摘要 12 - 类风湿关节炎患者非酒精性脂肪肝的患病率和风险因素:一项基于全国人口的研究

Shiyu Xiao, W. Xie
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NAFLD was defined by controlled attenuation parameter (CAP) scores of [Formula: see text]278 dB/m using vibration controlled transient elastography (VCTE) in the absence of other liver disease. Weighted multiple regression analysis was further performed to assess the independent risk factors. Results Of 2,848 people included in this study, 224 of them had self-reported RA. The prevalence of NAFLD in the overall sample was 41%, with a numerically higher prevalence in RA patients than those without arthritis (47% vs. 40%, p=0.30). Compared to those without NAFLD, RA patients with concomitant NAFLD had more prevalent metabolic comorbidities including obese (75% vs. 32%, p=0.006), central obesity (100% vs. 71%, p=0.008), diabetes (39% vs. 14%, p=0.003) and hyperlipidemia (88% vs. 76%, p=0.042). Regarding laboratory findings, RA patients with NAFLD exhibited higher levels of triglyceride (188 mg/dL vs. 131 mg/dL, p=0.010), fasting plasma glucose (131 mg/dL vs. 109 mg/dL, p=0.010) and HbA1c (5.77% vs. 6.41%, p=0.002). Meanwhile, elevated levels of liver enzymes (ALT: 29 U/L vs. 19 U/L, p=0.015; AST: 25 U/L vs. 19 U/L, p=0.007) and inflammatory indicator CRP (5.1 mg/dL vs. 3.4 mg/dL, p<0.001]) were more frequently reported in RA patients with NAFLD as compared with those without. Further, weighted multivariate logistic regression analysis showed that the presence of central obesity (adjusted OR=1.56 [95% CI 1.16-2.11], p=0.008) and diabetes (adjusted OR=1.28 [95% CI 1.07-1.54], p=0.014) were significantly associated with prevalent NAFLD in patients with RA. Conclusion In this population-based study, about one in two patients with RA had NAFLD, which is higher than its overall prevalence among general population. 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Growing evidence suggests a link between RA and nonalcoholic fatty liver disease (NAFLD). We aimed to determine the prevalence and explore the risk factors of developing NAFLD in RA population. Methods This population-based, cross-sectional study utilized data on US adults aged [Formula: see text]20 years old from the National Health and Nutrition Examination Survey (NHANES) 2017-2018, a representative sample of the general US population. Diagnosis of RA was derived from questionnaire data. NAFLD was defined by controlled attenuation parameter (CAP) scores of [Formula: see text]278 dB/m using vibration controlled transient elastography (VCTE) in the absence of other liver disease. Weighted multiple regression analysis was further performed to assess the independent risk factors. Results Of 2,848 people included in this study, 224 of them had self-reported RA. 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引用次数: 0

摘要

背景类风湿性关节炎(RA)是一种使人衰弱、经济负担沉重的疾病,因为它经常出现合并症,包括代谢和心血管异常。越来越多的证据表明,RA 与非酒精性脂肪肝(NAFLD)之间存在联系。我们的目的是确定 RA 患者非酒精性脂肪肝的患病率并探讨其风险因素。方法 这项基于人群的横断面研究利用了美国2017-2018年全国健康与营养调查(NHANES)中20岁[公式:见正文]美国成年人的数据,NHANES是美国普通人群的代表性样本。RA诊断来自问卷调查数据。在无其他肝脏疾病的情况下,使用振动控制瞬态弹性成像(VCTE),非酒精性脂肪肝的控制衰减参数(CAP)分数达到[公式:见正文]278 dB/m。为评估独立风险因素,进一步进行了加权多元回归分析。结果 在这项研究纳入的2848人中,有224人自我报告患有RA。在所有样本中,非酒精性脂肪肝的患病率为41%,其中RA患者的患病率高于无关节炎患者(47%对40%,P=0.30)。与没有非酒精性脂肪肝的患者相比,合并非酒精性脂肪肝的 RA 患者有更多的代谢合并症,包括肥胖(75% 对 32%,P=0.006)、中心性肥胖(100% 对 71%,P=0.008)、糖尿病(39% 对 14%,P=0.003)和高脂血症(88% 对 76%,P=0.042)。在实验室检查结果方面,患有非酒精性脂肪肝的 RA 患者甘油三酯(188 mg/dL vs. 131 mg/dL,p=0.010)、空腹血浆葡萄糖(131 mg/dL vs. 109 mg/dL,p=0.010)和 HbA1c(5.77% vs. 6.41%,p=0.002)水平较高。同时,与无非酒精性脂肪肝的 RA 患者相比,非酒精性脂肪肝的 RA 患者肝酶水平升高(ALT:29 U/L vs. 19 U/L,p=0.015;AST:25 U/L vs. 19 U/L,p=0.007)和炎症指标 CRP(5.1 mg/dL vs. 3.4 mg/dL,p<0.001])的频率更高。此外,加权多变量逻辑回归分析显示,中心性肥胖(调整后 OR=1.56 [95% CI 1.16-2.11],p=0.008)和糖尿病(调整后 OR=1.28 [95% CI 1.07-1.54],p=0.014)与 RA 患者的非酒精性脂肪肝发病率显著相关。结论 在这项基于人群的研究中,大约每两名 RA 患者中就有一人患有非酒精性脂肪肝,高于普通人群的总体患病率。中心性肥胖和糖尿病是导致 RA 非酒精性脂肪肝的易感因素。我们的研究结果突显了在RA人群中积极筛查非酒精性脂肪肝的重要性,尤其是对高危人群。
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Abstract 12 — Prevalence and Risk Factors of Non-Alcoholic Fatty Liver Disease in Patients with Rheumatoid Arthritis: A Nationwide Population-Based Study
Background Rheumatoid arthritis (RA) is a debilitating and financially burdensome disease because of frequent presence of comorbidities including metabolic and cardiovascular abnormalities. Growing evidence suggests a link between RA and nonalcoholic fatty liver disease (NAFLD). We aimed to determine the prevalence and explore the risk factors of developing NAFLD in RA population. Methods This population-based, cross-sectional study utilized data on US adults aged [Formula: see text]20 years old from the National Health and Nutrition Examination Survey (NHANES) 2017-2018, a representative sample of the general US population. Diagnosis of RA was derived from questionnaire data. NAFLD was defined by controlled attenuation parameter (CAP) scores of [Formula: see text]278 dB/m using vibration controlled transient elastography (VCTE) in the absence of other liver disease. Weighted multiple regression analysis was further performed to assess the independent risk factors. Results Of 2,848 people included in this study, 224 of them had self-reported RA. The prevalence of NAFLD in the overall sample was 41%, with a numerically higher prevalence in RA patients than those without arthritis (47% vs. 40%, p=0.30). Compared to those without NAFLD, RA patients with concomitant NAFLD had more prevalent metabolic comorbidities including obese (75% vs. 32%, p=0.006), central obesity (100% vs. 71%, p=0.008), diabetes (39% vs. 14%, p=0.003) and hyperlipidemia (88% vs. 76%, p=0.042). Regarding laboratory findings, RA patients with NAFLD exhibited higher levels of triglyceride (188 mg/dL vs. 131 mg/dL, p=0.010), fasting plasma glucose (131 mg/dL vs. 109 mg/dL, p=0.010) and HbA1c (5.77% vs. 6.41%, p=0.002). Meanwhile, elevated levels of liver enzymes (ALT: 29 U/L vs. 19 U/L, p=0.015; AST: 25 U/L vs. 19 U/L, p=0.007) and inflammatory indicator CRP (5.1 mg/dL vs. 3.4 mg/dL, p<0.001]) were more frequently reported in RA patients with NAFLD as compared with those without. Further, weighted multivariate logistic regression analysis showed that the presence of central obesity (adjusted OR=1.56 [95% CI 1.16-2.11], p=0.008) and diabetes (adjusted OR=1.28 [95% CI 1.07-1.54], p=0.014) were significantly associated with prevalent NAFLD in patients with RA. Conclusion In this population-based study, about one in two patients with RA had NAFLD, which is higher than its overall prevalence among general population. Central obesity and diabetes are predisposing factors for NAFLD in RA. Our results highlight the importance of active NAFLD screening in RA population, especially for high-risk subsets.
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