葉艷 韋全華

摘 要 目的：分析上海某社區(qū)65歲以上老年人脂肪肝與高血壓、糖尿病、血液生化指標(biāo)和中醫(yī)體質(zhì)的關(guān)系。方法：研究對象為2020年5-8月在上海某社區(qū)衛(wèi)生服務(wù)中心接受免費(fèi)體檢的1 043例65歲以上老年人，年齡65～96歲；其中女性559例，男性475例。通過調(diào)查問卷、腹部B超和實(shí)驗(yàn)室檢查等方法，將老年人群分成脂肪肝組及非脂肪肝組，比較兩組的血壓、糖尿病、血液生化指標(biāo)和中醫(yī)體質(zhì)等影響因素。結(jié)果：脂肪肝組中患高血壓、糖尿病以及體重超重、肥胖、腹型肥胖、中心性肥胖的比率高于非脂肪肝組（P<0.05）。脂肪肝組的血清天門冬氨酸氨基轉(zhuǎn)移酶（AST），血清丙氨酸氨基轉(zhuǎn)移酶（ALT），三酰甘油（TG）和空腹血糖（FPG）指標(biāo)均高于非脂肪肝組（P<0.05），而高密度脂蛋白膽固醇（HDL-C）則低于非脂肪肝組（P<0.05）。脂肪肝組患者中痰濕體質(zhì)位居首位（12.1%），其次是氣虛體質(zhì)（11.6%），而非脂肪肝組中比例最高的是平和質(zhì)，占31%，兩組構(gòu)成分布差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。logistic回歸分析結(jié)果顯示，體質(zhì)量指數(shù)（BMI）、高血壓、中心性肥胖、ALT、TG、HDL-C和部分體質(zhì)類型是脂肪肝的影響因素（P<0.05）。結(jié)論：BMI升高、高血壓、中心性肥胖、ALT、TG、部分體質(zhì)類型是65歲以上老年人脂肪肝的危險(xiǎn)因素，HDL-C是保護(hù)因素。

關(guān)鍵詞 脂肪肝；老年人；中醫(yī)體質(zhì)；影響因素

中圖分類號：R589.2 文獻(xiàn)標(biāo)志碼：A 文章編號：1006-1533（2021）20-0058-05

基金項(xiàng)目：寶山區(qū)名中醫(yī)傳承工作室（BSMZYGZS-201905）

Analysis of TCM constitution and related factors of fatty liver in the elderly people over 65 years old in a community of Shanghai

YE Yan1， WEI Quanhua2（1.General Practice Department of Traditional Chinese Medicine of Qilian Community Health Service Center of Dachang Town of Baoshan District， Shanghai 200444， China； Department of Traditional Chinese Medicine of Wusong Hospital of Zhongshan Hospital Affiliated to Fudan University， Shanghai 200940， China）

ABSTRACT Objective： To analyze the relationship between fatty liver and hypertension， diabetes， blood biochemical indexes and constitution of traditional Chinese medicine（TCM） in the elderly people over 65 years old in a community of Shanghai. Methods： The research objects were 1 043 elderly people over 65 years old who underwent free physical examination in a community health service center in Shanghai from May to August 2020， and the age was from 65 to 96 years old； there were 559 females and 475 males. By means of questionnaire， abdominal B ultrasound and laboratory examination， the elderly people were divided into a fatty liver group and a non-fatty liver group， and the influencing factors of blood pressure， diabetes， blood biochemical parameters and TCM constitution were compared between the two groups. Results： The rates of hypertension， diabetes， overweight， obesity， abdominal obesity and central obesity in the fatty liver group were higher than those in the nonfatty liver group（P<0.05）. The indexes of serum aspartate aminotransferase（AST）， serum alanine aminotransferase（ALT）， triacylglycerol（TG） and fasting blood glucose（FPG） in the fatty liver group were higher than those in the non fatty liver group（P<0.05）， and high density lipoprotein cholesterol（HDL-C） in the fatty liver group was lower than that in non fatty liver group（P<0.05）. In fatty liver group， phlegm dampness constitution ranked first（12.1%）， followed by qi deficiency constitution（11.6%）， the highest proportion of the non fatty liver group was pinghe quality， accounting for 31%， and there was significant difference in composition and distribution between the two groups（P<0.05）. Logistic regression analysis showed that BMI， hypertension， central obesity， ALT， TG， HDL-C and some physical types were the influencing factors of fatty liver（P<0.05）. Conclusion： increased BMI， hypertension， central obesity， ALT， TG and some physical types are the risk factors of fatty liver in the elderly over 65 years old， and HDL-C is the protective factor.