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[老年非酒精性脂肪性肝病患者死亡影响因素及死因分析]

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

作者信息

Xu J Y, Shao Y, Lu X L, Deng J, Li X L, Shi H T

机构信息

Department of Gastroenterology, Xibei Hospital, Xi'an Jiaotong University of Medicine, Xi'an 710004, China.

Department of Gastroenterology, Xibei Hospital, Xi'an Jiaotong University of Medicine, Xi'an 710004, China; Department of Gastroenterology, PUDONG Hospital, Fudan University, Shanghai 201399, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2019 Mar 20;27(3):204-209. doi: 10.3760/cma.j.issn.1007-3418.2019.03.007.

Abstract

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. 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. 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 ( < 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/m2, 24-27.9 kg/m(2) and > 32 kg/m(2), the prevalence of NAFLD was significantly higher in females than males ( < 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) ( > 0.05). BMI gradually decreased ( < 0.05) with the increase of age, and the incidence of NAFLD showed a downward trend ( < 0.05). An independent risk factors for NAFLD ( < 0.01) were gender ( = 0.616), age ( = 0.970), waist circumference ( = 1.065), triglycerides ( = 1.162), BMI ( = 1.238), and diastolic blood pressure ( = 1.012). The probability of NAFLD combined with three and four kinds of MS was significantly higher than control group ( < 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 control group. All deaths in NAFLD groups were associated with MS, and 70.83% combined with three or more MS. The primary cause of death in NAFLD group was tumors (37.5%), followed by cardiovascular disease (16.67%) and three cases died directly from MS. The prevalence of NAFLD in the elderly population in Kunshan city, Jiangsu province is relatively low, which may be associated with local diet and high-intensity workouts. MS disorders represented by obesity and diabetes mellitus are closely associated to the onset of NAFLD. Obesity is the most important risk factor for the incidence of NAFLD in the local elderly population over 60 years old. However, the risk of NAFLD should not be neglected in people with normal BMI, especially in aged women, and the weight control should be the most important means to prevent and control NAFLD. NAFLD may increase mortality rate and reduce life expectancy in the elderly population. The main reason to cause death in the elderly with NAFLD is cardiovascular disease and malignant tumors. Simultaneously, multiple MS development may increase the death rate in elderly with NAFLD.

摘要

了解并分析老年非酒精性脂肪性肝病(NAFLD)患者的发病率、危险因素、独立危险因素及死亡原因。此外,分析代谢综合征(MS)与NAFLD患者死亡率之间的关系,为老年人群NAFLD的防治提供依据。选取2016年江苏省昆山市60岁以上、具有当地户籍的7619名老年人作为研究对象,分析NAFLD患者的发病率、影响因素及死亡原因,以及MS与NAFLD患者死亡率之间的关系。根据不同数据,采用Kruskal-Wallis H检验、方差分析、t检验、卡方检验或逻辑回归分析。2016年江苏省昆山市60岁以上老年人中NAFLD患病率为14.10%(1074/7619),女性患病率显著高于男性(P<0.05)。当体重指数(BMI)<32(kg/m²)时,NAFLD患病率随BMI指数升高而增加。当BMI为18.5 - 23.9 kg/m²、24 - 27.9 kg/m²及>32 kg/m²时,女性NAFLD患病率显著高于男性(P<0.05)。BMI<18.5 kg/m²及28~31.9 kg/m²时,男女患病率差异无统计学意义(P>0.05)。BMI随年龄增长逐渐降低(P<0.05),NAFLD发病率呈下降趋势(P<0.05)。NAFLD的独立危险因素(P<0.01)为性别(OR = 0.616)、年龄(OR = 0.970)、腰围(OR = 1.065)、甘油三酯(OR = 1.162)、BMI(OR = 1.238)及舒张压(OR = 1.012)。NAFLD合并三种及四种MS的概率显著高于对照组(P<0.05)。随访期间,研究对象的死亡率为1.94%,NAFLD组为2.23%,对照组为1.89%。NAFLD组平均预期寿命为75.58岁,对照组为78.68岁。NAFLD组所有死亡均与MS相关,70.83%合并三种及以上MS。NAFLD组主要死亡原因是肿瘤(37.5%),其次是心血管疾病(16.67%),3例直接死于MS。江苏省昆山市老年人群NAFLD患病率相对较低,可能与当地饮食及高强度锻炼有关。以肥胖和糖尿病为代表的MS紊乱与NAFLD发病密切相关。肥胖是当地60岁以上老年人群NAFLD发病的最重要危险因素。然而,BMI正常者尤其是老年女性的NAFLD风险也不容忽视,控制体重应是防治NAFLD的最重要手段。NAFLD可能增加老年人群死亡率并缩短预期寿命。老年NAFLD患者的主要死亡原因是心血管疾病和恶性肿瘤。同时,多种MS的发生可能增加老年NAFLD患者的死亡率。

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