中老年非酒精性脂肪性肝病患者胆石症与代谢危险因素关系探讨

Incidence of gallstone disease in middle-aged and elderly patients with nonalcoholic fatty liver disease and its relation to metabolic risk factors

目的收集中老年非酒精性脂肪性肝病(NAFLD)患者资料,探讨NAFLD患者合并胆石症(GD)的危险因素。方法2018年1月~2020年12月在健康体检过程中发现的NAFLD患者216例,随机选择同期无NAFLD的健康体检者200例,使用超声检查诊断NAFLD和GD,采用单因素和多因素Logistic回归分析,以确定与NAFLD合并GD相关的独立危险因素。结果在216例NAFLD患者中,发现合并GD 52例,未合并GD 164例;GD组年龄为(62.4±11.3)岁,显著大于非GD组【(54.2±9.0)岁,P<0.05】,GD组糖尿病发生率为23.1%,与非GD组的12.8%比,差异有统计学意义(P<0.05),GD组舒张压为(87.5±10.2)mmHg,显著高于非GD组【(75.5±9.9)mmHg,P<0.05】,GD组FBG和HDL-C水平分别为(7.2±1.5)mmol/L和(1.0±0.3)mmol/L,与非GD组的【(6.0±1.7)mmol/L和(1.3±0.3)mmol/L】比,差异有统计学意义(P<0.05);GD组糖尿病、高血压、BMI和舒张压分别为23.1%、61.5%、(26.1±2.3)kg/m 2和(87.5±10.2)mmHg,与健康人【分别为9.5%、41.0%、(23.2±2.7)kg/m 2和(72.2±9.8)mmHg】比,差异有统计学意义(P<0.05);GD组FBG、ALT、AST、TG、TC、LDL-C和HDL-C水平分别为(7.2±1.5)mmol/L、(48.4±8.5)U/L、(54.5±6.3)U/L、(4.9±1.0)mmol/L、(5.2±1.0)mmol/L、(3.5±0.7)mmol/L和(1.0±0.3)mmol/L,与健康人【分别为(5.4±1.3)mmol/L、(17.7±9.6)U/L、(18.5±7.0)U/L、(1.3±0.7)mmol/L、(4.8±1.1)mmol/L、(2.1±0.6)mmol/L和(1.6±0.3)mmol/L】比,差异有统计学意义(P<0.05);应用二项分类变量Logistic回归模型对上述具有显著性差异的指标进行逐步回归分析,结果提示年龄、糖尿病、FBG、TG、LDL-C和HDL-C为NALFD患者合并GD的独立危险因素(P<0.05)。结论在患有NAFLD的中老年群体中,FBG升高或HDL-C降低会增加发生GD的风险。加强对健康体检者的宣教,早期发现合并的糖尿病或FBG升高和血脂异常,及时行超声检查,以早期发现合并的GD,减少急腹症的发生。

Objective The aim of this study was to collect the clinical data of middle-aged and elderly patients with non-alcoholic fatty liver disease(NAFLD)to explore the incidence of gallstone disease(GD)and its relation to the metabolic risk factors.Methods The clinical data of middle-aged and elderly patients with NAFLD found by physical examination were analyzed between January 2018 and December 2020,and the diagnosis of NAFLD and GD were based on sonography.The univariate and multivariate Logistic regression analysis were applied to determine the independent risk factors related to the concomitant GD.Results Out the 216 patients with NAFLD found by physical examination,the GD was diagnosed in 52 cases;the age in patients with GD was(62.4±11.3)yr,significantly older than[(54.2±9.0)yr,P<0.05]in patients without GD,the incidence of diabetes in patients with GD was 23.1%,significantly greater than 12.8%in patients without GD(P<0.05),the diastolic blood pressure in patients with GD was(87.5±10.2)mmHg,significantly higher than[(75.5±9.9)mmHg,P<0.05]in patients without GD,and the fasting blood glucose(FBG)and high-density lipoprotein cholesterol(HDL-C)levels in patients with GD were(7.2±1.5)mmol/L and(1.0±0.3)mmol/L,significantly different compared to[(6.0±1.7)mmol/L and(1.3±0.3)mmol/L,respectively,P<0.05]in patients without GD;the incidence of diabetes,high blood pressure,the body mass index and diastolic blood pressure in patients with GD were 23.1%,61.5%,(26.1±2.3)kg/m 2 and(87.5±10.2)mmHg,significantly different compared to[9.5%,41.0%,(23.2±2.7)kg/m 2 and(72.2±9.8)mmHg]in healthy individuals(P<0.05);the FBG,serum ALT,AST,TG,TC,LDL-C and HDL-C levels in patients with GD were(7.2±1.5)mmol/L,(48.4±8.5)U/L,(54.5±6.3)U/L,(4.9±1.0)mmol/L,(5.2±1.0)mmol/L,(3.5±0.7)mmol/L and(1.0±0.3)mmol/L,significantly different compared to[(5.4±1.3)mmol/L,(17.7±9.6)U/L,(18.5±7.0)U/L,(1.3±0.7)mmol/L,(4.8±1.1)mmol/L,(2.1±0.6)mmol/L and(1.6±0.3)mmol/L,respectively,P<0.05]in healthy persons;the multivariate Logistic regression analysis showed that the ages,FBG,blood TG,LDL-C and HDL-C levels were the independent risk factor for patients with NALFD having concomitant GD(P<0.05).Conclusion In the middle-aged and elderly patients with NAFLD,the increase of FBG and the decrease of blood HDL-C levels might hint the concomitant existence of GD,and the healthy education should be strengthened for individuals with risk factors for occurrence of GD,and early sonography should be carried out to find it.