目的 探讨代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)及其严重程度和肝纤维化程度与结直肠癌(colorectal cancer,CRC)的关系.方法 选取美国国家健康与营养调查(National Health and Nutrition Examination Survey,NHANES)数据库中 2017-2018 年同时具有肝脏超声瞬时弹性成像结果和"是否患有CRC"调查问卷(MCQ-230)结果的4365 例20 岁以上的成年人作为研究对象,根据是否患CRC将研究对象分为CRC组和非CRC组(对照组).比较CRC组与对照组一般资料及MAFLD患者数目之间的差异,将研究对象根据肝脏超声瞬时弹性成像结果及FIB-4无创肝纤维化评分进行肝脂肪变性严重程度和肝纤维化程度分层,分为无/轻度脂肪肝组和中重度脂肪肝组,非进展期肝纤维化组和进展期肝纤维化组,采用Logistic回归分析MAFLD及其严重程度和肝纤维化程度与CRC的相关性.结果 年龄、BMI、腰围、高血压史、糖尿病史、代谢综合征(metabolic syndrome,MetS)、MAFLD、TG、CRP、HbA1c、CAP、肝脏硬度值(E值)、FIB-4是CRC的危险因素(P<0.05),MAFLD是CRC的独立危险因素(OR=2.510,95%CI:1.045～6.032,P=0.040),在对肝脂肪变性严重程度和肝纤维化程度进一步分层后,中重度脂肪肝与FIB-4提示的进展期肝纤维化是CRC的独立危险因素(P<0.05),然而,肝脏超声瞬时弹性成像提示的进展期肝纤维化与CRC的风险差异无统计学意义(P>0.05).结论 MAFLD及其严重程度和肝纤维化程度与CRC密切相关,且MAFLD及其严重程度和FIB-4提示的肝纤维化程度是CRC发生的独立危险因素.
The relationship between severity of metabolic associated fatty liver disease and colorectal cancer
Objective To investigate the relationship between metabolic associated fatty liver disease(MAFLD)and its severity and degree of liver fibrosis and colorectal cancer(CRC).Methods A total of 4365 adults over the age of 20 years from the National Health and Nutrition Examination Survey(NHANES)database who had both liver instantane-ous elastography and CRC status questionnaire(MCQ-230)results from 2017 to 2018 were selected.The subjects were divided into CRC group and non-CRC group(control group)according to whether they had CRC or not.The differences in the general data and the number of MAFLD patients between CRC group and control group were compared.The sub-jects were divided into no/mild fatty liver group and moderate/severe fatty liver group,non-advanced and advanced he-patic fibrosis group according to the results of the liver ultrasound transient elastography and FIB-4 noninvasive liver fi-brosis score.Logistic regression analysis was used to investigate the correlation between CRC and MAFLD and its severi-ty and degree of liver fibrosis.Results Age,BMI,waist circumference,hypertension,diabetes,metabolic syndrome(MetS),MAFLD,TG,CRP,HbA1c,CAP,liver stiffness(E),FIB-4 were risk factors for CRC(P<0.05).MAFLD was an independent risk factor for CRC(OR=2.510,95%CI:1.045-6.032,P=0.040),moderate and severe fatty liver and FIB-4 suggested advanced liver fibrosis were independent risk factors for CRC after further stratification of liver steatosis severity and liver fibrosis severity(P<0.05).However,there was no statistically significant difference between the risk of advanced liver fibrosis and CRC suggested by liver ultrasound transient elastography(P>0.05).Conclusion MAFLD and its severity and degree of liver fibrosis are closely related to CRC,MAFLD and its severity and degree of liver fibrosis suggested by FIB-4 are independent risk factors for CRC.
Metabolic associated fatty liver diseaseFibroScanNoninvasive liver fibrosis scoreColorectal cancer
NETL
NSTL
万方数据
