上海某社区65岁以上老年人脂肪肝的中医体质及相关因素分析

叶艳 韦全华

摘 要 目的：分析上海某社區65岁以上老年人脂肪肝与高血压、糖尿病、血液生化指标和中医体质的关系。方法：研究对象为2020年5-8月在上海某社区卫生服务中心接受免费体检的1 043例65岁以上老年人，年龄65～96岁；其中女性559例，男性475例。通过调查问卷、腹部B超和实验室检查等方法，将老年人群分成脂肪肝组及非脂肪肝组，比较两组的血压、糖尿病、血液生化指标和中医体质等影响因素。结果：脂肪肝组中患高血压、糖尿病以及体重超重、肥胖、腹型肥胖、中心性肥胖的比率高于非脂肪肝组（P<0.05）。脂肪肝组的血清天门冬氨酸氨基转移酶（AST），血清丙氨酸氨基转移酶（ALT），三酰甘油（TG）和空腹血糖（FPG）指标均高于非脂肪肝组（P<0.05），而高密度脂蛋白胆固醇（HDL-C）则低于非脂肪肝组（P<0.05）。脂肪肝组患者中痰湿体质位居首位（12.1%），其次是气虚体质（11.6%），而非脂肪肝组中比例最高的是平和质，占31%，两组构成分布差异具有统计学意义（P<0.05）。logistic回归分析结果显示，体质量指数（BMI）、高血压、中心性肥胖、ALT、TG、HDL-C和部分体质类型是脂肪肝的影响因素（P<0.05）。结论：BMI升高、高血压、中心性肥胖、ALT、TG、部分体质类型是65岁以上老年人脂肪肝的危险因素，HDL-C是保护因素。

关键词 脂肪肝；老年人；中医体质；影响因素

中图分类号：R589.2 文献标志码：A 文章编号：1006-1533（2021）20-0058-05

基金项目：宝山区名中医传承工作室（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.