摘要
目的探讨上海社区老年人非酒精性脂肪性肝病(NAFLD)、高血压共病机制及中医体质分布规律,为社区老年人的中医体质调理提供理论依据。方法根据NAFLD、高血压的患病情况,将上海市浦东新区北蔡社区常规体检的老年人分为正常组、高血压组、NAFLD组、NAFLD合并高血压组(合并组)。回顾性分析相关资料(基本情况、中医体质分类与判定表),比较各组性别、腰臀比、体质量指数(BMI)等一般资料及三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿酸(UA)等实验室指标,探讨中医体质分布规律。运用Logistic回归分析对NAFLD合并高血压的危险因素进行分析,并对部分因素行相关性分析。结果(1)最终纳入550例研究对象,其中合并组170例、NAFLD组179例、高血压组127例、正常组74例。(2)与正常组比较,合并组BMI、腰臀比、收缩压、舒张压值及空腹血糖、TG、ALT、AST、UA水平升高(P<0.01),HDL-C水平降低(P<0.01);NAFLD组腰臀比、BMI值及ALT、AST、UA水平升高(P<0.01),HDL-C水平降低(P<0.05);高血压组收缩压、舒张压值及ALT、AST水平升高(P<0.05,P<0.01)。与高血压组比较,合并组腰臀比、BMI值及空腹血糖、TG、ALT、AST、UA水平升高(P<0.05,P<0.01),HDL-C水平降低(P<0.01);NAFLD组腰臀比、BMI、收缩压、舒张压值及TG、ALT、UA水平升高(P<0.05,P<0.01),HDL-C水平降低(P<0.01)。与NAFLD组比较,合并组BMI、腰臀比、收缩压、舒张压值及UA水平升高(P<0.05,P<0.01),HDL-C水平降低(P<0.05)。(3)合并组以痰湿质(11.18%)、兼夹质(11.18%)等偏颇体质为主,与NAFLD组、高血压组相比,中医体质总体分布差异有统计学意义(P<0.05)。(4)Logistic回归分析结果显示,校正性别、糖尿病史、高血脂病史、心脑血管病史、骨质疏松症病史等资料后,肥胖[OR=9.883,95%CI(3.347~29.180)]、高TG[OR=4.306,95%CI(1.762~10.522)]、低HDL-C[OR=4.796,95%CI(1.034~22.242)]、高UA[OR=3.255,95%CI(1.229~8.625)]为NAFLD合并高血压的危险因素,其中肥胖的危险性最大。(5)合并组中BMI与TG呈直线正相关关系(r=0.306,P<0.01)。结论NAFLD、高血压共病可能与BMI、TG、UA升高及HDL-C降低有关,中医体质以痰湿质和兼夹质为主;可以将痰湿质与兼夹质纳入社区体检中医体质辨识的重点,及早改善或治愈偏颇体质,可以有效防治社区老年人NAFLD合并高血压。
Objective To analyze the comorbidity mechanism of nonalcoholic fatty liver disease(NAFLD)and hypertension and the distribution characteristics of TCM constitution types among the elderly in Shanghai communities for the purpose of providing theoretical basis for TCM constitution adjustment of the elderly.Methods According to the prevalence of NAFLD and hypertension,elderly people who underwent routine physical examination in Beicai Community Health Service Center of Pudong New Area,Shanghai were divided into four groups:normal group,hypertension group,NAFLD group,and NAFLD combined with hypertension group(co-morbid group).The baseline data and TCM constitutions questionnaire were retrospectively analyzed.We compared general data such as gender,waist-hip ratio,body mass index(BMI),and laboratory indexes such as triglyceride(TG),total cholesterol(TC),high-density lipoproteins cholesterol(HDL-C),alanine aminotransferase(ALT),aspartate aminotransferase(AST),uric acid(UA),and investigated the distribution characteristics of TCM constitutions.Logistic regression was used to estimate risk factors of NAFLD and hypertension and correlation analysis was performed for some factors.Results(1)A total of 550 participants(170 cases in the co-morbid group,179 cases in the NAFLD group,127 cases in the hypertension group and 74 cases in the normal group)were included.(2)Compared with the condition in the normal group,BMI,waist-hip ratio,systolic blood pressure,diastolic blood pressure,fasting blood glucose(FBG),TG,ALT,AST,UA levels increased(P<0.01)and HDL-C level decreased(P<0.01)in the co-morbid group;the waist-hip ratio,BMI and ALT,AST,UA levels increased(P<0.01)and HDL-C level decreased(P<0.05)in the NAFLD group;systolic and diastolic blood pressure and ALT and AST levels increased(P<0.05,P<0.01)in the hypertensive group.Compared with the condition in the hypertension group,the waist-hip ratio,BMI and FBG,TG,ALT,AST and UA levels increased(P<0.05,P<0.01)and HDL-C level decreased(P<0.01)in the co-morbid group;the waist-hip ratio,BMI,systolic and diastolic blood pressure and TG,ALT,UA levels increased(P<0.05,P<0.01)and HDL-C level decreased(P<0.01)in the NAFLD group.Compared with the condition in the NAFLD group,BMI,waist-to-hip ratio,systolic blood pressure,diastolic blood pressure and UA level increased(P<0.05,P<0.01)and HDL-C level decreased(P<0.05)in the co-morbid group.(3)In the co-morbid group,the dominant body constitutions were phlegm-dampness constitution(11.18%),complex constitution(11.18%)and other biased constitutions,and the difference in the overall distribution of TCM constitutions was statistically significant compared with that of the NAFLD group and hypertension group(P<0.05).(4)Logistic regression analysis showed that obesity[OR=9.883,95%CI(3.347-29.180)],high TG[OR=4.306,95%CI(1.762-10.522)],low HDL-C[OR=4.796,95%CI(1.034-22.242)],and high UA[OR=3.255,95%CI(1.229-8.625)]were risk factors for the co-morbid condition of NAFLD and hypertension,with obesity as the greatest risk factor after adjusting gender,history of diabetes,hyperlipidemia,cardiovascular diseases,and osteoporosis.(5)According to the correlation analysis,there was a linear positive correlation between BMI and TG in the co-morbid group(r=0.306,P<0.01).Conclusion elevated BMI,TG and UA levels and reduced HDL-C level,and phlegm-dampness constitution and complex constitution are dominant TCM constitution types.The identification of phlegm-dampness and complex constitutions should be the key emphasis of TCM constitution identification when physical examination is conducted in communities so that the biased constitutions can be improved or regulated as early as possible to effectively prevent and treat the comorbid condition of NAFLD and hypertension among the elderly in communities.
作者
岳思冉
谭宜云
谢峰
张林芳
张峰玮
汪天英
郎卿
张磊
王健英
刘保成
王睿瑞
YUE Siran;TAN Yiyun;XIE Feng;ZHANG Linfang;ZHANG Fengwei;WANG Tianying;LANG Qing;ZHANGLei;WANG Jianying;LIU Baocheng;WANG Ruirui(Shanghai Innovation Center of TCM Health Service,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai Beicai Community Health Service Center,Pudong New Area,Shanghai 201204,China)
出处
《上海中医药杂志》
2022年第5期39-43,共5页
Shanghai Journal of Traditional Chinese Medicine
基金
上海市卫健委进一步加快中医药事业发展三年行动计划项目(ZY[2018-2020]-CCCX-2001-01)
教育部省部共建协同创新中心项目(2021科技02-37,2020科技01-01-30)
上海市卫健委科研课题(20184Y0121)
上海市浦东新区卫健委临床中医重点专病建设项目(PDZY-2018-0616)
关键词
非酒精性脂肪性肝病
高血压
老年人
中医体质
non-alcoholic fatty liver disease
hypertension
elderly people
traditional Chinese medicine constitution
作者简介
岳思冉,女,硕士研究生,主要从事中医药治疗非酒精性脂肪性肝病的临床研究工作;通信作者:王睿瑞,副研究员,E-mail:wangrr_tcm@126.com
