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摘要：
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摘要：目的 研究体检痩型非酒精性脂肪性肝病（non-alcoholic fatty liver disease，
NAFLD）人群与正常体质量NAFLD和超重/肥胖NAFLD人群特征的差异。方法 回
顾性分析2016年1月1日至2018年9月30日于西安交通大学第二附属医院体检中心体检
的96 100例研究对象的资料，最终纳入366例痩型NAFLD患者（瘦型NAFLD组）[体
重指数（body mass index，BMI）＜ 23 kg/m2]、2009例正常体质量NAFLD患者（正常体
质量NAFLD组）（23 kg/m2 ≤ BMI ＜ 25 kg/m2）、7221例超重/肥胖NAFLD患者（超重/
肥胖NAFLD组）（BMI ≥ 25 kg/m2）。比较各组患者年龄、舒张压（diastolic blood
pressure，DBP）、收缩压（systolic blood pressure，SBP）、空腹血糖（fasting plasma
glucose，FPG）、甘油三酯（triglyceride，TG）、低密度脂蛋白胆固醇（low-density
lipoprotein cholesterol，LDL-C）、高密度脂蛋白胆固醇（high-density lipoprotein
cholesterol，HDL-C）、尿酸（uric acid，UA）、血红蛋白（hemoglobin，Hb）、红细
胞计数（red blood cell，RBC）、红细胞体积（mean corpuscular volume，MCV）、血
小板（platelet count，PLT）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、
白蛋白（albumin，ALB）等差异。结果 与超重/肥胖NAFLD患者相比，痩型NAFLD
患者女性占比（46.17%比20.70%）和绝经期女性占比更高（79.88%比64.48%），年
龄更大 [（46.39 ± 9.90）岁比（44.16 ± 9.51）岁]，Hb [（149.09 ± 15.03）g/L比（155.57 ±
14.29）g/L]、RBC [（4.88 ± 0.47）× 1012/L比（5.07 ± 0.44）× 1012/L]、UA [（337.48 ±
82.19）μmol/L比（382.51 ± 86.16）μmol/L]、血脂异常占比（77.05%比85.36%）、代谢
异常占比（87.16%比93.43%）和ALT ≥ 2倍正常值上限占比（3.55%比8.67%）更低，差
异均有统计学意义（P均＜ 0.05）。与正常体质量NAFLD患者相比，痩型NAFLD患者女
性比例更高（46.17%比27.73%），年龄更大 [（46.39 ± 9.90）岁比（44.44 ± 9.85）岁]，Hb
[（149.09 ± 15.03）g/L比（153.31 ± 14.10）g/L]、RBC [（4.88 ± 0.47）× 1012/L比（5.02 ±
0.45）× 1012/L]、UA [（337.48 ± 82.19）μmol/L比（360.48 ± 81.18）μmol/L]、血脂异常
占比（77.05%比83.67%）更低，差异均有统计学意义（P均＜ 0.05）。痩型NAFLD组、
正常体质量NAFLD组、超重/肥胖NAFLD组患者TC [（5.13 ± 1.09）mmol/L 比（5.01 ±
1.01）mmol/L比（5.01 ± 0.96）mmol/L] 和LDL-C [（3.28 ± 0.82）mmol/L比（3.23 ±
0.80）mmol/L比（3.22 ± 0.76）mmol/L] 水平差异无统计学意义（P均＞ 0.05）。痩型
NAFLD组患者HDL-C水平高于正常体质量NAFLD组，正常体质量NAFLD组高于超重/
肥胖NAFLD组 [（1.17 ± 0.27）mmol/L比（1.10 ± 0.35）mmol/L比（1.05 ± 0.21）mmol/L；
F = 49.37，P ＜ 0.001]。痩型NAFLD组患者TG水平低于正常体质量NAFLD组，正常
体质量NAFLD组低于超重/肥胖NAFLD组（中位数：1.79 mmol/L比1.92 mmol/L比
2.07 mmol/L；H = 55.771，P ＜ 0.001）。结论 痩型NAFLD患者脂代谢与正常体质量、
超重/肥胖NAFLD患者存在差异，TG水平最低，HDL-C水平最高。痩型NAFLD患者女
性比例更高，年龄更大，UA水平更低，血脂异常占比更低。痩型NAFLD相比超重/肥
胖NAFLD绝经女性占比高，代谢异常占比和ALT ≥ 2倍正常值上限占比更低。
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Abstract: Objective To investigate the differences among lean non-alcoholic fatty liver disease
(NAFLD) population, normal weight NAFLD population and overweight/obese NAFLD
population. Methods Data of 96 100 subjects who underwent physical examination in the
Physical Examination Center of the Second Affiliated Hospital of Xi’an Jiaotong University
from January 1st, 2016 to September 30th, 2018 were retrospectively analyzed, and 366 lean
NAFLD patients (lean NAFLD group) [body mass index (BMI) ＜ 23 kg/m2], 2009 normal
weight NAFLD patients (normal weight NAFLD group) (23 kg/m2 ≤ BMI ＜ 25 kg/m2)
and 7221 overweight/obese NAFLD patients (overweight/obese NAFLD group) (BMI ≥ 25 kg/m2)
were finally included. Age, diastolic blood pressure (DBP), systolic blood pressure (SBP),
fasting plasma glucose (FPG), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C),
high-density lipoprotein cholesterol (HDL-C), uric acid (UA), hemoglobin (Hb), red blood
cell (RBC), mean corpuscular volume (MCV), platelet count (PLT), alanine aminotransferase
(ALT) and albumin (ALB) of patients in three groups were compared. Results Compared with
those in overweight/obese NAFLD group, the proportion of female (46.17% vs. 20.70%) and
menopausal women (79.88% vs. 64.48%) in lean NAFLD group were higher, the age [(46.39 ±
9.90) years vs. (44.16 ± 9.51) years] was older, Hb [(149.09 ± 15.03) g/L vs. (155.57 ± 14.29) g/L],
RBC [(4.88 ± 0.47) × 1012/L vs. (5.07 ± 0.44) × 1012/L], UA [(337.48 ± 82.19) μmol/L vs. (382.51 ±
86.16) μmol/L], proportion of dyslipidemia (77.05% vs. 85.36%), proportion of metabolic
abnormalities (87.16% vs. 93.43%) and proportion of ALT ≥ 2 × upper limit of normal (3.55%
vs. 8.67%) were lower, the differences were statistically significant (all P ＜ 0.05). Compared
with those in normal weight NAFLD group, the proportion of female in lean NAFLD group was
higher (46.17% vs. 27.73%), the age [(46.39 ± 9.90) years vs. (44.44 ± 9.85) years] was older,
Hb [(149.09 ± 15.03) g/L vs. (153.31 ± 14.10) g/L], RBC [(4.88 ± 0.47) × 1012/L vs. (5.02 ± 0.45) × 1012/L], UA
[(337.48 ± 82.19) μmol/L vs. (360.48 ± 81.18) μmol/L] and proportion of dyslipidemia (77.05%
vs. 83.67%) were lower, the differences were statistically significant (all P ＜ 0.05). There were
no statistically significant difference in TC [(5.13 ± 1.09) mmol/L vs. (5.01 ± 1.01) mmol/L vs.
(5.01 ± 0.96) mmol/L] and LDL-C [(3.28 ± 0.82) mmol/L vs. (3.23 ± 0.80) mmol/L vs. (3.22 ±
0.76) mmol/L] level among lean NAFLD group, normal weight NAFLD group and overweight/
obese NAFLD group. HDL-C level of patients in lean NAFLD group was higher than that of
normal weight NAFLD, and normal weight NAFLD group was higher than that of overweight/
obese NAFLD group [(1.17 ± 0.27) mmol/L vs. (1.10 ± 0.35) mmol/L vs. (1.05 ± 0.21) mmol/L;
F = 49.37, P ＜ 0.001]. TG level of patients in lean NAFLD group was lower than that of normal
weight NAFLD, and normal weight NAFLD group was lower than that of overweight/obese
NAFLD group (median: 1.79 mmol/L vs. 1.92 mmol/L vs. 2.07 mmol/L; F = 55.771, P ＜ 0.001).
Conclusions Lean NAFLD patients had differences in lipid metabolism compared with normal
weight and overweight/obese NAFLD patients, and had the lowest TG level and the highest
HDL-C level. In lean NAFLD patients, there was a higher proportion of female, older age, lower
UA level and lower proportion of dyslipidemia. Compared with overweight/obese NAFLD
patients, lean NAFLD patients had higher proportion of menopausal female, lower metabolic
abnormality and proportion of ALT ≥ 2 × upper limit of normal.
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