内地西藏籍大学生非酒精性脂肪性肝病现况调查及危险因素分析

A Cross-Sectional Investigation for Prevalence and Risk Factors of Non-Alcoholic Fatty Liver Disease in Tibetan College Students in Mainland

摘要: 目的：对内地西藏籍大学生的非酒精性脂肪性肝病(non-alcoholic fatty liver disease, NAFLD)现况进行调查并分析其危险因素，为高海拔地区青年人群NAFLD的进一步研究提供科学依据。方法：采用方便抽样，于2022年7月对参与调研的400名来内地求学的、西藏籍学生进行问卷调查、体格检查、腹部超声检查及血清学检查，运用SPSS 18.0软件对符合纳入标准的386名学生的相关数据进行分析总结。结果：1) 386名学生中，NAFLD 59例(15.3%)，其中轻度脂肪肝51例(13.2%)、中度脂肪肝5例(1.2%)，重度脂肪肝3例(0.8%)，女性患病率(16.9%)高于男性(13.0%)。2) 在59名NAFLD学生中，体重正常7例(11.9%)，有肥胖风险30例(50.8%)，肥胖22例(37.3%)。3) NAFLD学生比非NAFLD学生的ALT [(20 ± 22.7) U/L vs (13.9 ± 22.7) U/L)]、腹围[(86.81 ± 9.29) cm vs (73.68 ± 6.79) cm]、腰臀比[(0.88 ± 0.05) vs (0.84 ± 0.06)]、BMI [(26.60 ± 3.78) kg/m² vs (20.39 ± 2.56) kg/m²]、VAI [(1.98 ± 1.24) cm²/10cm vs (1.42 ± 0.75) cm²/10cm]均高于非NAFLD (P均<0.01)。4) 在对生活习惯分析时发现，男性中经常运动的人数(72%，占全部锻炼人数的52.7%)多于女性(46.2%，占全部锻炼人数的47.3%) (χ² = 25.5, P = 0.000)、男性的每周锻炼的频次(3.03 ± 1.41)也多于(t = 2.9, P < 0.01)女性(2.48 ± 1.42)；女性每天静坐的时间(4.31 ± 2.13)长于(t = −2.7, P < 0.01)男性(3.73 ± 1.96)。饮食方面：女性每周含糖饮料的摄入杯数(3.98 ± 2.67)多于(t = 6.46, P = 0.000)男性(2.26 ± 1.68)；男性总体进食蔬菜的量小于女性(χ² = 9.33, P = 0.025)。结论：1) 内地西藏籍大学生NAFLD的患病率处于国内较低、高校中较高水平；2) BMI、腹围、腰臀比和VAI的增大、ALT的升高可作为NAFLD的筛查指标；3) 久坐少动、运动量少、含糖饮料摄入多是本此次研究中女性患病率高于男性的主要危险因素。4) 非肥胖型NAFLD患病率接近肥胖型NAFLD的患病率，需引起重视。

Abstract: Objective: To investigate prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) in inland Tibetan college students, to provide a scientific basis for further research of NAFLD in the youth population at high altitude. Methods: Convenience sampling was used to choose students. Questionnaire survey, physical examination, abdominal ultrasound examination and serological examination were conducted to 400 Tibetan students who studying in mainland in 2022 July. 386 complyed with the inclusion criteria individuals’ data were summarized and analyzed by SPSS 18.0 Software. Results: 1) 59 students (13.2%) were diagnosed as NAFLD in total 386 subjects, including, 51 mild NAFLD (13.2%), 5 moderate NAFLD (1.2%) and 3 severe NAFLD (0.8%). The prevalence of female higher (16.9%) than that of male (13.0%). 2) Among the 59 NAFLD students, 7 (11.9%) were normal weight, 30 (50.8%) were overload and 22 (37.3%) were obese. 3) The ALT [(20 ± 22.7) U/L vs (13.9 ± 22.7) U/L)], circumference of abdomen [(86.81 ± 9.29) cm vs (73.68 ± 6.79) cm], waist-to-hipratio [(0.88 ± 0.05) vs (0.84 ± 0.06)], BMI [(26.60 ± 3.78) kg/m² vs (20.39 ± 2.56) kg/m²], VAI [(1.98 ± 1.24) cm2/10cm vs(1.42 ± 0.75) cm²/10cm] of NAFLD students were higher than non-NAFLD (P < 0.01). 4) In the analysis of lifestyle habits, it was found that men exercised more (72%, 52.7% among the total number of exercise people) than women (46.2%, 47.3% among the total number of exercise people) (χ² = 25.5, P = 0.000), the frequency of weekly exercise of men (3.03 ± 1.41) was more than (t = 2.9, P < 0.01) that of women (2.48 ± 1.42), the siting time per day of women (4.31 ± 2.13) is longer than (3.73 ± 1.96) that of men (t = −2.7, P < 0.01). We also found that, women consumed sugary drinks per day (3.98 ± 2.67) than (t = 6.46, P = 0.000) men (2.26 ± 1.68), and men consumed less vegetables than women (χ² = 9.33, P = 0.025). Conclusions: 1) The preva-lence of NAFLD among Tibetan college students in the mainland is relatively lower than national average but higher than other universities in the other regions. 2) Higher ALT, BMI, WC, waist-to- hip ratio and VAI can be used as screening indicators for NAFLD. 3) Sedentary time, lack of aerobic exercise, insufficient intake of vegetables, and regular weekly intake of sugary drinks are the mate-rial cause of the higher prevalence in women than in men. 4) The incidence of non-obese NAFLD is close to that of obese NAFLD, which should be paid attention to.