老年人糖化血红蛋白水平与非酒精性脂肪肝的相关性研究  

Association between glycosy lated hemoglobin and non alcoholic fatty liver in the elderly

作　　者：杨明[1] 张晏[1] 刘安楠[1] 付静[1] 李京荣[1] 曹素艳[1] Yang Ming;Zhang Yan;Liu Annan;Fu Jing;Li Jingrong;Cuo Suyan(General Practice Department(VIP Deparlment),Health Assessmenl and Management Center,Beijing Hospital,National Center of Gerontology,Institute of Geriutric Medicine.Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院全科医学科(特需医疗部)健康管理中心国家老年医学中心中国医学科学院老年医学研究院,100730

出　　处：《中华老年医学杂志》2021年第12期1541-1545,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨老年人糖化血红蛋白(HbA1c)水平与非酒精性脂肪肝(NAFL)的关系。方法回顾性病例对照研究, 连续入选2018年1-12月健康体检且符合入选条件的年龄65岁及以上老年人5 186例, 分为NAFL组1 731例和非NAFL组3 455例, 比较两组腰围、体质指数、吸烟史、舒张压、三酰甘油、低密度脂蛋白胆固醇、肾小球滤过率、丙氨酸氨基转移酶和天门冬氨酸氨基转移酶、空腹血糖及HbA1c水平, 并分析与NAFL的相关性。结果 NAFL的患病率为33.4%(1 731/5 186);NAFL组患者腰围、体质指数、吸烟史、舒张压、三酰甘油、低密度脂蛋白胆固醇、肾小球滤过率、丙氨酸氨基转移酶和天门冬氨酸氨基转移酶、空腹血糖及HbA1c的水平高于非NAFL组(均P<0.05), 而血肌酐、尿素氮和年龄均低于非NAFL组(P<0.05);根据HbA1c水平的四分位数分为Q1~Q4(HbA1c<5.7%, 5.7≤HbA1c<6.0%, 6.0%≤HbA1c<6.5%, HbA1c≥6.5%)组, NAFL的患病率Q1组22.8 %(225/1 120)、Q2组27.9 %(398/1 429)、Q3组36.5 %(514/1 409)、Q4组45.9 %(564/1 228)。随HbA1c水平逐渐升高, NAFL的患病率亦升高(P<0.01)。多元Logistic回归分析结果显示, 校正年龄、性别、腰围、体质指数、吸烟、收缩压、舒张压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、肌酐、丙氨酸氨基转移酶, 天门冬氨酸氨基转移酶及血糖后, 与Q1组比较, Q2组、Q3组、Q4组NAFL的患病风险分别为OR=1.274(95%CI:1.004~1.616)、OR=1.639(95%CI:1.294~2.077)和OR=1.787(95%CI:1.337~2.389), 均P<0.01。结论老年人NAFL患病率与HbA1c水平呈正相关, HbA1c是NAFL患病的一个独立危险因素。Objective To investigate an association between glycosylated hemoglobin(HbAlc)level and non alcoholic fatty liver(NAFL)in the elderly.Methods In this retrospective case control study.5186 elderly individuals aged 65 years and over meeting the inclusion conditions via health physical examination were successively selected from January to Dcember 2018.They were divided into NAFI.group(n=1731)and non-NAFI.group(n=3455).Waist circumference.body mass index.smoking history.diastolic blood pressure.glomerular filtration rate.serum levels of triglyceride.low density lipoprotein cholesterol.alanine aminotransferase.aspartic aminotransferase.fasting blood glucose and HbAlc were compared between the two groups.and their correlations with NAFL were analyzed.Results The prevalence of NAFL was 33.4%(1.731/5.186).The values of waistline.body mass index.smoking history,diastolic blood pressure.triglyceride.total cholesterol.low density lipoprotein cholesterol.glomerular filtration rate,alanine aminotransferase,aspartate aminotransferase,fasting glucose and HbA1c were higher in the NAFL group than in non NAFL group(all P<0.05).While levels of creatinine.urea nitrogen and age were lower in the NAFL group than in non-NAFL.group(P<0.05).According to the quartile of HbAlc level.these subjects were divided intoQl to Q4 groups(HbAlc<5.7%.5.7≤HbAlc<6.0%.6.0%≤HbAlc<6.5%.HbAlc≥6.5%).and the prevalence of NAFIin the Q1 to Q4 were 22.8%(225/1120).27.9%(398/1429).36.5%(514/1409).45.9%(564/1228)respectively.The prevalence of NAFL was increased along with the increase in the level of HbA1c(P<0.01).Multivariate Logistic regression analysis showed that after adjusting for age.gender and metabolic components,the risk for developing NAFL was gradually increased in Q2 group.Q3 group,Q4 group versus Ql group as the ollowing OR value:OR=1.274.95%C1:1.004-1.616;OR=1.639.95%CI:1.2942.077;OR=1.787.95%CI:1.337-2.389.respectively,all P<0.01.Conclusions The prevalence of NAFL is positively associated with HbAlc levels in the elderly and HbAlc is an i

关 键 词：脂肪肝 糖化血红蛋白 危险因素 

分 类 号：R575.5[医药卫生—消化系统]