台北市65歲以上老人非酒精性脂肪肝相關因素探討～某一地區醫院老人健檢資料分析

The Risk Factors of Non-Alcoholic Fatty Liver Disease in Older Population-An Elderly Health Examination Data Study in One District Hospital in Taipei

黃鈞源(Chun-Yuan Huang) ； 黃麗卿(Lee-Ching Hwang) ； 楊俊(Chun Yang)

《台灣老年醫學暨老年學雜誌》 5卷1期 (2010/02) Pp. 62-75

https://doi.org/10.29461/TGG.201002.0006

摘要

背景及目的：非酒精性脂肪肝已不再被認為是單純的良性疾病，在許多研究文獻均顯示其會造成肝炎或肝硬化甚至是肝癌，亦已被證實與許多慢性疾病具密切相關性，在台灣已邁入老年化國家之際，多種老年相關的慢性疾病均需一一來探討。
方法：本研究為橫斷面研究，收集了台北某地區醫院2009年3月至9月的65歲以上的老年健檢資料，排除B、C型肝炎與喝酒者（喝酒的人數有4位，B型肝炎人數有3位，C型肝炎人數有1位），共有效樣本162位，脂肪肝的診斷由本院肝膽專科醫師以超音波作影像判讀，分為無脂肪肝、輕度脂肪肝與中重度脂肪肝者，分析此三種程度的脂肪肝與理學檢查、實驗數據與生活行為的關聯性。
結果：有效樣本162人中，男性佔了77人(47.5%)，女性85人(52.5%)，平均年齡73.5±7.3歲，整體脂肪肝的盛行率有78人(48.1%)，其中輕度脂肪肝有51位(31.5%)，中重度脂肪肝有27位(16.7%)；在卡方檢定的單變項分析中，高血壓病史、高血脂病史、腰圍異常、空腹血糖異常、BMI異常、三酸甘油酯異常、丙胺酸基轉化酶(ALT)異常、丙胺酸基轉化酶／天門冬酸胺基轉化酶(ALT/AST)比值≧1、肌酸酐異常，有達統計意義；另外以one-way ANOVA作數值檢定並作事後檢定分析發現，中重度脂肪肝相較於無脂肪肝者年齡較輕，且尿酸值較高；而輕度脂肪肝相較於無脂肪肝者，則具有較高的體重、身體質量指數、空腹血糖、丙胺酸基轉化酶／天門冬酸胺基轉化酶比值、三酸甘油酯、尿酸等數值，均達統計上的意義。而輕度與中重度之間則未達統計上的意義。進一步用多變項邏輯回歸分析，女性(OR:2.7; 95% CI 1.1-6.5)、腰圍異常(OR:2.4; 95% CI 1.1-5.5)、有高血壓病史(OR:2.5; 95% CI 1.1-5.7)、空腹血糖異常(OR:2.5; 95% CI 1.1-5.6)、高尿酸血症（每增加一單位mg/dL；OR:1.5；95% CI 1.1-2.2）、三酸甘油酯異常(OR:3.2; 95% CI 1.0-9.2)較易罹患非酒精性脂肪肝，但年齡每增加一歲(OR:0.9; 95% CI 0.9-1.0)則呈現負相關。
結論：對於台北市65歲以上的老年族群，若是年齡較小者、女性、中心型肥胖、高血壓、三酸甘油酯異常、高尿酸血症、空腹血糖異常者須考慮有非酒精性脂肪肝的可能性。

關鍵字

非酒精性脂肪肝 ； 代謝症候群 ； 脂肪變性

並列摘要

Objectives: Non-alcoholic fatty liver disease (NAFLD) has been proved to have caused liver fibrosis, cirrhosis or hepatic carcinoma and be associated with various chronic diseases, such as metabolic syndrome and cardiovascular disease. To help tackle the increasingly severe problems of population aging in Taiwan, the study aims at investigating the risk factors of NAFLD, including behavior, biochemistry marker and physical examination in the aging group.
Methods: Subjects undergoing elderly health examination during the period from March to September 2009 in one district hospital in Taipei were enrolled with those having hepatitis B, hepatitis C and alcohol drinking excluded. The diagnosis of fatty liver was classified into 3 grades of normal, mild fatty liver, and moderate to severe fatty liver by abdominal ultrasonographic examination using ALOKA ProSound SSD 4000 by specialist. Multivariate logistic regression analysis was conducted to estimate the odds ratio for different degrees of fatty liver.
Result: A total of 162 participants were enrolled (male: 47.5%; mean age: 73.5±7.3), and 48.1% of the subjects was diagnosed NAFLD (mild fatty liver: 31.5%, moderate to severe fatty liver: 16.7%).Chi-square test showed that history of hypertension, history of hyperlipidemia, central obesity, impaired fasting glucose, abnormal body mass index (BMI), high triglyceride level, abnormal alanine aminotransferase (ALT), ALT/aspartate aminotransferase (AST)≧1, abnormal creatinine were all associated with NAFLD. Multivariate logistic regression analysis showed that female (OR: 2.7; 95% CI: 1.1-6.5), central obesity (OR:2.4; 95% CI:1.1-5.5), hypertension (OR:2.5; 95% CI: 1.1-5.7), impaired fasting glucose (OR:2.5; 95% CI:1.1-5.6), high uric acid level (increase every one unit, mg/dL; OR:1.5; 95% CI:1.1-2.2), high triglyceride level (OR:3.2; 95% CI:1.0-9.2) were independently associated with NAFLD; aging, however, appeared to be inversely related to NAFLD (OR: 0.9; 95% CI: 0.9-1.0).
Conclusion: The risk factors of NAFLD in the older population (≧65years) in Taipei were female, central obesity, hypertension, impaired fasting glucose, and high uric acid level.

並列關鍵字

non-alcoholic fatty liver disease ； steatosis ； metabolic syndrome