非酒精性脂肪肝临床风险分析

Analysis of clinical features and prognostic factors in patients with nonalcoholic fatty liver disease

目的评价非酒精性脂肪肝(NAFLD)住院患者的临床风险及预后。方法将2006年9月至2009年9月间在广东省人民医院住院治疗的4437例NAFLD病例纳入分析,采用方差分析和logistic回归分析比较不同年龄阶段NAFLD患者的住院病因、伴发疾病及NAFLD导致肝功能损伤和死亡的危险因素。结果 NAFLD患者入院病因依次为:非糖尿病相关血管病变(34.1%)、糖尿病相关病变(24.0%)、肝功能损伤(7.8%)、胆胰疾病(4.8%);NAFLD伴发疾病依次为:高血压(42.0%)、糖尿病(32.4%)、脑血管病(26.3%)、心血管病(16.6%)、胆道结石(11.2%)、胰腺炎(6.31%)。NAFLD伴随疾病的发病高峰年龄在不同年龄组有显著差异,其中胆道结石及胰腺炎发病高峰年龄均小于40岁,糖尿病、高血压、冠心病的发病高峰年龄为61～70岁;脑血管发病高峰年龄为71～80岁。NAFLD发生肝功能损伤的危险因素依次为胰腺炎(OR=3.0),胆道感染(OR=2.6),糖尿病相关外周血管病变(OR=1.7)和年龄(OR=0.8)(P<0.01);NAFLD发生死亡的危险因素依次为糖尿病相关外周血管病变(OR=29.5)、糖尿病相关外周血管病变(OR=24.6)、肿瘤(OR=9.8)、糖尿病相关感染(OR=4.7)及年龄(OR=1.7)(P<0.01)。结论 NAFLD与多种疾病密切相关,其伴发疾病往往是病情进展导致入院及死亡的主要原因。NAFLD在不同年龄阶段的表现及预后不尽相同。61～70岁容易出现严重并发症,年龄因素是制定NAFLD干预方案的重要参考因素之一。

Objective The aims of this study were to evaluate the clinical features and prognostic factors of patients with nonalcoholic fatty liver disease （NAFLD）. Methods Clinical data of 4,437 inpatients with NAFLD in Guangdong Provincial Hospital were collected. The distributions of concomitant diseases, causes of admission, risk factors of NAFLD related liver injury and death were analyzed. Results Major admission causes of NAFLD were non-diabetic related angiopathy （34.1%）, diabetes-related complications （24.0%）, liver injury （7.8%）, biliary-pancreatic diseases （4.8%）. Common concomitant diseases of NAFLD were hypertension （42.0%）, diabetes mellitus （32.4%）, cerebrovacular disease （26.3%）, coronary heart disease （16.6%）, cholelithiasis （11.2%）, and acute pancreatitis （6.3%）. The distributions of NAFLD concomitant diseases were different in different age groups. The peak age of diabetes mellitus, hypertension and coronary heart disease in patients with NAFLD was from 61 to 70 years old, whereas the cerebrovascular disease, cholelithiasis and pancreatitis was less than 40 years old, repectively. The risk factors of liver damage were pancreatitis （OR = 3.0）, biliary infection （OR = 2.6）, diabetic peripheral vascular complication （OR = 1.7） and age （OR = 0.8） （P 0.01）. The risk factors of death were diabetic peripheral vascular complication （OR = 29.5）, cardiovascular events （OR = 24.6）, tumor （OR = 9.8）, diabetes-related infection （OR = 4.7） and age （OR = 1.7） （P 0.01）. Conclusion The clinical manifestations and prognosis of NAFLD are closely related to age and its concomitant diseases. Age should be paid more attention when interventions are made.