老年人群非酒精性脂肪性肝病的危险因素分析

Analysis of risk factors for non-alcoholic fatty liver disease in elderly patients

目的探讨老年患者非酒精性脂肪性肝病(NAFLD)的危险因素。方法选择2013年1月至11月在上海交通大学医学院附属新华医院行颅脑磁共振和腹部超声检查的481例住院患者,其中年龄≥65岁250例,NAFLD患者225例,≥65岁NAFLD患者108例。通过生化指标、颈部血管超声等检测,分析老年NAFLD患者的危险因素。结果老年人群2型糖尿病、高血压病、心房颤动、急性脑梗死和既往脑梗死的患病率以及颈动脉斑块、颈动脉狭窄的阳性率显著升高,而NAFLD患病率则显著降低(P<0.05)。≥65岁NAFLD组急性脑梗死、2型糖尿病、心房颤动患病率以及存在颈动脉斑块和有既往脑梗死史的患者比例较年龄<65岁组显著升高(P<0.05);≥65岁NAFLD组BMI、24 h平均收缩压和舒张压、HbA1c、三酰甘油、空腹及餐后两小时血糖水平较对照组显著升高(P<0.05);多因素Logistic回归分析显示急性脑梗死与老年人群NAFLD关系密切(OR=3.055,95%CI1.132-8.24)。结论≥65岁组NAFLD患病率较年龄<65岁组显著下降;急性脑梗死与老年人群NAFLD独立相关。

Objective To explore the risk factors of non-alcoholic fatty liver disease（NAFLD）in elderly patients.Methods Four hundred and eighty-one patients without alcohol abuse were admitted to the Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2013 to November 2013,who had gone through abdominal ultrasound at the time of hospitalization,were enrolled.Among these patients,250 cases were elderly patients,225 cases had NAFLD,and 108 cases were elderly patients with NAFLD.Features including fasting plasma biochemical indexes,and carotid intima-media thickness（IMT）were evaluated to explore potential risk factors.Multiple logistic regression analysis was used to estimate the odds ratio for risk factors of NAFLD in elderly people.Results Compared with these in nonelderly group,the prevalence of type 2 diabetes,hypertension,atrial fibrillation,acute and previous ischemic stroke,carotid plaques and stenosis were higher in elderly group,while the prevalence of NAFLD were significantly lower（P〈0.05）.The prevalence of type 2 diabetes,atrial fibrillation,acute and previous ischemic stroke,carotid plaques were higher in elderly NAFLD patients,when compared with non-elderly NAFLD cases（P〈0.05）.In elderly fatty live patients,BMI,24-hour average systolic and diastolic blood pressure,HbA1 c,triglycerides,fasting and postprandial 2 hours blood glucose levels were all significantly higher than these in control group（P〈0.05）.Binomial logistic multivariate regression analysis identified acute ischemic stroke（OR=3.055,95% CI 1.132-8.24）.Conclusion The prevalence of NAFLD is significantly lower in elderly patients than that in non-elder group.Acute ischemic stroke might be independently associated with elder patients with NAFLD.