老年非酒精性脂肪性肝病患者代谢变化及血管疾病发生状况调查

Analysis of clinical features in elderly patients with nonalcoholic fatty liver disease

目的探讨老年非酒精性脂肪性肝病(NAFLD)患者代谢及血管疾病的发生情况。方法常规全面健康评估发现老年(≥60岁)NAFLD患者103例和非NAFLD老人181例,比较他们血生化学及血管影像学的变化;行Logistic回归分析老年人发生冠状血管病变的危险因素。结果在103例NAFLD患者,MS和DM的发生率分别为61%和39%,显著高于非NAFLD老人(22%和24%,P<0.01);NAFLD患者BMI(32.1kg/m2对27.6kg/m2)、HOMA-IR(3.4对2.9)、ALT(34.0u/L对22.9u/L)和HS-CRP(7.0mg/L对3.5 mg/L)均比对照组显著升高(均P<0.05);血管病变方面,冠状动脉狭窄(58%对30%)、CHD发生率(24%对12%)和脑血管事件发生率(18%对11%)均比对照组显著升高(均P<0.01);进一步分析表明,冠脉狭窄的危险因素依次为DM(OR=11.4)、NAFLD(OR=2.26)、MS(OR=1.99),而CHD的危险因素依次为MS(OR=2.84)、CRP(OR=1.19)和ALT(OR=1.06,P<0.05)。结论 NAFLD对老年人健康的影响主要表现为增加代谢紊乱和血管病变,心脑血管病变有持续进展的趋势,NAFLD及其引起的肝内外炎症反应对冠脉狭窄有重要影响。

Objective The aim of this study was to evaluate the effect of nonalcoholic fatty liver disease （NAFLD）on metabolic and vascular disease in elderly patients. Methods Clinical data including physical and imaging examination （ultrasonic scan of liver and carotid artery and CT scan of eardiocerebrovascular system） and serum biomarkers of insulin resistance,metabolic index,systemic inflammation and liver function index in 103 pa- tients with NAFLD and 181 non-NAFLD controls （all^60 year old） were collected. Logistic regression analysis was performed to evaluate the risk factors of coronary stenosis and coronary heart disease（CHD）. Results As compared with non NAFLD persons, there was an obvious higher prevalence of DM（39% vs. 24%）and MS（61% vs. 22%） in NAFLD patients; the serum indexes in NAFLD group showed slightly elevation of BMI （32.1kg/m^2 vs. 27.6kg/m^2）, HOMA-IR （3.4 vs. 2.9）,GHB （5.5% vs. 5.1%）,ALT （34.0u/L vs. 22.9u/L） and HS-CRP（7.0mg/L vs. 3.5mg/L（all P〈0.05）;the cerebral disease （18% vs. 11%）,coronary stenosis（58% vs. 30%） and CHD（24%vs. 12%） happened more common in NAFLD group;The risk factors of coronary stenosis were DM （OR=11.4）,MS （OR=1.99） and NAFLD（OR=2.26）;the risk factors of CHD were MS（OR=2.84）,CRP（OR=1.99） and ALT（OR=1.06,all P〈0.05）. Conclusion There is a higher incidence of metabolic and vascular diseases in elderly NAFLD patients.