J Gastroenterol Hepatol：非酒精性脂肪性肝病是代谢综合征独立表现

　　代谢综合征及其各组分与非酒精性脂肪性肝病（NAFLD）显著相关。这一点使得许多研究者提出NAFLD是代谢综合征的一项独立组分。近日，美国华盛顿大学Mark Smits采用验证因子分析对假说进行了检验，这种分析可对包括或不包括NAFLD做为代谢综合征组分的不同模型进行比较。研究指出，代谢综合征与非酒精性脂肪性肝病显著相关。不过，研究者没有发现非酒精性脂肪性肝病是代谢综合征的一项独立组分或表现的证据。有趣的是，这种相关性中重要的可能是人种差异，这还需要进一步研究。该文发表在2013年第28卷第4期《胃肠病学与肝脏病学杂志》（J Gastroenterol Hepatol）上。

　　研究者对来自第三次全国卫生和营养检查普查的3846名对象的数据进行了分析。医师团队对非酒精性脂肪性肝病的定义为超声测定的肝脏脂肪增加。

　　按照成人治疗组III的标准，21%的研究对象有代谢综合征，30%有非酒精性脂肪性肝病，根据超声确定为轻度、中度或重度脂肪变。一项采用目前所接受的组分的基本代谢综合征模型在验证因子分析中表现出优良的拟合优度统计。将非酒精性脂肪性肝病作为第五项独立因子加入模型使得模型拟合降低，提示非酒精性脂肪性肝病不是代谢综合征的又一项独立组分。按人种进行的分析显示加入非酒精性脂肪性肝病在白人中降低模型拟合，不过在非西班牙裔黑人和墨西哥裔美国人中可有轻度优化。

与肝病相关的拓展阅读：

• NEJM：Sofosbuvir用于慢性丙肝病毒感染初治安全有效
• 胆汁淤积性肝病诊断治疗专家共识2013
• Nature：肝干细胞治疗肝病模型获益
• J Hepatol：分析呼气有机物可检测肝病
• 脂肪性肝病：无声的流行病 更多信息请点击：有关肝病更多资讯

Non-alcoholic fatty liver disease as an independent manifestation of the metabolic syndrome: Results of a US national survey in three ethnic groups
BACKGROUND AND AIM
The metabolic syndrome (MetS) and each of its components are strongly associated with non-alcoholic fatty liver disease (NAFLD). This has led many investigators to suggest that NAFLD is an independent component of the MetS. We formally tested this hypothesis using confirmatory factor analysis, which allows comparison of different models, with or without including NAFLD as a component of the MetS.
METHODS
We analyzed data from 3846 subjects of the Third National Health and Nutrition Examination Survey (1988-1994). NAFLD was defined by increased liver fat measured by ultrasonography.
RESULTS
MetS by Adult Treatment Panel III criteria was present in 20.5%, and 30.2% had NAFLD, defined as mild, moderate, or severe ultrasonographic steatosis. Using confirmatory factor analysis, a basic model representing the MetS using its currently accepted components (glucose, waist, triglyceride/high-density lipoprotein ratio, and mean arterial pressure) showed excellent goodness-of-fit statistics. Addition of NAFLD to the model as a fifth independent variable decreased model fit, suggesting that NAFLD is not an additional independent component of the MetS. Analysis by ethnicity showed that addition of NAFLD decreased model fit in Whites but resulted in minor improvements in non-Hispanic Blacks and Mexican Americans.
CONCLUSIONS
The MetS is strongly associated with NAFLD. However, we found no evidence that NAFLD is an independent component or manifestation of the MetS. Interestingly, ethnic differences might be important in this relationship and require further study.