Abstract: Background　Studies have shown that the incidence of nonalcoholic fatty liver disease（NAFLD）is increasing，and it has a risk of worsening to hepatocellular carcinoma.However，available studies about the pathogenesis and progression of NAFLD are mainly from the biological perspective，few from the sociological perspective.Objective　To study the relationship between socioeconomic status（SES） and NAFLD among retirees in Huaian，Jiangsu Province，in order to find a reference for the intervention of NAFLD from the sociological perspective.Methods　From the 1 277 retirees participating in the physical examination of Diabetes Prevention Program（ChiCTR-TRC-14005029）held by the Affiliated Huaian Hospital of Xuzhou Medical University，930 were selected according to the inclusion and exclusion criteria of this study.Data concerning liver fat content（LFC）were collected，and by the tertiles of the LFC，participants were stratified into control group（LFC<9.15%，n=197），low LFC group（9.15%≤LFC≤20.00%，n=532）and high LFC group（LFC>20.00%，n=201）．General personal data and biochemical parameters were also obtained.Results　In the retirees，the prevalence of NAFLD in women was higher than that in men（P<0.05）．The prevalence of NAFLD in different age groups significantly varied（P<0.05）．Compared with the control group，low LFC group demonstrated a younger age，and lower serum creatinine（Scr），but higher rate of regular exercise，higher body mass index（BMI），and triglyceride（TG）（P<0.05），high LFC group showed a younger age，and lower Scr，but higher incidence of sleep disorder，higher BMI，fasting plasma glucose（FPG），alanine aminotransferase（ALT），aspartate aminotransferase（AST），TG，high-density lipoprotein cholesterol（HDL-C），and serum uric acid（SUA），and estimated glomerular filtration rate（eGFR）（P<0.05）．Compared with the low LFC group，the proportion of men，BMI，ALT，AST，TG and SUA in HLFC group were higher，rate of regular exercise and HDL-C were lower（P<0.05）．The rate of regular exercise，incidence of sleep disorder，and prevalence of NAFLD differed significantly by monthly income（P<0.05）．Monthly income was positively associated with age，rate of sodium intake，rate of regular exercise，and levels of TC，TG，SUA and LFC（P<0.05），but negatively associated with ALT（P<0.05）．Multivariate Logistic regression analysis showed that monthly income was a factor associated with NAFLD（P<0.05）．Conclusion　SES is closely related with NAFLD in retirees in Huaian.High monthly income is an independent risk factor for NAFLD.Increased monthly income is associated with increased SES and increased risk of NAFLD.Enhancing monthly income without improving educational level and health consciousness may increase the incidence of NAFLD.

Key words: Liver diseases, Nonalcoholic fatty liver disease, Social class, Retirement, Causality

摘要： 背景　研究显示非酒精性脂肪性肝病（NAFLD）的发病率日趋增长，其有进一步恶化成肝细胞癌的风险。然而目前针对NAFLD发病及进展的研究多集中在生物学的病因，针对其社会学病因的研究较少。目的　研究淮安地区离退休人员社会经济地位（SES）与NAFLD的关系，以期为在社会层面干预NAFLD的发病寻找依据。方法　选择2015年5—7月徐州医科大学附属淮安医院《糖尿病预防项目》（ChiCTR-TRC-14005029）体检人群1 277例，根据纳入与排除标准，最终纳入930例研究对象。根据肝脏脂肪含量（LFC），将研究对象分为正常对照组（LFC<9.15%，197例）、低肝脏脂肪含量组（LLFC组，9.15%≤LFC≤20.00%，532例）、高肝脏脂肪含量组（HLFC组，LFC>20.00%，201例）。收集研究对象一般资料、一般生化指标。结果　男性NAFLD发生率低于女性（P<0.05）。不同年龄段研究对象NAFLD发生率比较，差异有统计学意义（P<0.05）。LLFC组年龄、血清肌酐（Scr）低于正常对照组，规律运动率、体质指数（BMI）、三酰甘油（TG）高于正常对照组（P<0.05）；HLFC组年龄、Scr低于正常对照组，睡眠障碍发生率、BMI、空腹血糖（FPG）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、TG、高密度脂蛋白胆固醇（HDL-C）、血尿酸（SUA）、估算肾小球滤过率（eGFR）高于正常对照组（P<0.05）；HLFC组男性率、BMI、ALT、AST、TG、SUA高于LLFC组，规律运动率、HDL-C低于LLFC组（P<0.05）。不同经济收入研究对象规律运动率、睡眠障碍发生率、NAFLD发生率比较，差异有统计学意义（P<0.05）。研究对象经济收入与年龄、钠盐摄入率、规律运动率、TC、TG、SUA、LFC呈正相关，与ALT呈负相关（P<0.05）。多因素Logistic回归分析结果显示，经济收入是NAFLD的影响因素（P<0.05）。结论　淮安地区离退休人员SES与NAFLD的发展密切相关，经济收入是NAFLD的独立危险因素，经济收入越高，SES越高，NAFLD的发生风险越大。但如不改善国民的受教育水平及提高其健康意识，单纯提高经济收入，反而会增加NAFLD的发生率。

关键词: 肝疾病, 非酒精性脂肪性肝病, 社会阶级, 退休, 因果律