老年非酒精性脂肪性肝病治疗现况调查及应对策略

Current situation and coping strategies in the treatment of nonalcoholic fatty liver disease in the elderly

目的调查老年非酒精性脂肪性肝病(NAFLD)的治疗现况及规范性,为提高NAFLD的标准治疗提供依据。方法收集就诊的老年NAFLD患者的临床资料,包括血压、腰围、体重指数(BMI)、肝功能、血糖、血脂、尿酸(BUA)、肝脏彩超检查,记录患者的日常生活方式、伴随疾病及治疗情况,并参照我国2010年《非酒精性脂肪性肝病诊疗指南》进行评估。结果 389例老年NAFLD患者,年龄60～82岁,平均年龄(69. 8±9. 5)岁,男性51%(198/389),女性49%(191/389);病史6个月～20年,平均(8. 6±7. 3)年。按NAFLD诊疗指南中的治疗原则,结合患者实际情况,老年NAFLD患者329例(84. 6%)需接受基础治疗,76例(19. 5%)需应用肝保护剂,132例(33. 9%)需应用胰岛素增敏剂,240例(61. 7%)需应用调脂药,49例(12. 6%)需应用减肥药,207例(53. 2%)需应用血管紧张素酶受体拮抗剂(ARB)。而实际应用占需要应用的百分比依次为:基础治疗42. 9%,肝保护剂77. 6%,胰岛素增敏剂36. 4%,调脂药30. 4%,减肥药4%,ARB 56. 0%。治疗依从性最高为减肥药100%,最低为基础治疗23. 4%; ARB治疗完全依从达到50%以上;胰岛素增敏剂、调脂药治疗完全依从低于50%;肝保护剂治疗完全依从仅10. 2%。结论老年NAFLD治疗现况与非酒精性脂肪性肝病诊疗指南的要求差距较大,需进一步提高治疗的规范性及依从性。

Objective To investigate the current situation and normative treatment of non-alcoholic fatty liver disease(NAFLD)in the elderly so as to provide basis for improving the standard treatment of NAFLD.Methods The clinical data of elderly patients with NAFLD who were admitted and treated in our hospital were collected,including blood pressure,waist circumference,body mass index(BMI),liver function,plasma glucose,lipid profiles,uric acid(BUA),liver ultrasound examination.Daily practice including life style,accompanying diseases and treatment status,moreover,the data were assessed according to 2010 Chinese NAFLD treatment guidelines.Results A total of 389 elderly patients with NAFLD were enrolled in the study,whose age range:60~82 years,average age:(69.8±9.5)years,51%of males(198/389)and 49%of females(191/389).The medical history was during 6 months^20 years,with an average value being(8.6±7.3)years.According to the treatment principle of NAFLD in the guidelines,329 patients(84.6%)with NAFLD had to receive basic treatment,76 patients(19.5%)had to be treated by liver protective agents,132 patients(33.9%)had to be treated by insulin sensitization agents,and 240 patients(61.7%)needed to be treated by fat-regulating drugs,49 patients(12.6%)needed to be treated by anti-obesity agents and 207 patients(53.2%)had to be treated by enzyme angiotensin receptor blockers(ARB).However the percentage of practical application was 42.9%for basic treatment,77.6%for liver protection,36.4%for insulin sensitizer,30.4%for fat-regulating drugs,4%for anti-obesity agents and 56.0%for ARB.The treatment compliance was the highest in anti-obesity agents(100%),and the lowest in basic treatment(23.4%).The treatment compliance of ARB reached more than 50%,however,the treatment compliance of insulin sensitizer and fat-regulating drugs was less than 50%,that of hepatoprotective egents was only 10.2%.Conclusion There is a large gap between the current treatment situation in elderly patients with NAFLD and Chinese NAFLD treatment guidelines,therefor,it is necessary to further improve the standardization and compliance of treatment.