北京某地区中老年保健人群代谢相关脂肪性肝病患病情况及危险因素分析

庄颖洁; 刘正一; 徐世平; 高利利

doi:10.3969/j.issn.2095-5227.2023.05.004

北京某地区中老年保健人群代谢相关脂肪性肝病患病情况及危险因素分析

Prevalence and risk factors of metabolic associated fatty liver disease among middle-aged and elderly patients in Beijing

摘要

摘要:
背景代谢相关脂肪性肝病(metabolic associated fatty liver disease， MAFLD)，曾用名非酒精性脂肪性肝病(non-alcoholic fatty liver disease， NAFLD)，是全球广泛流行的慢性肝病。中老年保健人群作为特殊群体，其MAFLD患病率及危险因素分析尚未见报道。
目的分析北京某地区中老年保健人群MAFLD患病情况及危险因素。
方法以2021年1 - 12月于解放军总医院第二医学中心门诊行年度体检的中老年保健人群为研究对象，明确中老年保健人群MAFLD患病情况，并探究MALFD患病危险因素。
结果纳入2825例中老年保健对象，平均年龄(71.62 ± 11.29)岁，男性占95.8%(2705例)。MAFLD患病率为55.5%(1569/2825)。男性患病率高于女性(56.0% vs 45.5%，P=0.031)。45 ~ 59岁、60 ~ 69岁、70 ~ 79岁和≥80岁人群的患病率分别为45.1%、58.9%、59.9%、53.0%。吸烟人群的患病率高于不吸烟人群(59.5% vs 54.7%，P=0.047)。饮酒人群的患病率高于不饮酒人群(59.3% vs 52.3%，P＜0.001)。多因素logistic回归分析显示，60 ~ 69岁、70 ~ 79岁、≥80岁人群MAFLD患病风险分别是45 ~ 59岁人群的1.953(95% CI：1.490 ~ 2.559)、2.029(95% CI：1.522 ~ 2.707)、1.722(95% CI：1.279 ~ 2.317)倍；肥胖、超重人群患MAFLD风险分别是BMI正常人群的23.131(95% CI：14.451 ~ 37.025)、6.232(95% CI：5.170 ~ 7.512)倍；高血压(OR=1.279，95% CI：1.055 ~ 1.551)、糖尿病(OR=3.053，95% CI：2.245 ~ 4.153)、谷丙转氨酶(alanine aminotransferase，ALT)增高(OR=1.016，95% CI：1.007 ~ 1.026)、高尿酸血症(OR=1.535，95% CI：1.211 ~ 1.947)、高三酰甘油血症(OR=2.927，95% CI：2.334 ~ 3.670)、有甲状腺结节(OR=1.344，95% CI：1.077 ~ 1.677)人群发生MAFLD的风险概率均升高。ROC曲线显示，年龄、体质量指数、高血压、糖尿病、ALT、高尿酸血症、高三酰甘油血症、甲状腺结节联合应用时，ROC-AUC、敏感度、特异度、准确度分别为0.812(95% CI：0.797 ~ 0.828)、0.743、0.748、0.745，对MAFLD有较好的诊断价值。
结论本组中老年保健对象MAFLD患病率为55.5%，年龄≥60岁、超重/肥胖、高血压、糖尿病、ALT升高、高尿酸血症、高三酰甘油血症、甲状腺结节为中老年保健人群患MAFLD的潜在危险因素。

Abstract:
Background Metabolic associated fatty liver disease (MAFLD), previously known as non-alcoholic fatty liver disease (NAFLD), is one of the most prevalent chronic liver diseases worldwide. The prevalence rate and risk factors of MAFLD among middle-aged and elderly patients are unclear.
Objective To analyze the prevalence and risk factors of MAFLD in middle-aged and elderly patients in Beijing.
Methods A cross sectional study was designed to collect the physical examination results of middle-aged and elderly patients from January to December in 2021 in the Second Medical Center of Chinese PLA General Hospital. Prevalence of MAFLD in middle-aged and elderly patients was investigated. Univariate and multivariate logistic regression were used to analyze the risk factors of MAFLD.
Results Totally 2 825 middle-aged and elderly patients were included with an average age of (71.62 ± 11.29) years, and male patients accounted for 95.8% (2 705 cases). The prevalence of MAFLD was 55.5%, with higher incidence in male than in female (56.0% vs 45.5%, P=0.031). The prevalence rates of patients aged 45-59, 60-69, 70-79 and ≥80 years old were 45.1%, 58.9%, 59.9%, 53.0% (P<0.05). The prevalence of MAFLD in smokers was significantly higher than that of non-smokers (59.5% vs 54.7%, P=0.047). The prevalence of MAFLD in drinkers was also significantly higher than that of non-drinkers (59.3% vs 52.3%, P<0.05). Multivariate logistic regression analysis showed that the risk of MAFLD in patients aged 60-69, 70-79 and ≥80 years old was 1.953 (95% CI: 1.490-2.559), 2.029 (95% CI: 1.522-2.707) and 1.722 (95% CI: 1.279-2.317) times higher than that of 45-59 years old, respectively. The risk of obese, overweight patients was 23.131 (95% CI: 14.451-37.025), 6.232 (95% CI: 5.170-7.512) times higher than that of normal weight cases. In addition, patients with hypertension (OR=1.279, 95% CI: 1.055-1.551), diabetes (OR=3.053, 95% CI: 2.245-4.153), higher ALT level (OR=1.016, 95% CI: 1.007-1.026), hyperuricemia (OR=1.535, 95% CI: 1.211-1.947), hypertriglyceridemia (OR=2.927, 95% CI: 2.334-3.670) or thyroid nodules (OR=1.344, 95% CI: 1.077-1.677) had a higher risk of MAFLD. ROC curve showed that combined application of facotrs including age, BMI, hypertension, diabetes, ALT, hyperuricemia, hypertriglyceridemia and thyroid nodules would be helpful in the diagnosis of MAFLD, with an area under the ROC curve of 0.812 (95% CI: 0.797-0.828), a sensitivity of 0.743, a specificity of 0.748, and an accuracy of 0.745.
Conclusion The prevalence of MAFLD among middle-aged and elderly patients in our study is 55.5%. Age over 60 years, overweight/obesity, hypertension, diabetes, higher ALT level, hyperuricemia, hypertriglyceridemia and thyroid nodules are potential risk factors for MAFLD among middle-aged and elderly patients.

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