnaire was used to collect the research objects. Like sex, age, age, nationality, education, occupation, smoking history, drinking history, medicine history, history of NAFLD and other metabolic diseases, physical examination collected height, weight, abdominal circumference, heart rate, blood pressure and so on, and calculated body mass index (BMI). All subjects examined serum albumin, total bilirubin, alanine aminotransferase (ALT), Aspartate aminotransferase (AST), alkaline phosphatase (AKP), glutamyl transaminopeptidase (GGT), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), total cholesterol (FPG), total cholesterol (TCH), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood calcium and blood phosphorus, and other biochemical indicators. Detection of hepatitis B surface antigen and HCV antibody by combined immunosorbent assay. The upper abdominal liver ultrasonography screening fatty liver, and making a mild, moderate, severe hepatic steatosis severity assessment. According to the inclusion and exclusion criteria, 104 patients were finally included in the NAFLD diagnostic criteria, and the age and sex of the population in the same period of physical examination. 98 healthy controls were matched. Serum 25- hydroxyvitamin D[25 (OH) D] concentration was detected by radioimmunoassay. Two independent sample t- test, x 2 test, ANOVA analysis, multiple logistic regression analysis and other statistical methods were used to analyze the correlation between serum 25 (OH) D concentration and NAFLD. ST, GGT, LDH, UA, TG, TCH, LDL-C, HDL-C, FPG and other parameters were statistically significant (P0.001 or P0.05), and there was no statistical difference between the 25 (20.87 + 6.73 + 8.22) concentrations in the NAFLD group and the control group and the level of calcium and phosphorus. The difference between the two groups was also not statistically significant (P 0.05). Age, sex, and BMI stratified study showed that the concentration of 25 (OH) D in group NAFLD was lower than that of the control group, and the difference was statistically significant (16.85 + 7.56 vs.22.23 + 5.78ng/ml, P=0.04), and the proportion of 25 (OH) D deficiency (15ng/ml) in group NAFLD was higher than that of the control group =0.025); the proportion of NAFLD group 25 (OH) D deficiency (15ng/ml) in BMI < 25kg/m2 > was higher than that of the control group (x 2=3.734, OR=4.97,95%C.I.2.27~10.89, P0.001). In the age layer of 30-50 and 50, the proportion of the 25 (OH) D deficiency in the group and the control group was not statistically significant (25) in the two groups. There was no statistical significance (P0.05). According to the 25 (OH) D four quantiles, the stratified study of the whole research samples showed that the differences in age, sex, body mass index, ALT, AST, AKP, GGT, LDH, UA, Cr, TCH, LDL-C and other parameters were not statistically significant. The levels of blood glucose and triglycerides were statistically significant between the 25 (OH) D four quantiles HDL-C (P0.001), the lowest (P=0.02) at the highest level of 25 (OH) D four digits (P=0.02), and the highest level of 25 (OH) D four in the highest level (P=0.02). There was no significant difference in the concentration of 25 (OH) D between degrees and severe hepatic steatosis (F=0.419, P=0.740), and there was no significant difference in the number of cases of 25 (OH) D15ng/ml or 25 (OH) D30ng/ml occurring between each group (x 2=3.844, P=0.279; Chi 2=2.143, P=0.516). Factors: BMI < 25kg/m2 population multivariate logistic regression analysis corrected age, sex, TG, TCH, HDL-C, LDL-C, GLU, UA and other confounding factors, 25 (OH) D and NAFLD correlation. Vitamin D deficiency may be a risk factor for NAFLD patients younger than 30 years old and normal body mass index.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575

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