摘要目的 分析军事飞行人员非酒精性脂肪肝(NAFLD)流行状况和影响因素,为防治NAFLD提供依据.方法 调查飞行人员年龄、飞行年限、机种,测定体质指数(BMI),检测丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)、空腹血糖(FBG)、尿酸(UA)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),及进行肝脏超声检查,根据有无NAFLD(分为2组)、BMI数值(分为2组)及ALT数值(分为3组)进行分组,并采用方差分析和Logistic回归分析处理数据.结果 426例男性飞行人员中,超重、NAFLD、ALT升高检出率分别为34.98%、19.48%和16.67%.超重组与体重正常组比较,NAFLD患病率、ALT异常率有显著差异(χ~2=145.152、58.959,P<0.01).与ALT<40 U/L组比较,40 U/L≤ALT<80 U/L组和ALT≥80 U/L组的BMI、TG,差异均有统计学意义(F=13.476、13.176,P<0.01).NAFLD组与对照组比较,年龄、飞行时间、BMI、ALT、AST、GGT、FBG、UA、TG、TC、LDL-C显著增高(t=2.287～7.002,P<0.05或0.01),而HDL-C水平显著降低(t=2.932,P<0.01).高速机种与低速机种组比较,年龄、飞行时间、BMI、ALT、AST、GGT、FBG、UA、TC、TG、HDL-C、LDL-C及NAFLD发病率差异均无统计学意义.单因素Logistic回归分析显示显著影响NAFLD的变量为BMI、TG和飞行机种(Z=37.353、8.658、4.486,P<0.05或0.01).结论 飞行人员NAFLD患病率偏高,存在超重、血脂异常等危险因素,早期发现并治疗NAFLD是阻止其发展及预防心脑血管事件的重要措施之一.

abstractsObjective To analyze the pathogenetic status and risk factors of nonalcoholic fatty liver disease (NAFLD) in military airerews, in order to provide evidence for the treatment and prevention of NAFLD. Methods The study included collecting data as military airerew's age, flying hours and type of aircraft, calculating body mass index (BMI), measuring liver function [alanine transaminase (ALT), aspartase aminotransferase (AST), gamma-glutamyltransferase (GGT)], fasting blood glucose (FBG), uric acid (UA), total cholesterol (TC), triglyceride(TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (HDL-C), as well as examining liver by B-ultrasound. Results were processed by variance and Logistic regression analysis according to the groups that respectively divided by NAFLD (2 groups), BMI value (2 groups) and ALT value (3 groups by the ranges within ALT<40 U/L, 40 U/L≤ALT<80 U/L and ALT≥ U/L). Results Out of 426 male aircrews, 34.98% were overweight, 19.48% had NAFLD and 16.67% were with high ALT. Compared with normal weight group, morbidity rate of NAFLD and level of ALT were significantly higher than those in over weight group (χ~2=145.152, 58.959, P< 0.01). Aircrews in ALT≥40 U/L group showed statistical differences on BMI and TG compared to those in ALT<40 U/L group (F=13.476, 13.176, P<0.01). ATL, AST, C, GT, TG, TC, LDL-C, FBG and UA in NAFLD group were significantly higher than those in control group (t= 2.287-7.002, P<0.05 or 0.01), but HDL-C level was significantly lower (t=2.932, P<0.01). There were no statistical differences between fast jet and low speed aircraft (transporter, bomber, helicopter, etc.) aircrews in age, flying hours, BMI and other biochemical indexes. Logistic regression analysis showed that the factors that induced NAFLD were BMI, TG and type of aircraft (Z=37.353, 8.658, 4.486, P<0.05 or 0.01). Conclusions The aircrews have higher morbidity rate of NAFLD with such high risk factors as over weight, high blood lipid (high TG, high LDL-C and low HDLC). So early diagnosis and treatment of NAFLD would be one of the most important measures for limiting its growth and preventing cardiovascular and cerebrovaseular diseases.