發(fā)布時間：2018-06-17 00:27

  本文選題：維生素D + 非酒精性脂肪性肝病��； 參考：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的目前維生素D被認(rèn)為是一種類固醇激素,不僅具有經(jīng)典的調(diào)節(jié)鈣磷代謝的作用,亦具有抗炎、抗感染及免疫調(diào)節(jié)等功能。已知維生素D缺乏參與多種疾病的發(fā)生、發(fā)展過程,而維生素D缺乏與非酒精性脂肪性肝病(NAFLD)發(fā)病關(guān)系的的臨床研究資料較少,且研究結(jié)果尚存在分歧,本課題擬采用病例對照研究探討維生素D缺乏與NAFLD之間的相關(guān)性。方法納入2013年4-6月來我院門診健康體檢的1150例人群為研究對象。首先建立NAFLD病史資料調(diào)查表,通過問卷調(diào)查收集研究對象一般情況,包括性別、年齡、民族、學(xué)歷、職業(yè)、吸煙史、飲酒史、服藥史、NAFLD病程及其他代謝性疾病史,體格檢查收集身高、體重、腹圍、心率、血壓等指標(biāo),并計算體質(zhì)量指數(shù)(BMI)。所有研究對象均檢測血清白蛋白、總膽紅素、丙氨酸氨基轉(zhuǎn)移酶(ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(AST)、堿性磷酸酶(AKP)、谷氨酰轉(zhuǎn)肽酶(GGT)、乳酸脫氫酶(LDH)、血尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、空腹血糖(FPG)、總膽固醇(TCH)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、血鈣和血磷等生化指標(biāo)。酶聯(lián)免疫吸附法檢測乙肝表面抗原和丙型肝炎病毒抗體。上腹部肝臟超聲檢查篩查脂肪肝,并做出輕度、中度、重度肝臟脂肪變性嚴(yán)重程度的評定。依照納入和排除標(biāo)準(zhǔn),最終納入符合NAFLD診斷標(biāo)準(zhǔn)的患者104例,及同期體檢人群中年齡、性別相匹配的健康對照98例。放免法檢測血清25-羥維生素D[25(OH)D]濃度。采用兩獨立樣本t-檢驗、χ2檢驗、ANOVA分析、多元logistic回歸分析等統(tǒng)計學(xué)方法分析血清25(OH)D濃度與NAFLD之間的相關(guān)性。結(jié)果NAFLD組與對照組臨床變量相比,BMI、腹圍、血壓、ALT、AST、GGT、LDH、UA、TG、TCH、LDL-C、HDL-C、FPG等參數(shù)的差異均有統(tǒng)計學(xué)意義(P0.001或P0.05);NAFLD組與對照組的年齡、性別、AKP、Cr、血清25(OH)D濃度(20.87±6.73 vs.21.63±8.22 ng/ml,P=0.474)以及鈣、磷水平差異無統(tǒng)計學(xué)意義(P0.05),且血清25(OH)D濃度15ng/ml與≥15ng/ml的狀態(tài)在兩組間的差異亦無統(tǒng)計學(xué)意義(P均0.05)。年齡、性別、BMI的分層研究顯示,≤30歲NAFLD組25(OH)D濃度低于對照組,差異有統(tǒng)計學(xué)意義(16.85±7.56 vs.22.23±5.78ng/ml,P=0.04),且NAFLD組25(OH)D缺乏(15ng/ml)的比例高于對照組(χ2=6.679,OR=13.71,95%C.I.1.38~136.21,P=0.025);BMI≤25kg/m2的NAFLD組25(OH)D缺乏(15ng/ml)的比例高于對照組(χ2=3.734,OR=4.97,95%C.I.2.27~10.89,P0.001)。在30-50歲與50歲的年齡層中,25(OH)D缺乏在NAFLD組與對照組中的比例差異無統(tǒng)計學(xué)意義(P0.05),在性別以及BMI25kg/m2的分層中,25(OH)D缺乏在兩組中的差異亦無統(tǒng)計學(xué)意義(P0.05)。根據(jù)25(OH)D四分位數(shù)對整體研究樣本分層研究顯示,各組間年齡、性別、體質(zhì)量指數(shù)、ALT、AST、AKP、GGT、LDH、UA、Cr、TCH、LDL-C等參數(shù)的差異無統(tǒng)計學(xué)意義(P0.05);各組間NAFLD發(fā)生率的差異亦無統(tǒng)計學(xué)意義(P0.05)。HDL-C、空腹血糖及甘油三酯的水平在各組間的差異有統(tǒng)計學(xué)意義,在最低25(OH)D四分位數(shù)HDL-C的數(shù)值最低(P0.001);在最高的25(OH)D四分位數(shù)空腹血糖的水平最低(P=0.02),在最高的25(OH)D四分位數(shù)也顯示了甘油三酯的水平最高(P=0.02)。超聲判定的輕度、中度與重度肝脂肪變各組間25(OH)D濃度差異無統(tǒng)計學(xué)意義(F=0.419,P=0.740);且各組間發(fā)生25(OH)D15ng/ml的例數(shù)或發(fā)生25(OH)D30ng/ml的例數(shù)差異均無統(tǒng)計學(xué)意義(χ2=3.844,P=0.279;χ2=2.143,P=0.516)。多元logistic回歸分析顯示,整體樣本中BMI、TG是NAFLD的危險因素;BMI≤25kg/m2群體多元logistic回歸分析校正年齡、性別、TG、TCH、HDL-C、LDL-C、GLU、UA等混雜因素后顯示,25(OH)D與NAFLD相關(guān)(OR=1.16,95%C.I.1.03~1.3,P=0.032);多元回歸分析顯示,超聲判定的肝脂肪變嚴(yán)重程度與UA、TCH、年齡相關(guān),與25(OH)D濃度無明顯關(guān)聯(lián)。結(jié)論維生素D缺乏可能是≤30歲年輕人和正常體質(zhì)量指數(shù)的NAFLD患者發(fā)病的危險因素。
[Abstract]:Aim at present, vitamin D is considered as a steroid hormone, which not only has the function of regulating calcium and phosphorus metabolism, but also has the functions of anti-inflammatory, anti infection and immunoregulation. It is known that vitamin D deficiency is involved in the occurrence and development of various diseases and the relationship between vitamin D deficiency and non-alcoholic fatty liver disease (NAFLD). There are few research data and there are still differences in the results of the study. A case control study is intended to study the correlation between vitamin D deficiency and NAFLD. Methods the study was taken in the outpatient health check-up of our hospital in 4-6 months in 2013 as the research object. First, a questionnaire on the medical history of NAFLD was established, and a questionnaire was used to collect the research objects. Like sex, age, age, nationality, education, occupation, smoking history, drinking history, medicine history, history of NAFLD and other metabolic diseases, physical examination collected height, weight, abdominal circumference, heart rate, blood pressure and so on, and calculated body mass index (BMI). All subjects examined serum albumin, total bilirubin, alanine aminotransferase (ALT), Aspartate aminotransferase (AST), alkaline phosphatase (AKP), glutamyl transaminopeptidase (GGT), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), total cholesterol (FPG), total cholesterol (TCH), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood calcium and blood phosphorus, and other biochemical indicators. Detection of hepatitis B surface antigen and HCV antibody by combined immunosorbent assay. The upper abdominal liver ultrasonography screening fatty liver, and making a mild, moderate, severe hepatic steatosis severity assessment. According to the inclusion and exclusion criteria, 104 patients were finally included in the NAFLD diagnostic criteria, and the age and sex of the population in the same period of physical examination. 98 healthy controls were matched. Serum 25- hydroxyvitamin D[25 (OH) D] concentration was detected by radioimmunoassay. Two independent sample t- test, x 2 test, ANOVA analysis, multiple logistic regression analysis and other statistical methods were used to analyze the correlation between serum 25 (OH) D concentration and NAFLD. ST, GGT, LDH, UA, TG, TCH, LDL-C, HDL-C, FPG and other parameters were statistically significant (P0.001 or P0.05), and there was no statistical difference between the 25 (20.87 + 6.73 + 8.22) concentrations in the NAFLD group and the control group and the level of calcium and phosphorus. The difference between the two groups was also not statistically significant (P 0.05). Age, sex, and BMI stratified study showed that the concentration of 25 (OH) D in group NAFLD was lower than that of the control group, and the difference was statistically significant (16.85 + 7.56 vs.22.23 + 5.78ng/ml, P=0.04), and the proportion of 25 (OH) D deficiency (15ng/ml) in group NAFLD was higher than that of the control group =0.025); the proportion of NAFLD group 25 (OH) D deficiency (15ng/ml) in BMI < 25kg/m2 > was higher than that of the control group (x 2=3.734, OR=4.97,95%C.I.2.27~10.89, P0.001). In the age layer of 30-50 and 50, the proportion of the 25 (OH) D deficiency in the group and the control group was not statistically significant (25) in the two groups. There was no statistical significance (P0.05). According to the 25 (OH) D four quantiles, the stratified study of the whole research samples showed that the differences in age, sex, body mass index, ALT, AST, AKP, GGT, LDH, UA, Cr, TCH, LDL-C and other parameters were not statistically significant. The levels of blood glucose and triglycerides were statistically significant between the 25 (OH) D four quantiles HDL-C (P0.001), the lowest (P=0.02) at the highest level of 25 (OH) D four digits (P=0.02), and the highest level of 25 (OH) D four in the highest level (P=0.02). There was no significant difference in the concentration of 25 (OH) D between degrees and severe hepatic steatosis (F=0.419, P=0.740), and there was no significant difference in the number of cases of 25 (OH) D15ng/ml or 25 (OH) D30ng/ml occurring between each group (x 2=3.844, P=0.279; Chi 2=2.143, P=0.516). Factors: BMI < 25kg/m2 population multivariate logistic regression analysis corrected age, sex, TG, TCH, HDL-C, LDL-C, GLU, UA and other confounding factors, 25 (OH) D and NAFLD correlation. Vitamin D deficiency may be a risk factor for NAFLD patients younger than 30 years old and normal body mass index.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575

【共引文獻(xiàn)】

相關(guān)博士學(xué)位論文 前3條

1 彭峰;核受體VDR在高糖誘導(dǎo)人血管內(nèi)皮細(xì)胞氧化應(yīng)激中的作用及機制[D];福建醫(yī)科大學(xué);2013年

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相關(guān)碩士學(xué)位論文 前3條

1 戴W歐，

本文編號：2028735