老年居民非酒精性脂肪性肝病的影响因素和死因分析  

Analysis of influencing factors and causes of death in elderly residents with non-alcoholic fatty liver disease

作　　者：徐静远 邵勇 鲁晓岚[1,3] 邓江 李小玲 史海涛 Xu Jingyuan;Shao Yong;Lu Xiaolan;Deng Jiang;Li Xiaoling;Shi Haitao(Department of Gastroenterology,Xibei Hospital,Xi'an Jiaotong University of Medicine,Xi'an 710004,China;Community Health Service Center of Jinxi town,Kunshan,Jiangsu 215324,China;Department of Gastroenterology,PUDONG Hospital,Fudan University,Shanghai 201399,China)

机构地区：[1]西安交通大学第二附属医院消化科,710004 [2]昆山市锦溪镇社区卫生服务中心,江苏昆山215324 [3]复旦大学附属浦东医院消化科,201399

出　　处：《中华肝脏病杂志》2019年第3期204-209,共6页Chinese Journal of Hepatology

基　　金：国家自然科学基金(81070328);昆山市社会发展科技专项(KS1525);上海市浦东新区卫生系统重点学科建设资助(PWZx2017-27).

摘　　要：目的了解老年人群非酒精性脂肪肝(NAFLD)的检出率、危险因素和独立危险因素,以及死亡原因;分析NAFLD患者代谢综合征(MS)与死亡的关系,为老年人群NAFLD的预防和控制提供依据。方法以2016年江苏省昆山市某镇当地户口60岁以上老年人群7 619人为研究对象,分析NAFLD患者的发病率、影响因素及死亡原因,以及NAFLD患者合并MS与死亡的关系。根据资料不同采用H检验、方差分析、t检验、χ^2检验或logistic回归分析进行统计学分析。结果2016年江苏省昆山市某镇60岁以上老人NAFLD患病率为14.10%(1 074/7 619),女性患病率显著高于男性(P<0.05);当体质量指数(BMI)<32 kg/m^2时,NAFLD的患病率随着BMI指数的升高而升高,在BMI为18.5~23.9 kg/m^2、24.0~27.9 kg/m^2、>32.0 kg/m^2时,女性患病率显著高于男性(P<0.05),而在BMI<18.5 kg/m^2及BMI为28~31.9 kg/m^2时,男性和女性的患病率差异无统计学意义(P>0.05);随着年龄的增长,BMI逐渐下降(P<0.05),同时NAFLD的发病率也呈现下降趋势(P<0.05);性别(OR=0.616)、年龄(OR=0.970)、腰围(OR=1.065)、甘油三酯(OR=1.162)、BMI(OR=1.238)、舒张压(OR=1.012)为NAFLD的独立危险因素(P<0.01)。NAFLD合并3种及4种MS的概率显著高于对照组(P<0.05)。随访期间研究对象的病死率为1.94%,NAFLD组为2.23%,对照组为1.89%;NAFLD组死亡人群的平均寿命为75.58岁,对照组78.68岁;所有NAFLD组的死亡者均合并MS,且70.83%合并3种及以上MS;NAFLD组的首要死亡原因为肿瘤(37.5%),其次为心血管意外(16.67%),直接死因为MS者3例。结论被调查人群NAFLD患病率较低,可能与当地老人饮食偏素、劳动强度较大有关,以肥胖、糖尿病为代表的MS紊乱与NAFLD的发病密切相关,其中肥胖为当地60岁以上老年人群NAFLD发病的最重要危险因素,控制体质量应作为预防和控制老年人群NAFLD最重要的手段。然而对正常BMI的人群,也不应忽视NAFLD的风险,尤其是老年女性。NAFLD可能Objective To understand and analyze the incidence rate,risk factors,independent risk factors and the causes of death in elderly population with non-alcoholic fatty liver disease(NAFLD).Furthermore,analyze the relationship between metabolic syndrome(MS)and mortality rate in patients with NAFLD to provide evidence for the prevention and control of NAFLD in the elderly population.Methods A total of 7 619 elderly people aged over 60 years,and local household registered in Kunshan city,Jiangsu province in 2016 were included as subjects to analyze the incidence rate,influencing factors and causes of death in patients with NAFLD and the relationship between MS and mortality rate in patients with NAFLD.According to different data,using Kruskal-Wallis H test,analysis of variance,t-test,chi-square test or logistic regression analysis were performed.Results The prevalence of NAFLD was14.10%(1 074/7 619)among the elderly over 60 years in Kunshan city,Jiangsu province in 2016,and the female prevalence rate was significantly higher than that of males(P<0.05).When the body mass index(BMI)was<32(kg/m^2),the prevalence of NAFLD increased with the increase of BMI index.When BMI was 18.5-23.9 kg/m^2,24-27.9 kg/m^2 and>32 kg/m^2,the prevalence of NAFLD was significantly higher in females than males(P<0.05).There was no significant difference in prevalence between males and females with BMI<18.5 kg/m^2 and 28~31.9 kg/m^2(P>0.05).BMI gradually decreased(P<0.05)with the increase of age,and the incidence of NAFLD showed a downward trend(P<0.05).An independent risk factors for NAFLD(P<0.01)were gender(OR=0.616),age(OR=0.970),waist circumference(OR=1.065),triglycerides(OR=1.162),BMI(OR=1.238),and diastolic blood pressure(OR=1.012).The probability of NAFLD combined with three and four kinds of MS was significantly higher than control group(P<0.05).Subjects’mortality rate during the follow-up period was 1.94%,2.23%in the NAFLD group,and 1.89%in the control group.Average life expectancy was 75.58 years in NAFLD group and 78.68 years in the

关 键 词：脂肪肝 非酒精性 老年居民 死亡原因 代谢综合征 危险因素 

分 类 号：R575.5[医药卫生—消化系统]