Biomedical Research Centre in Ageing - Liver Theme, Newcastle University, Newcastle, UK.
Gerontology. 2009;55(6):607-13. doi: 10.1159/000235677. Epub 2009 Aug 19.
Non-alcoholic fatty liver disease (NAFLD) is principally a disease of middle and old age. Previous studies reported it to be benign in old age, however more recent studies suggest an increased mortality in the >60-year-olds.
To define the prevalence of risk factors and the laboratory and histological differences between different age groups with NAFLD, in order to confirm/refute findings in previous smaller studies.
Retrospective, cohort study set in a tertiary liver clinic in the UK. 351 consecutive patients with biopsy-proven NAFLD were divided into an older (> or =60), a middle-aged (> or =50 to <60) and a younger (<50) group. Blood pressure, body mass index, serum lipids, glucose, HbA1C, albumin, liver enzymes, bilirubin, mean cell volume (MCV), platelets, and insulin resistance were recorded. In addition, liver biopsy was analyzed for steatosis, inflammation and fibrosis.
Older patients had significantly more risk factors (hypertension, obesity, diabetes, hyperlipidaemia). Albumin, alanine aminotransferase (ALT), ALT/aspartate aminotransferase ratio and platelets significantly reduced with advancing age. MCV and alkaline phosphatase significantly increased with increasing age. Older patients had significantly greater fibrosis on biopsy with less percentage fat, with the cirrhotic patients being significantly older than non-cirrhotics. Insulin resistance was similar in younger and older groups.
NAFLD affects mainly the middle-aged and the elderly. With advancing age come more risk factors for its development. Older patients show more severe biochemical, haematological and histological changes, with cirrhotics having a significantly greater age than those with milder disease.
非酒精性脂肪性肝病（NAFLD）主要发生于中老年人。既往研究认为该病在老年人群中呈良性经过，然而最近的研究表明年龄＞60 岁的患者病死率增加。
明确不同年龄组 NAFLD 患者的危险因素、实验室及组织学差异，以证实/反驳既往小样本研究的结果。
该研究为回顾性队列研究，在英国一家三级肝脏诊疗中心进行。351 例经肝活检证实的 NAFLD 患者被分为 3 个年龄组：老年组（年龄≥60 岁）、中年组（年龄≥50 岁且＜60 岁）和年轻组（年龄＜50 岁）。记录血压、体质量指数、血脂、血糖、糖化血红蛋白（HbA1C）、白蛋白、肝酶、胆红素、平均红细胞体积（MCV）、血小板和胰岛素抵抗。同时分析肝活检标本的脂肪变、炎症和纤维化程度。
老年组患者具有更多的危险因素（高血压、肥胖、糖尿病、高脂血症）。随着年龄的增加，白蛋白、丙氨酸氨基转移酶（ALT）、ALT/天冬氨酸氨基转移酶（AST）比值和血小板逐渐降低，MCV 和碱性磷酸酶逐渐升高。肝活检纤维化程度随年龄增加而加重，脂肪变程度减轻，肝硬化患者显著比非肝硬化患者年龄大。年轻组和老年组患者的胰岛素抵抗相似。
NAFLD 主要影响中老年人，且随年龄增加，危险因素增加。老年患者表现出更严重的生化、血液学和组织学改变，且严重程度与年龄呈正相关。
