血清超敏C反应蛋白与老年人非酒精性脂肪肝的相关性

陈长喜; 杜娟; 宋健; 张丞; 李梦婷; 李红亮

doi:10.16766/j.cnki.issn.1674-4152.003153

血清超敏C反应蛋白与老年人非酒精性脂肪肝的相关性

doi: 10.16766/j.cnki.issn.1674-4152.003153

陈长喜¹,
杜娟²,
宋健¹,
张丞¹,
李梦婷¹,
李红亮^1, ,

1.
宁波大学附属人民医院消化内科，浙江宁波 315000
2.
宁波市镇海区炼化医院内科, 浙江宁波 315207

基金项目:

浙江省医药卫生科技计划项目 2022KY1182

宁波市自然基金项目 2017A610276

宁波市鄞州区农社科类科技项目 2021AS0053

详细信息

通讯作者:
李红亮，E-mail：rmlihongliang@nbu.edu.cn

中图分类号: R575.5
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出版历程
- 收稿日期: 2023-02-03
- 网络出版日期: 2023-10-19

Study on correlation between serum hypersensitive C-reactive protein and nonalcoholic fatty liver disease in the elderly

1.
Department of Gastroenterology, the Affiliated People' s Hospital of Ningbo University, Ningbo, Zhejiang 315000, China

摘要

摘要: 目的探讨血清超敏C反应蛋白(hs-CRP)与老年人非酒精性脂肪肝(NAFLD)间的关系，为防治NAFLD提供依据。方法调查2013年3—11月符合研究条件的2 124名年龄60岁及以上宁波市镇海区某石化企业退休员工，测量腰围、血压、体重指数、空腹血糖、尿酸、血脂谱、肝功能、hs-CRP和腹部B超结果。按hs-CRP水平的四分位数分为Q1组为≤0.4 mg/L(n=667)，Q2组为>0.4 mg/L~≤0.7 mg/L(n=437)，Q3组为>0.7 mg/L~≤1.4 mg/L(n=515)，Q4组为>1.4 mg/L(n=505)，NAFLD患病危险因素采用logistic回归分析。结果老年人NAFLD的患病率为25.8%(548/2 124)；随着年龄的增长，患病率逐渐降低差异有统计学意义(P＜0.05)，Q1、Q2、Q3、Q4组的NAFLD患病率为13.2%(88/667)、24.5%(107/437)、32.6%(168/515)、36.6%(185/505)，患病率逐渐增高，差异有统计学意义(χ²=99.246，P＜0.001)；多因素logistic回归分析显示升高的血清hs-CRP是老年人患NAFLD的危险因素，未校正相关因素前Q2、Q3、Q4分组的NAFLD患病风险分别是Q1的2.133、3.185、3.804倍，校正相关因素后分别是Q1组的1.554、1.828、1.895倍。结论升高的血清hs-CRP是老年人NAFLD患病的独立危险因素。
- 老年人 /
- 非酒精性脂肪肝 /
- 超敏C反应蛋白 /
- 流行病学
Abstract: Objective To investigate the relationship between serum hypersensitive C-reactive protein (hs-CRP) and nonalcoholic fatty liver disease (NAFLD) in the elderly, and provide the basis for prevention and treatment of NAFLD. Methods A total of 2 124 senior citizens aged 60 and above in a petrochemical enterprise in Zhenhai District, Ningbo City were investigated from March to November 2013, and their waist circumference, body mass index, blood pressure, fasting blood glucose, uric acid, blood lipid profile, liver function, hs-CRP and upper abdominal B-ultrasound were measured. Groups were categorized by quartiles of hs-CRP levels as follows: group Q1 (≤0.4 mg/L, n=667), Q2 (>0.4 mg/L-≤0.7 mg/L, n=437), Q3 (>0.7 mg/L-≤1.4 mg/L, n=515), and Q4(>1.4 mg/L, n=505). The risk factors of NAFLD were analyzed by logistic regression. Results The prevalence of NAFLD in the elderly was 25.8% (548/2 124), and with the growth of age, the prevalence rate gradually decreases (P < 0.05). The prevalence of NAFLD in Q1, Q2, Q3 and Q4 groups were 13.2%(88/667), 24.5%(107/437), 32.6%(168/515) and 36.6% (185/505), respectively, and the prevalence gradually increased (χ²=99.246, P < 0.001). Multivariate unconditional logistic regression analysis showed that elevated serum hs-CRP was an independent risk factor for NAFLD in the elderly. The prevalence of NAFLD in Q2, Q3 and Q4 groups before the adjustment of the relevant factors were 2.133, 3.185, 3.804 times of Q1, and 1.554, 1.828, 1.895 times of Q1 group after the adjustment of the relevant factors. Conclusion Elevated serum hs-CRP is an independent risk factor for NAFLD in the elderly.
- Elderly /
- Non-alcoholic fatty liver disease /
- Hypersensitive C-reactive protein /
- Epidemiologic

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表 1 对照组和NAFLD组临床、实验室检查指标比较

Table 1. Comparison of clinical and laboratory examination indexes between control group and NAFLD group

组别	例数	年龄 (x±s，岁)	腰围 (x±s，cm)	BMI (x±s)	收缩压 (x±s，mmHg)	舒张压 (x±s，mmHg)	TC [M(P₂₅, P₇₅)，mmol/L]	TG [M(P₂₅, P₇₅)，mmol/L]	HDL-C (x±s，mmol/L)
对照组	1 576	69.2±7.2	82.9±8.1	23.1±2.7	131.1±16.9	77.7±10.4	4.9(4.3, 5.6)	1.2(0.7, 1.6)	1.6±0.4
NAFLD组	548	68.3±6.5	90.3±7.8	26.0±2.6	135.9±16.6	80.8±9.9	4.9(4.3, 5.7)	1.6(1.2, 2.2)	1.4±0.3
t值		2.698^a	18.533^a	20.608^a	5.734^a	6.144^a	0.252^b	13.381^b	10.727^a
P值		0.007	< 0.001	< 0.001	< 0.001	< 0.001	0.801	< 0.001	< 0.001

组别	例数	LDL-C (x±s，mmol/L)	ALT [M(P₂₅, P₇₅)，U/L]	AST [M(P₂₅, P₇₅)，U/L]	GGT [M(P₂₅, P₇₅)，U/L]	空腹血糖 (x±s，mmol/L)	尿酸 (x±s，μmol/L)	HbA1c [M(P₂₅, P₇₅)，%]	hs-CRP [M(P₂₅, P₇₅)，mg/L]
对照组	1 576	2.7±0.8	16(13, 21)	23(19, 26)	20(16, 29)	5.4±0.6	318.8±77.9	5.1(4.8, 5.4)	0.6(0.3, 1.2)
NAFLD组	548	2.7±0.8	21(16, 29)	24(20, 28)	27(19, 39)	5.5±0.7	360.2±78.2	5.3(4.9, 5.6)	1.0(0.6, 1.9)
t值		0.681^a	12.660^b	4.222^b	10.470^b	4.140^a	10.712^a	5.021^b	10.149^b
P值		0.496	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：1 mmHg=0.133 kPa；^a为t值，^b为Z值。

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表 2 不同性别不同hs-CRP浓度组NAFLD患病情况[例(%)]

Table 2. Prevalence of NAFLD in different sex groups with different hs-CRP concentrations[cases (%)]

性别	Q1(n=667)	Q2(n=437)	Q3(n=515)	Q4(n=505)	χ²值	P值
男性	66(18.8)	77(21.9)	107(30.5)	101(28.8)	52.159	< 0.001
女性	22(11.2)	30(15.2)	61(31.0)	84(42.6)	60.509	< 0.001
合计	88(13.2)	107(24.5)	168(32.6)	185(36.6)	99.246	< 0.001

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表 3 hs-CRP分层后老年人的临床特征

Table 3. Clinical characteristics of the elderly after hs-CRP stratification

项目	Q1(n=667)	Q2(n=437)	Q3(n=515)	Q4(n=505)	统计量	P值
年龄(x±s，岁)	67.9±6.6	68.5±7.1	69.5±7.0	70.2±7.3	12.196^a	< 0.001
腰围(x±s，cm)	82.0±8.3	84.7±8.0	86.5±8.5	86.9±8.8	41.502^a	< 0.001
BMI(x±s)	22.8±2.9	23.9±2.6	24.4±2.9	24.7±3.0	48.356^a	< 0.001
收缩压(x±s，mmHg)	129.9±16.2	132.3±17.6	133.6±16.7	134.3±16.9	7.974^a	< 0.001
舒张压(x±s，mmHg)	77.3±9.8	78.3±9.8	79.2±10.3	79.4±10.6	5.086^a	0.002
TC[M(P₂₅, P₇₅)，mmol/L]	4.8(4.2, 5.5)	5.0(4.3, 5.6)	5.0(4.4, 5.7)	5.0(4.4, 5.7)	17.099^b	0.001
TG[M(P₂₅, P₇₅)，mmol/L]	1.1(0.8, 1.4)	1.2(0.9, 1.8)	1.4(1.0, 1.9)	1.4(1.0, 1.9)	104.223^b	< 0.001
HDL-C(x±s，mmol/L)	1.6±0.4	1.6±0.4	1.5±0.3	1.4±0.3	-19.633^a	< 0.001
LDL-C(x±s，mmol/L)	2.6±0.8	2.7±0.7	2.7±0.7	2.8±0.8	10.832^a	0.001
ALT[M(P₂₅, P₇₅)，U/L]	17(13, 22)	18(13, 24)	18(14, 24)	17(13, 24)	13.339^b	0.004
AST[M(P₂₅, P₇₅)，U/L]	22(19, 27)	23(19, 27)	23(20, 28)	23(19, 27)	9.447^b	0.024
GGT[M(P₂₅, P₇₅)，U/L]	19(15, 26)	22(16, 33)	24(18, 34)	25(18, 38)	11.248^b	< 0.001
空腹血糖(x±s，mmol/L)	5.4±0.6	5.4±0.6	5.4±0.6	5.5±0.6	1.614^a	0.184
尿酸(x±s，μmol/L)	313.0±70.4	324.7±79.6	339.9±78.8	344.7±88.9	19.453^a	< 0.001
HbA1c[M(P₂₅, P₇₅)，%]	5.1(4.8, 5.4)	5.2(4.9, 5.5)	5.2(4.8, 5.5)	5.2(4.9, 5.6)	21.524^b	< 0.001
注：^a为F值，^b为H值。

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表 4 老年人NAFLD的患病危险因素的logistic回归分析

Table 4. Logistic regression analysis of risk factors for NAFLD in the elderly

项目	B	SE	Wald χ²	P值	OR(95% CI)
年龄	-0.040	0.009	21.516	＜0.001	0.961(0.944~0.977)
腰围	0.809	0.131	38.104	＜0.001	2.245(1.737~2.902)
体重指数	0.133	1.045	61.524	＜0.001	2.842(2.189~3.690)
收缩压	0.189	0.136	1.950	0.163	1.209(0.926~1.577)
舒张压	0.072	0.182	0.157	0.692	1.075(0.752~1.536)
三酰甘油	0.121	0.838	47.677	＜0.001	2.312(1.822~2.932)
高密度脂蛋白	0.215	0.211	1.032	0.310	1.240(0.819~1.876)
谷丙转氨酶	0.382	0.474	0.651	0.420	1.466(0.579~3.710)
谷草转氨酶	0.701	0.350	4.004	0.045	2.015(1.014~4.002)
谷氨酰转肽酶	0.219	0.227	0.924	0.336	1.244(0.797~1.942)
空腹血糖	0.586	0.153	14.721	＜0.001	1.797(1.332~2.423)
尿酸	0.494	0.133	13.809	＜0.001	1.639(1.263~2.126)
糖化血红蛋白	0.551	0.274	4.059	0.044	1.735(1.015~2.967)
hs-CRP			27.394	＜0.001	1
Q2 vs. Q1	0.416	0.177	5.547	0.019	1.516(1.072~2.143)
Q3 vs. Q1	0.730	0.166	19.425	＜0.001	2.075(1.500~2.871)
Q4 vs. Q1	0.790	0.166	22.556	＜0.001	2.203(1.590~3.053)

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表 5 不同hs-CRP浓度对老年人NAFLD的患病影响的logistic回归分析

Table 5. Logistic regression analysis of the influence of different hs-CRP concentrations on the incidence of NAFLD in the elderly

组别	例数	模型1		模型2
组别	例数	P值	OR(95% CI)	P值	OR(95% CI)
Q2	437	＜0.001	2.133(1.560~2.917)	0.016	1.554(1.086~2.223)
Q3	515	＜0.001	3.185(2.383~4.258)	0.001	1.828(1.298~2.574)
Q4	505	＜0.001	3.804(2.851~5.074)	＜0.001	1.895(1.335~2.692)
注：以Q1为参照。模型1为未校正; 模型2为调整年龄、性别、BMI、腰围、收缩压、舒张压、空腹血糖、TC、TG、HDL-C、ALT、AST、GGT、尿酸、HbA1c。

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