臺灣中部地區某區域醫院非酒精性脂肪肝疾病與肥胖相關因子之研究

Non-Alcoholic Fatty Liver Disease and Obesity-Associated Factors: A Study in a Regional Hospital in Mid-Taiwan

非酒精性脂肪肝疾病（non-alcoholic fatty liver disease; NAFLD）可能引發肝臟纖維化及肝硬化，甚至是末期肝臟疾病，近年來隨著肥胖人口的增加，估計其亦在增加當中，是值得我們去注意的公共衛生問題。本研究為了了解非酒精性脂肪肝疾病的相關因子，從2004年3月至2005年2月間，以台中市某區域醫院自費全身健康檢查居民為對象，選取年齡為18歲以上，平均為47.7±12.0歲，排除平均每日喝酒大於20克酒精量者後，共收集有效樣本700人做分析，其中男性佔57.9%，NAFLD以腹部超音波做為診斷依據。結果顯示非酒精性脂肪肝疾病有232人（33.1%），有B型及C型肝炎者分別佔有76人（10.9%）及32人（4.6%）。卡方檢定分析發現年齡越大、血壓高、中央型肥胖、空腹血糖高、三酸甘油酯高、總膽固醇高、高密度脂蛋白膽固醇低、低密度脂蛋白膽固醇高、天門冬酸胺基轉化值高、丙胺酸胺基轉化值高及尿酸值高者有較高比率NAFLD，達統計學上的顯著差異（p<0.001），C型肝炎抗體陰性者有較高比率NAFLD，達統計學上的顯著差異（p=0.044）。進一步以逐步多變項邏輯斯迴歸分析，顯示年齡越大者（危險對比值[OR]=1.1；95% CI 1.0-1.1）、腹圍異常者（OR=4.2；95% CI 2.8-6.4）、高空腹血糖者（OR=2.3；95% CI 1.3-4.0）、高三酸甘油酯（OR=2.5；95% CI 1.7-3.7）及丙胺酸胺基轉化值高者（OR=2.6；95%CI 1.6-4.2）皆較易有NAFLD之趨勢，但C型肝炎抗體陽性者有NAFLD之危險對比值是陰性的0.2倍（OR=0.2；95% CI 0.1-0.7）。因此對於較大年齡、有中央型肥胖、空腹血糖高、三酸甘油酯高及丙胺酸胺基轉化高者要考慮是否有NAFLD，而C型肝炎抗體陽性與NAFLD之負相關則有待進一步研究證實。

Non-alcoholic fatty liver disease (NAFLD) may progress to liver fibrosis, cirrhosis, and even end stage liver disease. The aim of the present study was to investigate the relationship between NAFLD and obesity-associated factors among those subjects who underwent health examinations in a regional hospital in Taichung between March 2004 and February 2005. Subjects who drank an average of ＜20 grams of alcohol per day were excluded. A total of 700 participants had an abdominal ultrasonographic examination using a TOSHIBA A220 (convex probe; 3.75MHz), of whom 33.1% of the subjects were diagnosed with NAFLD. Of all subjects, 10.9% were hepatitis B virus carriers and 4.6% were positive for hepatitis C virus. Chi-square analysis showed that increased age, high blood pressure, central obesity, impaired fasting glucose or diabetes mellitus, high triglyceride levels, high total cholesterol levels, low levels of high density lipoprotein-cholesterol, high levels of low density lipoprotein-cholesterol, high aspartate aminotransferase levels, high alanine aminotransferase levels, and hyperuricemia were all associated with NAFLD, and all of these measures reached statistical significance (p＜0.001). The subjects with negative anti-hepatitis C antibody titers had features of NAFLD (p=0.044). The result of a stepwise multivariate logistic regression model revealed that age (Odds Ratio [OR]=1.1; 95% confidence interval [CI] 1.0-1.1), central obesity (OR=4.2; 95% CI 2.8-6.4), impaired fasting glucose or diabetes mellitus (OR=2.3; 95% CI 1.3-4.0), hypertriglyceridemia (OR=2.5; 95% CI 1.7-3.7) and high alanine aminotransferase (OR=2.6; 95% CI 1.6-4.2) were more commonly associated with NAFLD. However, subjects with hepatitis C virus infection weren't predisposed to NAFLD (OR=0.2; 95% CI 0.1-0.7). In conclusion, physicians should consider the possibility of NAFLD, if patients are elderly, have central obesity, impaired fasting glucose or diabetes mellitus, high triglyceride levels, high alanine aminotransferase levels, and negative anti-hepatitis C antibody titers.