老年人非酒精性脂肪性肝病与骨质疏松的关联分析

Association between nonalcoholic fatty liver disease and osteoporosis in elderly patients

目的分析老年人非酒精性脂肪性肝病(NAFLD)与骨质疏松的关系及影响因素。方法选取2016年6月—2023年4月于北京大学人民医院老年科住院的年龄≥60岁的824例患者,其中骨质疏松组398例,非骨质疏松组426例。收集研究对象的一般资料、血生化指标,肝脏B超检查及双光能X线骨密度结果等。符合正态分布的计量资料2组间比较采用成组t检验,非正态分布的计量资料2组间比较采用Mann-Whitney U检验,分类变量采用χ^(2)检验进行分析;采用二元Logistic回归分析骨质疏松的独立影响因素。结果与非骨质疏松组相比,骨质疏松组年龄较大,女性更多见,糖尿病占比较高,身体质量指数(BMI)较低,差异均有统计学意义(P值均<0.05)。骨质疏松组患者NAFLD占比高于非骨质疏松组(36.2%vs 24.6%,χ^(2)=12.878,P<0.001)。骨质疏松组患者血红蛋白、尿酸、Alb水平低于非骨质疏松组,总胆固醇、低密度脂蛋白胆固醇(LDL-C)、骨特异性碱性磷酸酶、抗酒石酸酸性磷酸酶水平高于非骨质疏松组,差异均有统计学意义(P值均<0.05)。二元Logistic回归分析结果显示,高龄(OR=1.040,95%CI:1.015~1.066,P=0.002)、女性(OR=4.089,95%CI:2.607~6.411,P<0.001)、NAFLD(OR=1.697,95%CI:1.076~2.678,P=0.023)、糖尿病(OR=1.509,95%CI:1.008~2.260,P=0.046)、LDL-C(OR=1.431,95%CI:1.010~2.029,P=0.044)是老年患者骨质疏松的独立危险因素。考虑糖尿病对研究结果的影响,进一步对非糖尿病老年患者进行亚组分析,结果显示NAFLD仍是老年非糖尿病患者骨质疏松的独立危险因素(OR=1.573,95%CI:1.015~2.439,P=0.043)。结论NAFLD、高龄、女性是影响老年患者骨质疏松的独立危险因素。

Objective To investigate the association between nonalcoholic fatty liver disease(NAFLD)and osteoporosis in elderly patients.Methods A total of 824 patients,aged≥60 years,who were hospitalized in Department of Gerontology,Peking University People’s Hospital,from June 2016 to April 2023 were enrolled,with 398 patients in the osteoporosis group and 426 in the non-osteoporosis group.Related data were collected from all subjects,including general information,blood biochemical parameters,liver ultrasound,and bone mineral density measured by dual-energy X-ray examination.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical variables;a binary Logistic regression analysis was used to investigate the independent risk factors for osteoporosis.Results Compared with the non-osteoporosis group,the osteoporosis group had a significantly higher age,a significantly higher proportion of female patients or patients with diabetes,and a significantly lower body mass index(all P<0.05).The osteoporosis group had a significantly higher proportion of patients with NAFLD than the non-osteoporosis group(36.2%vs 24.6%,χ^(2)=12.878,P<0.001).Compared with the non-osteoporosis group,the osteoporosis group had significantly lower levels of hemoglobin,uric acid,and albumin and significantly higher levels of total cholesterol,low-density lipoprotein cholesterol(LDL-C),bone-specific alkaline phosphatase,and tartrate-resistant acid phosphatase(all P<0.05).The binary Logistic regression analysis showed that old age(odd ratio[OR]=1.040,95%confidence interval[CI]:1.015—1.066,P=0.002),female sex(OR=4.089,95%CI:2.607—6.411,P<0.001),NAFLD(OR=1.697,95%CI:1.076—2.678,P=0.023),diabetes(OR=1.509,95%CI:1.008—2.260,P=0.046),and LDL-C(OR=1.431,95%CI:1.010—2.029,P=0.044)were independent risk factors for osteoporosis in elderly patients.Considering the impact of diabetes on the research findings,a subgroup analysis was performed for the patients without diabetes,and the results showed that NAFLD(OR=1.573,95%CI:1.015—2.439,P=0.043)was an independent risk factor for osteoporosis in the elderly patients without diabetes.Conclusion NAFLD,old age,and female sex are independent risk factors for osteoporosis in elderly patients.