中老年人群非酒精性脂肪肝与抑郁症的相关性研究

Correlation of non-alcoholic fatty liver disease and depression in an elderly Chinese population

目的探讨中老年人群中非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)与抑郁症的相关性及其潜在的影响因素。方法采用整群抽样法于2015-2016年间选取重庆市沙坪坝区45岁以上居民为研究对象。所有受试者进行问卷调查、体格检查并留取血液检测肝肾功能、血脂等生化指标。最终4 970个符合条件的受试者被纳入分析。采用脂肪肝指数(fatty liver index,FLI)评定非酒精性脂肪肝及其程度,采用患者健康问卷抑郁自评量表(patient health questionnaire,PHQ-9)评定抑郁症及其程度,分析NAFLD与抑郁症患病风险的相关性及其潜在的影响因素。结果在该抽样人群中,轻度和中重度抑郁症的患病率分别为3.3%和1.4%,而在此人群NAFLD患者中,轻度和中重度抑郁症的患病率分别上升至14.2%和51.4%。与非抑郁症相比,抑郁患者(轻度和中重度抑郁)都存在较高的总胆固醇、甘油三酯、低密度脂蛋白、FLI、IL-6水平及糖尿病患病率,并且拥有较低的HDL水平及较少的步行时间(P<0.05,P<0.01)。多元回归分析发现NAFLD与抑郁症密切相关,且其相关性独立于BMI和是否患有糖尿病,但可以受血脂和炎症指标的影响。结论在中老年人群中,NAFLD与抑郁症显著相关,其机制可能与抑郁症所致脂质代谢紊乱和慢性炎症反应有关,而不直接受BMI和糖尿病的调控。

Objective To investigate the correlation of depression with non-alcoholic fatty liver disease （NAFLD） in the Chinese middle-aged and aged population, and explore the possible influencing factors. Methods A cross-section study was performed in the 5 321 〉45-year-old residents living in some communities of Shapingba District, Chongqing during 2014 and 2015. They all received blood tests, anthropometric measurements, and standard questionnaire. Totally 4 970 eligible subjects were finality included for further analysis. NAFLD were assessed by fatty liver index （FLI） , and depression was evaluated by the night-item Patient Health Questionnaire （PHQ-9）. Results The incidence rate of mild and moderately severe depression was 3.3% and 1.4%, respectively, but the rates increased to 14.2% and 51.4% respectively in the NAFLD patients （P〈0. 001）. Compared with non-depressive participants, the depressive patients （including mild and moderately severe depression） had higher levels of total cholesterol （TC）, triglyeeride （TG）, low density lipoprotein （LDL）, FLI, interleukin 6 （IL-6）, higher incidence ofdiabetes, lower high density lipoprotein （HDL）, and shorter walk time. In multiple regressive analysis, depression was closely associated with NAFLD, and the association was independent from body mass index （BMI） and with diabetes or not, but was affected by lipid profiles and inflammatory indicators. Conclusion NAFLD is significantly correlated with depression among middle-aged and aged population. The mechanism is related with lipid metabolic disorder and chronic inflammatory reactions, but is independent from obesity and diabetes.