上海社区老年瘦型代谢相关脂肪性肝病临床特征及中医体质分布规律研究

Study on clinical characteristics and TCM constitution distribution pattern of lean MAFLD in the elderly in Shanghai communities

目的探讨上海社区老年瘦型代谢相关脂肪性肝病(MAFLD)的临床特征及中医体质分布规律,为防治本病提供客观依据。方法根据MAFLD发病情况,将上海市嘉定区参加社区体检的老年人分为瘦型MAFLD组、瘦型无MAFLD组和非瘦型MAFLD组。比较各组性别、年龄、体质量指数(BMI)、吸烟和饮酒情况等一般资料,以及空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、肌酐(Scr)、尿酸(UA)、白细胞(WBC)、中性粒细胞百分比(NEU%)、淋巴细胞百分比(LYMPH%)、血红蛋白(Hb)和血小板计数(PLT)等实验室指标;探讨中医体质分布规律;运用Logistic回归模型对瘦型MAFLD的危险因素进行分析。结果①最终纳入48448例研究对象,其中瘦型MAFLD患者2270例,在社区老年人群中患病率为4.7%,男女比例为1∶3.27。②与瘦型无MAFLD组比较,瘦型MAFLD组的男女比例以及吸烟、饮酒人员占比偏低(P<0.05),HDL-C、Scr、NEU%水平降低(P<0.05);而BMI、TG、TC、LDL-C、FBG、ALT、UA、WBC、LYMPH%、Hb、PLT水平升高(P<0.05)。与非瘦型MAFLD组比较,瘦型MAFLD组男女比例以及吸烟、饮酒人员占比较低(P<0.05);TG、FBG、ALT、AST、Scr、UA、WBC、Hb水平降低(P<0.05);而TC、LDL-C、HDL-C、LYMPH%、PLT水平升高(P<0.05)。③与瘦型无MAFLD组比较,瘦型MAFLD组阴虚质(20.8%)、气虚质(18.2%)、痰湿质(9.3%)、湿热质(8.2%)、血瘀质(3.0%)占比较高(P<0.05)。与非瘦型MAFLD组比较,瘦型MAFLD组气虚质(18.2%)、湿热质(8.2%)、阳虚质(5.3%)的占比较高(P<0.05)。④BMI、TG、LDL-C和FBG水平升高可能是发生老年瘦型MAFLD的危险因素[OR(95%CI)分别为1.500(1.432~1.572)、2.125(1.896~2.382)、2.089(1.682~2.595)和1.163(1.133~1.192)];中医体质血瘀质、湿热质、痰湿质、阴虚质可能是发生老年瘦型MAFLD的危险因素[OR(95%CI)分别为1.716(1.256~2.346)、1.702(1.387~2.089)、1.543(1.272~1.873)和1.146(1.003~1.310)]。结论对于60岁以上老年瘦型MAFLD的防治应重视降低血脂、尿酸水平,并控制BMI和血糖;建议进行中医体质特点的辨识,对痰湿质、湿热质、血瘀质和老年主流的气虚质、阴虚质者进行定期体检和个体化调治,将有助于预防和改善瘦型MAFLD症状。

Objective To investigate the clinical characteristics and traditional Chinese medicine(TCM)constitution distribution pattern of lean metabolic associated fatty liver disease(MAFLD)in the elderly in Shanghai communities,and to provide an objective basis for the prevention and treatment of lean MAFLD.Methods According to the prevalence of MAFLD,elderly people who participated in community-based physical examinations in Jiading District,Shanghai were selected and divided into lean MAFLD group,lean no-MAFLD group and non-lean MAFLD group to investigate their general information including gender,age,BMI,smoking and alcohol consumption,as well as fasting blood glucose(FBG),triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),Serum creatinine(Scr),uric acid(UA),white blood cells(WBC),neutrophil percentage(NEU%),lymphocyte percentage(LYMPH%),hemoglobin(Hb)and platelet count(PLT),and other laboratory indices.The distribution pattern of TCM body constitution types was explored and the risk factors of lean MAFLD were analyzed with the logistic regression model.Results①A total of 48,448 study subjects were finally included,including 2,270 patients with lean MAFLD,with a prevalence of 4.7%in the community-based elderly population and a male-to-female ratio of 1:3.27.②The male-to-female ratio and the proportion of smoking and alcohol consumption in the lean MAFLD group were lower than those in the lean no-MAFLD group(P<0.05).The lean MAFLD group had lower levels of HDL-C,Scr,and NEU%(P<0.05)and higher levels of BMI,TG,TC,LDL-C,FBG,ALT,UA,WBC,LYMPH%,Hb and PLT(P<0.05)than the lean no-MAFLD group.The male-to-female ratio and the proportion of smoking and alcohol consumption were lower in the lean MAFLD group than those in the non-lean MAFLD group(P<0.05).The lean MAFLD group had lower levels of TG,FBG,ALT,AST,Scr,WBC,and Hb(P<0.05)and higher levels of TC,LDL-C,HDL-C,UA,LYMPH%and PLT(P<0.05)than the non-lean MAFLD group.③The lean MAFLD group had a higher proportion in TCM constitutions including yin deficiency(20.8%),qi deficiency(18.2%),phlegm-damp(9.3%),damp-heat(8.2%)and blood stasis(3.0%)(P<0.05)than the lean no-MAFLD group.The lean MAFLD group had a higher proportion in TCM constitutions including qi deficiency(18.2%),damp-heat(8.2%)and yang deficiency(5.3%)(P<0.05)than the non-lean MAFLD group.④Elevated levels of BMI,TG,LDL-C and FBG may be risk factors for the development of lean MAFLD in the elderly[OR(95%CI)1.500(1.432-1.572),2.125(1.896-2.382),2.089(1.682-2.595)and 1.163(1.133-1.192),respectively].The TCM constitution types of blood stasis,damp-heat,phlegm-damp,and yin deficiency may be risk factors for the development of lean MAFLD in the elderly[OR(95%CI)1.716(1.256-2.346),1.702(1.387-2.089),1.543(1.272-1.873),and 1.146(1.003-1.310),respectively].Conclusion Prevention and treatment of lean MAFLD in the elderly over 60 years of age should focus on reducing BMI as well as lipid and uric acid levels,and controlling blood glucose.The identification of features of each TCM constitution type is recommended.Regular physical examinations and individualized treatment for the elderly with constitution types of phlegm-damp,damp-heat,blood-stasis and qi-deficiency and yin-deficiency(which are two main types in the elder)can help prevent and improve the symptoms of lean MAFLD.