Objective: To investigate the characteristics of non-alcoholic fatty liver disease (NAFLD) and its associated factors in rheumatoid arthritis (RA) patients. Methods: This cross-sectional study recruited 385 RA patients [including 72 (18.7%) male and 313 (81.3%) female] who received abdominal sonographic examination from August 2015 to May 2021 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. There were 28 RA patients at 16-29 years old and 32, 80, 121, 99, 25 at 30-39, 40-49, 50-59, 60-69, ≥ 70 years old, respectively. Demographic and clinical data were collected including age, gender, history of alcohol consumption, disease duration, body mass index (BMI), waist circumference, blood pressure, RA disease activity indicators and previous medications. Logistic regression analyses were used to identify the associated factors of NAFLD in RA patients. Results: The prevalence of NAFLD was 24.2% (93/385) in RA patients, 26.3% (21/80) in 40-49 age group and 33.1% (40/121) in 50-59 age group. There were 22.1% (85/385) and 3.6% (14/385) RA patients with overweight and obese, in which the prevalence of NAFLD was 45.9% (39/85) and 78.6% (11/14) respectively, which was 2.6 folds and 4.5 folds that of RA patients with normal BMI. Although there was no significant difference of age, gender and RA disease activity indicators between RA patients with or without NAFLD, those with NAFLD had higher proportions of metabolic diseases including obese (11.8% vs. 1.0%), central obesity (47.3% vs. 16.8%), hypertension (45.2% vs. 29.8%) and type 2 diabetes mellitus (24.7% vs. 12.0%), consistent with higher levels of total cholesterol [(5.33±1.31) mmol/L vs. (4.73±1.12) mmol/L], triglyceride [(1.51±1.08) mmol/L vs. (0.98±0.54) mmol/L] and low-density lipoprotein cholesterol [(3.37±0.97) mmol/L vs. (2.97±0.78) mmol/L, all P<0.05]. Multivariate logistic regression analysis showed that BMI (OR=1.314) and triglyceride (OR=1.809) were the independent factors positively associated with NAFLD in RA patients. Conclusion: NAFLD is a common comorbidity in RA patients, especially in those with middle-aged, overweight or obese, which is associated with high BMI or high triglyceride. Screening and management of NAFLD in RA patients especially those with overweight, obese or dyslipidemia should be emphasized.
目的： 探讨类风湿关节炎（RA）患者非酒精性脂肪性肝病（NAFLD）的临床特征及其相关因素。 方法： 采用横断面研究入组2015年8月至2021年5月就诊于中山大学孙逸仙纪念医院风湿免疫科并行腹部B超检查的385例RA患者，男性72例（18.7%），女性313例（81.3%）；其中16~29岁的患者28例、30~39岁的32例、40~49岁的80例、50~59岁的121例、60~69岁的99例和≥70岁的25例。收集临床资料包括年龄、性别、饮酒史、病程、体重指数（BMI）、腰围、血压、RA疾病活动指标、血生化指标和既往用药，采用logistic回归分析RA患者合并NAFLD的相关因素。 结果： 385例RA患者NAFLD的患病率为24.2%（93/385例），其中40~49岁、50~59岁RA患者中的患病率分别为26.3%（21/80例）和33.1%（40/121例）。RA患者超重和肥胖的比例分别为22.1%（85/385例）和3.6%（14/385例），超重和肥胖的RA患者NAFLD的患病率分别为45.9%（39/85例）和78.6%（11/14例），为正常BMI组RA患者的2.6倍和4.5倍。与非NAFLD组相比，合并NAFLD的RA患者年龄、性别和RA病情特征无明显差异，而代谢性疾病包括肥胖（11.8% vs. 1.0%）、中心性肥胖（47.3% vs. 16.8%）、高血压（45.2% vs. 29.8%）、2型糖尿病（24.7% vs. 12.0%）的比例以及总胆固醇［（5.33±1.31）mmol/L vs.（4.73±1.12）mmol/L］、甘油三酯［TG（1.51±1.08）mmol/L vs.（0.98±0.54）mmol/L］和低密度脂蛋白胆固醇［（3.37±0.97）mmol/L vs.（2.97±0.78）mmol/L］则明显高于非NAFLD组（均P<0.05）。多因素logistic回归分析显示，BMI（OR=1.314）和TG（OR=1.809）为RA患者合并NAFLD的独立相关因素。 结论： NAFLD可能是RA患者尤其是中年、超重及肥胖的RA患者的常见合并症，其发生可能与高BMI或高TG相关。临床上对于超重、肥胖及血脂异常的RA患者应加强NAFLD的筛查与管理。.