乌鲁木齐市维吾尔族急性缺血性脑梗塞合并非酒精性脂肪性肝病患者的临床分析

A clinical analysis of Uygur patients with acute ischemic cerebral infarction complicated by nonalcoholic fatty liver disease in Urumqi,China

目的探讨乌鲁木齐市维吾尔族急性缺血性脑梗塞(AICI)患者合并非酒精性脂肪性肝病(NAFLD)的临床特点及可能的危险因素。方法回顾性分析新疆医科大学第二附属医院2011年9月-2017年7月收治的294例维吾尔族AICI患者的临床资料,根据腹部超声诊断分为病例组(合并NAFLD者)110例和对照组(非合并NAFLD者)184例。观察2组患者的基本情况,生化指标及颈总动脉内膜中层厚度(IMT)。另将所收集病例根据年龄分为5组(≤30岁组、31~45岁组、46~60岁组、61~75岁组和≥76岁组),比较各年龄组AICI患者NAFLD发生情况。计量资料组间比较采用t检验。计数资料2组间比较采用χ2检验。多因素分析采用logistic多元回归分析。结果病例组患者年龄、BMI、腰臀比、糖化血红蛋白、空腹血糖、尿酸、ALT、GGT、TG、TC、LDL-C等指标显著高于对照组,AST水平显著低于对照组,2组间差异均有统计学意义(t值分别为9.814、5.569、8.139、3.592、3.514、15.703、15.113、8.092、10.834、7.719、11.481、7.561,P值均<0.05)。病例组有吸烟史的患者比例显著高于对照组(χ2=14.060,P<0.05)。Logistic回归分析显示年龄、血清ALT、TG和LDL-C水平升高和吸烟史与AICI患者合并NAFLD关系密切,比值比(95%可信区间)分别为1.301(1.065~1.589)、1.383(1.059~1.805)、1.335(1.091~1.634)、1.358(1.125~1.639)、1.423(1.105~1.833),P值均<0.05。AICI患者NAFLD发生率随年龄增加呈升高趋势,组间比较差异具有统计学意义(χ2=13.558,P=0.009),其中61~75岁组和≥76岁组患者NAFLD发生率分别为44.09%和51.35%,显著高于其余3组(P值均<0.05)。结论年龄、血清ALT、TG和LDL-C水平升高和吸烟史是AICI患者合并NAFLD的独立危险因素,>60岁为高发年龄段。

Objective To investigate the association between acute ischemic cerebral infarction（AICI） and nonalcoholic fatty liver disease（NAFLD） in Uygur patients in Urumqi,China and possible risk factors. Methods A retrospective analysis was performed for the clinical data of 294 Uygur patients with AICI who were admitted to The Second Affiliated Hospital of Xinjiang Medical University from September2011 to July 2017,and according to the diagnosis based on abdominal ultrasound,these patients were divided into case group with 110 patients（AICI complicated by NAFLD） and control group with 184 patients（without NAFLD）. The two groups were observed in terms of general information,biochemical parameters,and intima-media thickness（IMT） of the common carotid artery. The AICI patients were divided into ≤30 years group,31-45 years group,46-60 years group,61-75 years group,and ≥60 years group according to age,and the incidence rate of NAFLD was compared between these groups. The t-test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and a multivariate logistic regression analysis was performed.Results Compared with the control group,the case group had significantly higher age,body mass index,waist-hip ratio,Hb A1 c,fasting blood glucose,uric acid,alanine aminotransferase（ALT）,gamma-glutamyl transpeptidase,triglyceride（TG）,total cholesterol,and low-density lipoprotein cholesterol（LDL-C） and a significantly lower aspartate aminotransferase level（t = 9. 814,5. 569,8. 139,3. 592,3. 514,15. 703,15. 113,8. 092,10. 834,7. 719,11. 481,and 7. 561,all P 0. 05）. The case group had a significantly higher proportion of the patients with a smoking history than the control group（χ2= 14. 060,P 0. 05）. The logistic regression analysis showed that the increases in age（odds ratio [OR]= 1. 301,95% confidence interval [CI]： 1. 065-1. 589,P 0. 05） and serum levels of ALT（OR =1. 383,95% CI： 1. 059-1. 805,P 0. 05）,TG（OR = 1. 335,95% CI： 1. 091-1. 634,P 0. 05）,and LDL-C（OR = 1. 358,95%CI： 1. 125-1. 639,P 0. 05） and a smoking history（OR = 1. 423,95% CI： 1. 105-1. 833,P 0. 05） were closely associated with NAFLD in AICI patients. The incidence rate of NAFLD in AICI patients increased with age,and there was a significant difference between different age groups（χ2= 13. 558,P = 0. 009）; the 61-75 years group and the 76 years group had an incidence rate of NAFLD of44. 09% and 51. 35%,respectively,which were significantly higher than that in the other three groups（P 0. 05）. Conclusion Increases in age and serum levels of ALT,TG,and LDL-C and a smoking history are independent risk factors for NAFLD in patients with AICI,and AICI patients aged over 60 years have a high incidence rate of NAFLD.