非酒精性脂肪肝盛行率高血壓與糖尿病發生率之研究以十五年來高醫健檢資料庫之橫斷及世代研究

The prevalence of nonalcoholic fatty liver disease and the incidence of hypertension and diabetes study: Cross-sectional and cohort studies of health check-up database in fifteen years of Department of Preventive Medicine of Kaohsiung Medical University Chung-Ho Memorial Hospital

吳冠達(Kuan-Ta Wu)

指導教授 ： 郭柏麟

共同指導教授 ： 余明隆(Ming-Lung Yu)

高雄醫學大學/醫學院/臨床醫學研究所/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00027

摘要

【背景與目的】
臺灣大規模的成人健康檢查數據，包括高血壓、糖尿病、高血脂以及非酒精性脂肪肝的資料並不多，我們需要大型數據來說明臺灣地區的成年人健康檢查的結果。總膽固醇、三酸甘油酯、高密度脂蛋白膽固醇，是健康檢查血脂肪的重要項目。目前只有三酸甘油酯、三酸甘油酯與高密度脂蛋白膽固醇的比值，被公認與非酒精性脂肪肝有關。先發生高血壓還是糖尿病，過去並沒有專文討論，也不清楚這兩個疾病之間有無交互作用。我們採用世代研究的方式，來分析高血壓與糖尿病的關係及其終生累積發生率。

【方法與材料】
我們採用1999-2013這十五年間，在高醫健康管理中心接受超音波與身體檢查且有完整的肝腎功能、血壓、血糖評估的成年人。分成兩個方向來做分析。

橫斷研究，參與者需有完整體檢數據，包括總膽固醇、三酸甘油酯、高密度脂蛋白膽固醇、尿酸、丙麩氨轉肽酶的第一筆數據；排除酒精性脂肪肝與重大器官移植。再根據血脂肪的比值分組：總膽固醇除以高密度脂蛋白膽固醇以4.0為切點、三酸甘油酯除以高密度脂蛋白膽固醇以2.0為切點分成四組。根據吸菸史、身體質量指數、血壓、空腹血糖、腎功能、脂肪肝程度、肝功能指數與病毒標記，逐步分析四組成員的異同。

世代研究，十五年間至少接受兩次以上的超音波體檢，其資料足以判定是否罹患高血壓、糖尿病者，且第一次來體檢的年齡介於18到65歲之間。排除酒精性脂肪肝、重大器官移植、中重度腎功能不良、體檢當年或翌年被診斷出高血壓或糖尿病者。根據高血壓與糖尿病的發生狀況，計算臺灣地區人們的終生累積發生率，並進行各項代謝因子的分析，描繪其對高血壓、糖尿病發生的影響。

【結果】
橫斷研究指出，臺灣脂肪肝盛行率53.87%。其中身體質量指數、男性、吸菸、血壓、血糖、尿酸、丙麩氨轉肽酶，均為血脂肪的比值升高的獨立因子。肝脂肪囤積程度愈高，血脂肪比值亦愈高，即使調整了血壓、血糖、性別、吸菸、身體質量指數、肝腎功能，脂肪肝的程度與血脂肪比值仍然顯著而獨立。

世代研究指出，脂肪肝、身體質量指數偏高、血壓偏高、男性、吸菸，均為發生高血壓的獨立因子。發生糖尿病的獨立因子，則包括脂肪肝程度、身體質量指數、血壓血糖偏高、男性、三酸甘油酯偏高、吸菸。而且脂肪肝程度愈厲害，愈容易在年輕的時候就得到高血壓或糖尿病。

【結論】
脂肪肝的程度，在當下即為高血壓、高血糖、高血脂的獨立因子。即使目前尚未發病，亦為未來罹患高血壓或糖尿病的獨立風險因子。中重度脂肪肝的人，容易於年輕的時候罹患高血壓與糖尿病。而且高血壓的發生年紀早於糖尿病的發生年紀，這兩個疾病有相關意義。

關鍵字

代謝症候群 ； 高血壓前期 ； 終生累積發生率 ； 總膽固醇 ； 三酸甘油酯 ； 高密度脂蛋白膽固醇

並列摘要

Background and aim:
The relationship between nonalcoholic fatty liver disease (NAFLD) severity and total cholesterol-to-high-density lipoprotein cholesterol (TC/HDL-C) and triglyceride-to-high-density lipoprotein cholesterol (TG/HD-C) ratios were not clear. People also cannot well identify the order of newly onset hypertension and diabetes in their lifetime.

Material and method:
Adult with comprehensive health check-up in 1999-2013. In cross-sectional study, the 39846 subjects were divided by the lipid ratios into four subgroups and were analyzed with the severity of NAFLD. In cohort study, the 34865 subjects without hypertension or diabetes were analyzed with the risk factor of incident hypertension and diabetes. Lifetime cumulative incidence were also illustrated by the survival curve.

Result:
The prevalence rate of NAFLD in our study population was 53.87%. In cross-sectional study, the both higher ratios of TC/HDL-C and TG/HDL-C were strong associated with the high grade fatty liver.

In cohort study, male gender, smoke, prehypertension, NAFLD, and higher BMI were independent risk factor for both newly onset hypertension and diabetes. In addition, impaired fasting glucose, hypertriglyceridemia, and incident hypertension were also the independent risk factor for newly onset diabetes.

Conclusion:

In cross-sectional study, those with higher lipid ratios were easily to get hypertension, diabetes and NAFLD. Abdominal ultrasounds is a popular and easily to get examination tool in Taiwan, not worldwide. Adult people should go for health check-up their blood pressure, fasting glucose and lipid profile especially in their middle age.

NAFLD was one of the independent risk factors for newly onset hypertension and diabetes. Younger and higher incidence of hypertension and diabetes were found in those with NAFLD. NAFLD is an important issue for health promotion.

並列關鍵字

Metabolic syndrome ； prehypertension ； cumulative incidence rate ； total cholesterol ； triglyceride ； high density lipoprotein cholesterol

參考文獻

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