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Article(id=1241023929108713972, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408279, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723651200000, receivedDateStr=2024-08-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812761808, onlineDateStr=2026-03-18, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812761808, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812761808, creator=13701087609, updateTime=1773812761808, updator=13701087609, issue=Issue{id=1241023927812682133, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812761500, creator=13701087609, updateTime=1773812858867, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024336258200259, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024336258200260, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=520, endPage=525, ext={EN=ArticleExt(id=1241023930648023542, articleId=1241023929108713972, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the association and dose-response relationship between residual cholesterol and metabolically associated fatty liver disease in the elderly, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the relationship between residual cholesterol (RC) and metabolically associated fatty liver disease (MAFLD) in the elderly population of Zhongshan, and to explore the potential application value of RC in the diagnosis of MAFLD in older adults.

Methods

A cluster sampling method was employed to select elderly individuals aged 60 and above who underwent health check-ups at two community hospitals in Zhongshan, Guangdong Province. Baseline data were collected through questionnaire surveys, physical examinations, and laboratory tests. Multivariable logistic regression analysis was used to assess the association between RC and MAFLD, and a restricted cubic spline model was utilized to further analyze the dose-response relationship between RC and MAFLD.

Results

A total of 6 756 elderly individuals were recruited, with an overall prevalence of MAFLD at 31.0%, higher in females (35.0%) than in males (24.7%). After adjusting for confounding factors, logistic regression analysis indicated that RC, treated as a continuous variable (OR: 1.70, 95%CI: 1.47-1.97), was positively associated with the risk of MAFLD. As a categorical variable, the highest RC group (OR: 2.13, 95%CI: 1.72-2.63) also showed a positive correlation with MAFLD risk. A non-linear relationship was observed between RC levels and MAFLD (P overalltrend <0.001, P non-linearity < 0.05), with a more pronounced risk increase in males (male OR: 1.83, 95%CI: 1.42-2.38 vs. female OR: 1.64,95%CI: 1.36-1.96).

Conclusion

RC is an independent risk factor for MAFLD in the elderly, and there exists a non-linear dose-response relationship between the two. The impact of RC levels on MAFLD risk is particularly significant in elderly males. Monitoring and managing RC is of great clinical significance in the prevention and treatment of MAFLD in older adults.

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目的

分析中山地区老年人群中残余胆固醇（RC）和代谢相关脂肪性肝病（MAFLD）的关系，探讨RC在老年人MAFLD患病诊断中的潜在的应用价值。

方法

采用整群抽样法，选取广东省中山市两家社区医院接受健康体检的60岁及以上老年人作为研究对象，通过问卷调查、体格检查和实验室检测收集基线数据。运用多因素logistic回归分析，评估RC与MAFLD之间的关联，利用限制性立方样条模型深入分析RC与MAFLD之间的剂量-反应关系。

结果

共招募了6 756名老年人，MAFLD的总体患病率为31.0%，女性患病率为35.0%，高于男性的24.7%。调整混杂因素后，logistic回归分析表明，RC作为连续变量（OR=1.70, 95%CI: 1.47～1.97）与MAFLD患病风险呈正相关。作为分类变量，RC最高组（OR=2.13, 95%CI: 1.72～2.63）与MAFLD患病风险仍呈正相关。RC水平与MAFLD存在非线性关系（P总趋势<0.001，P非线性<0.05），且在男性中这一风险上升更为显著［男性OR=1.83（95%CI: 1.42～2.38）vs.女性（OR=1.64, 95%CI:1.36～1.96）］。

结论

RC是老年人患MAFLD的独立危险因素，且二者之间存在非线性剂量-反应关系。RC水平对MAFLD风险的影响在老年男性中更突出。RC的监测和管理在老年人MAFLD的预防和治疗中具有重要的临床意义。

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陈青松，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=udO2mNuagnvtVKks/OAOGQ==, magXml=v/nibswAdFJD93BnNodXRQ==, pdfUrl=null, pdf=AsRSxT1GZAAqCKuGxHn73w==, pdfFileSize=728625, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=ReR6b/AKkTIu+GLWG9upyw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=MB6TI10qjNx0ai6XoJa6kg==, mapNumber=null, authorCompany=null, fund=null, authors=

梁宝怡（1999—），女，硕士，初级医师，研究方向：疾病预防与控制

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梁宝怡（1999—），女，硕士，初级医师，研究方向：疾病预防与控制

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梁宝怡（1999—），女，硕士，初级医师，研究方向：疾病预防与控制

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注：黑色实线为校正后的OR值；黑色实线上下虚线为OR值的95%置信区间；水平虚线为OR值为1；图A为总人群RC与MAFLD剂量—反应关系；图B为男性RC与MAFLD剂量—反应关系；图C为女性RC与MAFLD剂量—反应关系；模型调整年龄、性别、受教育程度、居住地、吸烟状况、饮酒状况、BMI、糖尿病患病情况、高血压患病情况、LDL-C、ALT、AST、Scr；性别分层分析中未对性别进行调整。

, figureFileSmall=8oXAQwC3VBv5LUh8XxU+8Q==, figureFileBig=ReR6b/AKkTIu+GLWG9upyw==, tableContent=null), ArticleFig(id=1241023936230642340, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023929108713972, language=EN, label=Table 1, caption=

Comparison of basic characteristics of MAFLD and non-MAFLD

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体(n=6 756)非MAFLD(n=4 660)MAFLD(n=2 096)χ2/Z值P值
年龄(岁)68(64,72)68(64,72)67(65,71)-2.5420.011
性别80.226<0.001
男2617(38.74)1971(42.30)646(30.82)
女4139(61.26)2689(57.70)1450(69.18)
受教育程度8.4640.004
高中以下5408(80.05)3686(79.10)1722(82.16)
高中及以上1348(19.95)974(20.90)374(17.84)
居住地21.686<0.001
农村1339(19.82)853(18.30)486(23.19)
城镇5417(80.18)3807(81.70)1610(76.81)
目前吸烟44.767<0.001
否5870(86.89)3963(85.04)1907(90.98)
是886(13.11)697(14.96)189(9.02)
目前饮酒16.701<0.001
否5805(85.92)3950(84.76)1855(88.50)
是951(14.08)710(15.24)241(11.50)
BMI(kg/m2)23.96(21.88,26.16)23.19(21.23,25.27)25.67(23.69,27.70)-28.781<0.001
WC(cm)86.4(80.1,92.3)84.5(78.3,90.0)90.5(84.8,96.4)-26.004<0.001
SBP(mmHg)137(125,150)135(123,148)140(129,153)-11.18<0.001
DBP(mmHg)82(76,89)82(75,88)84(78,90)-9.432<0.001
FPG(mmol/L)5.23(4.81,5.81)5.12(4.76,5.62)5.54(5.00,6.27)-18.242<0.001
TC(mmol/L)5.30(4.61,6.05)5.26(4.56,6.00)5.42(4.71,6.19)-5.322<0.001
TG(mmol/L)1.47(1.08,2.07)1.33(0.99,1.80)1.90(1.41,2.56)-27.674<0.001
HDL-C(mmol/L)1.31(1.13,1.53)1.36(1.17,1.58)1.23(1.07,1.41)-16.621<0.001
LDL-C(mmol/L)3.10(2.56,3.68)3.05(2.50,3.61)3.23(2.67,3.81)-8.068<0.001
RC(mmol/L)0.84(0.60,1.12)0.80(0.58,1.08)0.93(0.67,1.20)-10.468<0.001
ALT(U/L)18.0(13.9,24.0)16.7(13.0,21.8)21.6(16.4,29.0)-22.6<0.001
AST(U/L)22.0(19.1,25.7)21.7(19.0,25.1)22.8(19.5,26.9)-7.066<0.001
Scr(mol/L)70.0(60.0,83.7)71.0(60.4,85.0)68.0(59.0,80.0)-6.87<0.001
糖尿病183.229<0.001
否5 405(80.00)3 934(84.42)1 471(70.18)
是1 351(20.00)726(15.58)625(29.82)
高血压119.044<0.001
否2 042(30.22)1 599(34.31)443(21.14)
是4 714(69.78)3 061(65.69)1 653(78.86)
), ArticleFig(id=1241023936343888557, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023929108713972, language=CN, label=表1, caption=

MAFLD和非MAFLD的基本特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体(n=6 756)非MAFLD(n=4 660)MAFLD(n=2 096)χ2/Z值P值
年龄(岁)68(64,72)68(64,72)67(65,71)-2.5420.011
性别80.226<0.001
男2617(38.74)1971(42.30)646(30.82)
女4139(61.26)2689(57.70)1450(69.18)
受教育程度8.4640.004
高中以下5408(80.05)3686(79.10)1722(82.16)
高中及以上1348(19.95)974(20.90)374(17.84)
居住地21.686<0.001
农村1339(19.82)853(18.30)486(23.19)
城镇5417(80.18)3807(81.70)1610(76.81)
目前吸烟44.767<0.001
否5870(86.89)3963(85.04)1907(90.98)
是886(13.11)697(14.96)189(9.02)
目前饮酒16.701<0.001
否5805(85.92)3950(84.76)1855(88.50)
是951(14.08)710(15.24)241(11.50)
BMI(kg/m2)23.96(21.88,26.16)23.19(21.23,25.27)25.67(23.69,27.70)-28.781<0.001
WC(cm)86.4(80.1,92.3)84.5(78.3,90.0)90.5(84.8,96.4)-26.004<0.001
SBP(mmHg)137(125,150)135(123,148)140(129,153)-11.18<0.001
DBP(mmHg)82(76,89)82(75,88)84(78,90)-9.432<0.001
FPG(mmol/L)5.23(4.81,5.81)5.12(4.76,5.62)5.54(5.00,6.27)-18.242<0.001
TC(mmol/L)5.30(4.61,6.05)5.26(4.56,6.00)5.42(4.71,6.19)-5.322<0.001
TG(mmol/L)1.47(1.08,2.07)1.33(0.99,1.80)1.90(1.41,2.56)-27.674<0.001
HDL-C(mmol/L)1.31(1.13,1.53)1.36(1.17,1.58)1.23(1.07,1.41)-16.621<0.001
LDL-C(mmol/L)3.10(2.56,3.68)3.05(2.50,3.61)3.23(2.67,3.81)-8.068<0.001
RC(mmol/L)0.84(0.60,1.12)0.80(0.58,1.08)0.93(0.67,1.20)-10.468<0.001
ALT(U/L)18.0(13.9,24.0)16.7(13.0,21.8)21.6(16.4,29.0)-22.6<0.001
AST(U/L)22.0(19.1,25.7)21.7(19.0,25.1)22.8(19.5,26.9)-7.066<0.001
Scr(mol/L)70.0(60.0,83.7)71.0(60.4,85.0)68.0(59.0,80.0)-6.87<0.001
糖尿病183.229<0.001
否5 405(80.00)3 934(84.42)1 471(70.18)
是1 351(20.00)726(15.58)625(29.82)
高血压119.044<0.001
否2 042(30.22)1 599(34.31)443(21.14)
是4 714(69.78)3 061(65.69)1 653(78.86)
), ArticleFig(id=1241023936440357555, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023929108713972, language=EN, label=Table 2, caption=

The logistic regression analysis of the relationship between RC and MAFLD in the elderly

, figureFileSmall=null, figureFileBig=null, tableContent=
RC 模型1模型2模型3
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
总人群（n=6756）
RC（连续型）2.33(2.04～2.66)<0.0011.97(1.72～2.26)<0.0011.70(1.47～1.97)<0.001
Q1(0.38[0～0.60])1.001.001.00
Q2(0.72[>0.60～0.84])1.79(1.49～2.16)<0.0011.59(1.31～1.94)<0.0011.51(1.23～1.86)<0.001
Q3(0.97[>0.84～1.12])2.68(2.22～3.23)0.0082.26(1.85～2.75)0.0082.07(1.67～2.55)0.008
Q4(1.35[>1.12])3.04(2.52～3.66)<0.0012.49(2.05～3.03)<0.0012.13(1.72～2.63)<0.001
P趋势<0.001<0.001<0.001
男性（n=2617）
RC（连续型）2.58(2.05～3.23)<0.0012.19(1.72～2.78)<0.0011.83(1.42～2.38)<0.001
Q1(0.33[0～0.56])1.001.001.00
Q2(0.67[>0.56～0.78])1.58(1.12～2.21)10.0081.34(0.94～1.91)0.1071.17(0.80～1.70)0.424
Q3(0.91[>0.78～1.07])2.77(2.00～3.84)<0.0012.06(1.46～2.91)<0.0011.66(1.15～2.40)0.007
Q4(1.32[>1.07])3.48(2.51～4.82)<0.0012.67(1.89～3.77)<0.0012.09(1.43～3.05)<0.001
P趋势<0.001<0.001<0.001
女性（n=4139）
RC（连续型）2.10(1.79～2.47)<0.001<0.0011.82(1.54～2.15)<0.0011.64(1.36～1.96)
Q1(0.41[0～0.63])1.001.001.00
Q2(0.75[>0.63～0.87])1.72(1.37～2.15)1<0.0011.58(1.24～1.99)<0.0011.58(1.24～2.03)<0.001
Q3(1.00[>0.87～1.15])2.59(2.07～3.24)<0.0012.29(1.81～2.90)<0.0012.20(1.71～2.83)<0.001
Q4(1.38[>1.15])2.72(2.18～3.40)<0.0012.29(1.81～2.90)<0.0012.09(1.62～2.69)<0.001
P趋势<0.001<0.001<0.001
), ArticleFig(id=1241023936578769597, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023929108713972, language=CN, label=表2, caption=

老年人RC与MAFLD的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
RC 模型1模型2模型3
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
总人群（n=6756）
RC（连续型）2.33(2.04～2.66)<0.0011.97(1.72～2.26)<0.0011.70(1.47～1.97)<0.001
Q1(0.38[0～0.60])1.001.001.00
Q2(0.72[>0.60～0.84])1.79(1.49～2.16)<0.0011.59(1.31～1.94)<0.0011.51(1.23～1.86)<0.001
Q3(0.97[>0.84～1.12])2.68(2.22～3.23)0.0082.26(1.85～2.75)0.0082.07(1.67～2.55)0.008
Q4(1.35[>1.12])3.04(2.52～3.66)<0.0012.49(2.05～3.03)<0.0012.13(1.72～2.63)<0.001
P趋势<0.001<0.001<0.001
男性（n=2617）
RC（连续型）2.58(2.05～3.23)<0.0012.19(1.72～2.78)<0.0011.83(1.42～2.38)<0.001
Q1(0.33[0～0.56])1.001.001.00
Q2(0.67[>0.56～0.78])1.58(1.12～2.21)10.0081.34(0.94～1.91)0.1071.17(0.80～1.70)0.424
Q3(0.91[>0.78～1.07])2.77(2.00～3.84)<0.0012.06(1.46～2.91)<0.0011.66(1.15～2.40)0.007
Q4(1.32[>1.07])3.48(2.51～4.82)<0.0012.67(1.89～3.77)<0.0012.09(1.43～3.05)<0.001
P趋势<0.001<0.001<0.001
女性（n=4139）
RC（连续型）2.10(1.79～2.47)<0.001<0.0011.82(1.54～2.15)<0.0011.64(1.36～1.96)
Q1(0.41[0～0.63])1.001.001.00
Q2(0.75[>0.63～0.87])1.72(1.37～2.15)1<0.0011.58(1.24～1.99)<0.0011.58(1.24～2.03)<0.001
Q3(1.00[>0.87～1.15])2.59(2.07～3.24)<0.0012.29(1.81～2.90)<0.0012.20(1.71～2.83)<0.001
Q4(1.38[>1.15])2.72(2.18～3.40)<0.0012.29(1.81～2.90)<0.0012.09(1.62～2.69)<0.001
P趋势<0.001<0.001<0.001
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老年人群残余胆固醇与代谢相关脂肪性肝病的关联性和剂量反应关系的研究
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梁宝怡 1 , 沈天然 1 , 郑秋潼 1 , 谢灵香 1 , 喻陆 1, 3 , 陈青松 1, 2
现代预防医学 | 健康与社会行为 2025,52(3): 520-525
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现代预防医学 | 健康与社会行为 2025, 52(3): 520-525
老年人群残余胆固醇与代谢相关脂肪性肝病的关联性和剂量反应关系的研究
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梁宝怡1, 沈天然1, 郑秋潼1, 谢灵香1, 喻陆1, 3, 陈青松1, 2
作者信息
  • 1.广东药科大学公共卫生学院，广东 广州 510310
  • 2.广东省公共卫生检测与评估工程技术研究中心，广东 广州 510000
  • 3.国药集团国药医疗健康产业有限公司北京

    • 梁宝怡（1999—），女，硕士，初级医师，研究方向：疾病预防与控制

通讯作者:

陈青松，E-mail:
Research on the association and dose-response relationship between residual cholesterol and metabolically associated fatty liver disease in the elderly
Bao-yi LIANG1, Tian-ran SHEN1, Qiu-tong ZHENG1, Ling-xiang XIE1, Lu YU1, 3, Qing-song CHEN1, 2
Affiliations
  • School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510310, China
出版时间: 2025-02-10 doi: 10.20043/j.cnki.MPM.202408279
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摘要
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目的

分析中山地区老年人群中残余胆固醇（RC）和代谢相关脂肪性肝病（MAFLD）的关系，探讨RC在老年人MAFLD患病诊断中的潜在的应用价值。

方法

采用整群抽样法，选取广东省中山市两家社区医院接受健康体检的60岁及以上老年人作为研究对象，通过问卷调查、体格检查和实验室检测收集基线数据。运用多因素logistic回归分析，评估RC与MAFLD之间的关联，利用限制性立方样条模型深入分析RC与MAFLD之间的剂量-反应关系。

结果

共招募了6 756名老年人，MAFLD的总体患病率为31.0%，女性患病率为35.0%，高于男性的24.7%。调整混杂因素后，logistic回归分析表明，RC作为连续变量（OR=1.70, 95%CI: 1.47～1.97）与MAFLD患病风险呈正相关。作为分类变量，RC最高组（OR=2.13, 95%CI: 1.72～2.63）与MAFLD患病风险仍呈正相关。RC水平与MAFLD存在非线性关系（P总趋势<0.001，P非线性<0.05），且在男性中这一风险上升更为显著［男性OR=1.83（95%CI: 1.42～2.38）vs.女性（OR=1.64, 95%CI:1.36～1.96）］。

结论

RC是老年人患MAFLD的独立危险因素，且二者之间存在非线性剂量-反应关系。RC水平对MAFLD风险的影响在老年男性中更突出。RC的监测和管理在老年人MAFLD的预防和治疗中具有重要的临床意义。

残余胆固醇  /  代谢相关脂肪性肝病  /  剂量反应关系  /  老年人
Objective

To analyze the relationship between residual cholesterol (RC) and metabolically associated fatty liver disease (MAFLD) in the elderly population of Zhongshan, and to explore the potential application value of RC in the diagnosis of MAFLD in older adults.

Methods

A cluster sampling method was employed to select elderly individuals aged 60 and above who underwent health check-ups at two community hospitals in Zhongshan, Guangdong Province. Baseline data were collected through questionnaire surveys, physical examinations, and laboratory tests. Multivariable logistic regression analysis was used to assess the association between RC and MAFLD, and a restricted cubic spline model was utilized to further analyze the dose-response relationship between RC and MAFLD.

Results

A total of 6 756 elderly individuals were recruited, with an overall prevalence of MAFLD at 31.0%, higher in females (35.0%) than in males (24.7%). After adjusting for confounding factors, logistic regression analysis indicated that RC, treated as a continuous variable (OR: 1.70, 95%CI: 1.47-1.97), was positively associated with the risk of MAFLD. As a categorical variable, the highest RC group (OR: 2.13, 95%CI: 1.72-2.63) also showed a positive correlation with MAFLD risk. A non-linear relationship was observed between RC levels and MAFLD (P overalltrend <0.001, P non-linearity < 0.05), with a more pronounced risk increase in males (male OR: 1.83, 95%CI: 1.42-2.38 vs. female OR: 1.64,95%CI: 1.36-1.96).

Conclusion

RC is an independent risk factor for MAFLD in the elderly, and there exists a non-linear dose-response relationship between the two. The impact of RC levels on MAFLD risk is particularly significant in elderly males. Monitoring and managing RC is of great clinical significance in the prevention and treatment of MAFLD in older adults.

Residual cholesterol  /  Metabolically associated fatty liver disease  /  Dose-response relationship  /  The elderly
梁宝怡, 沈天然, 郑秋潼, 谢灵香, 喻陆, 陈青松. 老年人群残余胆固醇与代谢相关脂肪性肝病的关联性和剂量反应关系的研究. 现代预防医学, 2025 , 52 (3) : 520 -525 . DOI: 10.20043/j.cnki.MPM.202408279
Bao-yi LIANG, Tian-ran SHEN, Qiu-tong ZHENG, Ling-xiang XIE, Lu YU, Qing-song CHEN. Research on the association and dose-response relationship between residual cholesterol and metabolically associated fatty liver disease in the elderly[J]. Modern Preventive Medicine, 2025 , 52 (3) : 520 -525 . DOI: 10.20043/j.cnki.MPM.202408279
正文
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非酒精性脂肪肝（nonalcoholic fatty liver disease，NAFLD）是排除酒精、药物及其他肝病的慢性肝病，以肝脏脂肪积累为特征[1]，全球患病率约为29.8%[2]。预计到2030年，我国NAFLD患病率将大幅增长，构成重大公共卫生挑战[3]。代谢异常与NAFLD关系密切，因此，2020年国际脂肪肝专家组提出了代谢相关脂肪性肝病（metabolically associated fatty liver disease，MAFLD）的概念，强调代谢风险因素在肝脏疾病进展中的作用[4]。同年，亚太肝病学会发布了MAFLD诊疗指南[5]。中华医学会肝病学分会也在2024年5月修订并更名了NAFLD指南[6]。
血脂异常与MAFLD之间存在密切关联。血脂异常促使脂肪在肝脏大量积累，形成脂肪肝；而肝脏脂质过度沉积又会进一步加剧血脂异常[7]。尽管甘油三酯（TG）和低密度脂蛋白胆固醇（LDL-C）等传统血脂指标与脂肪肝的关系已得到广泛研究，但残余胆固醇（remnant cholesterol，RC），这一更具风险的成分却研究有限[8]。RC是指在血液中去除LDL-C和高密度脂蛋白胆固醇（HDL-C）后剩余的胆固醇浓度[9]，已证实其与不良心血管事件有独立关联[10]。研究表明，作为非传统血脂参数的RC，在鉴别脂肪性肝病合并心血管疾病方面优于LDL-C等传统指标[11]，这主要归因于RC颗粒较大、胆固醇含量高，具有较强的致动脉粥样硬化能力。同时，RC具有与TG相似的脂肪肝鉴别能力，但受生物学变异及饮食因素影响较小[12]，这意味着在评估脂肪肝风险和监测治疗效果时提供了更稳定的信息。
老年人群常常伴随多种慢性疾病，例如高血压和高血脂等，这些疾病会增加肝脏的负担。老年人是NAFLD的高发人群，60岁以上的老年人群患病率高达44.43%[13]。由于命名和标准调整，RC与老年人MAFLD患病风险尚不明确。本研究旨在探讨RC与MAFLD患病风险的关联及其剂量-反应关系，以期为老年人MAFLD防控中非传统血脂指标的应用提供科学依据和实践指导。
1　对象与方法
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1.1　对象
于2020年6月—2021年7月，在广东省中山市民众镇和火炬开发区，通过国家基本公共卫生服务健康体检项目招募60岁及以上老年人作为研究对象。纳入标准：年龄达到60岁及以上，自愿参与健康体检，在当地居住至少六个月（不论户籍）且体检记录完整。排除标准：体检信息不完整的个体，患有严重精神疾病或残疾的人士，癌症患者以及RC计算值为零或负数的样本。最终收集到6 756名有效样本。本研究已获得广东药科大学伦理委员会的正式批准[医伦理(2019)第109号]，并且所有参与者均已自愿签署知情同意书。
1.2　方法
1.2.1　资料采集
本研究的资料收集包括问卷调查、体格检查和实验室检查三部分。问卷调查由受过专业培训的人员在现场一对一进行，内容包括：性别、年龄、受教育程度（高中以下/高中及以上）、居住地区（农村/城镇）、吸烟状况（目前不吸烟/目前吸烟）、饮酒状况（目前不饮酒/目前饮酒）。体格检查使用标准化方法和设备，测量身高、体重、腰围（WC）、收缩压（SBP）和舒张压（DBP），并进行腹部B超影像学检查。体质指数（BMI）计算公式为体重（kg）除以身高（m）的二次方。所有体检对象都被要求空腹8 h以上，由专业医师和护士进行静脉采血，利用美国AU680临床生化分析仪测定总胆固醇（TC）、HDL-C、LDL-C、TG、空腹血糖（FPG）、血清肌酐（Scr）、丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）等生化指标。非高密度脂蛋白胆固醇（Non-HDL-C）通过修正的Friedewald方程计算得出：Non-HDL-C=TC-(HDL-C)[14]；RC的计算公式为：RC=TC -(HDL-C) -(LDL-C)[15-16]。
1.2.2　相关定义
MAFLD诊断参考《代谢功能障碍相关性脂肪肝的新定义：国际专家共识声明》[17]：诊断基于空腹腹部彩超所证实的肝脏脂肪变性，并且至少伴有一项以下标准：（1）超重/肥胖（BMI≥23 kg/m2）；（2）存在2型糖尿病；（3）至少有两种代谢异常：①腰围超标（男性≥90 cm，女性≥80 cm）；②血压升高（≥130/85 mm Hg）或正在接受相应药物治疗；③甘油三酯水平升高（≥1.7 mmol/L）或正在接受治疗；④HDL-C降低（男性<1.0 mmol/L，女性<1.3 mmol/L）或正在接受治疗；⑤糖尿病前期状态（FPG：5.6～6.9 mmol/L，糖化血红蛋白：5.7%～6.4%）；⑥胰岛素抵抗评分≥2.5；⑦高敏C反应蛋白>2 mg/L。糖尿病诊断参考《中国2型糖尿病防治指南（2020年版）》[18]。高血压诊断参照《中国老年高血压管理指南2023》[19]。
1.3　统计学分析
数据分析采用SPSS 26.0和R 4.3.3软件。正态分布的计量资料以（）表示，非正态分布的则用中位数和四分位间距［M（P25，P75）］描述，组间差异比较用t检验或非参数检验。计数资料以频数和百分比呈现，组间比较用χ2检验。RC按照四分位数分为四组，以最低分位数组为参照，运用多变量调整的logistic回归模型评估老年人RC对MAFLD患病风险的影响。趋势性检验则使用各组中位数作为连续变量进入回归模型。剂量-反应关系通过限制性立方样条模型进行分析。性别差异通过分层分析探讨。所有统计检验均为双侧，显著性水平α=0.05。
2　结果
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2.1　研究对象基本情况
本研究共纳入6 756名老年人，其中男性2 617人（占38.74%），女性4 139人（占61.26%）。年龄中位数为68（64，72）岁。MAFLD总体患病率为31.0%，其中女性的患病率为35.0%，高于男性的24.7%。非MAFLD患者和MAFLD患者在性别、受教育程度、居住地、吸烟状况、饮酒状况、体重指数、腰围、慢性病患病情况（高血压、糖尿病）、血压（SBP、DBP）、糖代谢（FPG）、传统血脂水平（TC、TG、HDL-C、LDL-C）、肝功能（AST、ALT）和肾功能（Scr）等方面差异具有统计学意义（P<0.05）。MAFLD组的RC水平高于非MAFLD组（P<0.05）。见表1。
2.2　老年人RC和MAFLD的患病风险
以MAFLD为结局变量，RC以连续型自变量进入多变量调整的logistic回归模型时，RC与MAFLD呈现正相关关系（P<0.05）。将RC根据四分位数分为四个水平组（Q1，Q2，Q3，Q4）作为自变量进入多变量调整的logistic回归模型，调整混杂因素后（模型3），与Q1组相比，Q2～Q4组患MAFLD的风险增加（P<0.05）。见表2。
2.3　不同性别老年人RC和MAFLD的患病风险
在老年男性中，与Q1组相比，Q3和Q4组患MAFLD的风险增加（P<0.05）。在老年女性中，与Q1组相比，Q2～Q4组患MAFLD的风险均增加（P<0.05）。见表2。
2.4　RC和MAFLD患病风险的剂量-反应关系
在调整混杂因素后，总人群中RC与MAFLD患病风险之间呈现非线性的剂量反应关系（P总趋势<0.001，P 非线性<0.001）。当RC浓度在0 ～ 1 mmol/L之间时，OR值逐渐上升，残余胆固醇浓度增加与MAFLD风险增加呈正相关；当残余胆固醇浓度在1～2 mmol/L之间时，OR值达到峰值。无论男性或女性，RC与MAFLD患病风险之间均存在非线性的剂量反应关系（P总趋势<0.001，P非线性<0.05），男性的曲线斜率更大；在相同的RC水平下，男性的OR值高于女性。见图1。
3　讨论
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目前，脂肪肝的研究中针对MAFLD的调查仍然有限。Liu等人[20]通过比较我国上海地区成年人NAFLD与MAFLD患者的患病率、年龄、生理指标，认为两者存在相似的患病率和患者特征。北京针对65岁社区居民的一项调查中，有366名老年人同时符合MAFLD和NAFLD的诊断标准，这部分人群分别占MAFLD患者总数的94.6%和NAFLD患者总数的99.5%[21]。根据以上的报道，可以合理推断，两者具有很大程度的重叠性，NAFLD的流行病学特征在一定程度上可以代表MAFLD的流行情况[22]。
本次结果显示，该地区老年人MAFLD的总体患病率为31.0%，其中男性患病率为24.7%，女性的患病率为35.0%。高于三亚市某地区老年人的检出率（23.78%）[23]和深圳某社区中老年人的检出率（27.41%）[24]，低于温州某地区健康老年人的检出率（36.99%）[25]。不同地区老年MAFLD的患病率差异可能受到饮食习惯、环境因素、经济水平等各方面的影响。与既往研究一致的是，老年女性MAFLD的患病率高于男性[26]，这与绝经期后女性雌激素水平下降有关[27]。
研究结果显示，处于RC最高四分位数范围的老年人患MAFLD的风险是最低四分位数范围的2.13倍。RC每增加一个单位，患MAFLD的风险增加70%，表明高RC水平是老年人群MAFLD的一个独立危险因素。Liu等人[28]发现RC和NAFLD的发生独立相关。Miao等人[29]的研究中表示RC的动态轨迹的变化也影响NAFLD的发生。程玉林等[30]同样在老年人群中发现，RC每升高一个单位，NAFLD的患病风险增加56.30%，研究存在一致性。
为了能够更直观、准确地描述连续性RC变化与老年人MAFLD患病风险变化趋势的关系，本研究采用了限制性立方样条模型进行进一步的分析发现：总体的RC与MAFLD的风险表现为非线性的剂量反应关系，与Chen等人[31]和Zhang等人[32]的研究结果是一致的。RC相关的MAFLD患病风险的上升趋势在男性老年人中表现得更为明显。有研究发现脂肪和肝脏组织中的许多脂质和胰岛素相关途径及炎症过程在雄性小鼠NAFLD中发挥了更显著的作用[33]。此外，生活方式和饮食习惯在两性之间也有所不同。这些因素可能共同促成了RC与MAFLD关系的性别差异，具体的原因需要进一步探讨。
本研究分析了老年人群RC水平与MAFLD的剂量 - 反应关系，并探讨了性别差异，为非传统血脂指标在MAFLD中的应用提供了新见解。然而，研究也存在局限性：一是横断面设计仅能揭示潜在关联；二是尽管已控制混杂因素，但可能仍有遗漏；三是超声评估脂肪变性可能会低估了轻度肝脂肪变性。
综上，RC与老年人MAFLD之间存在紧密联系，二者呈现出非线性的剂量-反应关系，特别是在男性老年人群中，RC水平的升高与MAFLD患病风险的显著增加密切相关。因此，在老年人代谢相关脂肪性肝病的诊断、治疗和预防中，除了关注常规血脂指标外，还应重视RC水平的监测。
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2025年第52卷第3期
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doi: 10.20043/j.cnki.MPM.202408279
  • 接收时间：2024-08-15
  • 首发时间：2026-03-18
  • 出版时间：2025-02-10
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  • 收稿日期：2024-08-15
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    1.广东药科大学公共卫生学院，广东 广州 510310
    2.广东省公共卫生检测与评估工程技术研究中心，广东 广州 510000
    3.国药集团国药医疗健康产业有限公司北京

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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