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目的探讨老年非酒精性脂肪性肝病(NAFLD)与原发性高血压的关系及可能机制。方法选择2008-04-2009-10在我院门诊健康体检的非脂肪肝老年人60例,其中原发性高血压患者19例(A组),非原发性高血压患者41例(B组),老年科住院患者根据肝脏二维B型超声检查结果诊断为NAFLD患者94例,其中伴原发性高血压患者62例(C组),单纯非酒精性脂肪肝32例(D组)。测定血脂、肝功、肾功、血糖、胰岛素浓度、高敏C反应蛋白。结果与B组比较,C组的体质量指数[(31.6±5.0)比(25.4±3.2)kg/m2]、腰臀比值(0.93±0.06比0.81±0.07)、空腹血糖[(6.3±1.6)比(5.2±0.5)mmol/L]、胰岛素浓度[(17.8±9.5)比(7.5±4.0)U/L]、三酰甘油[(1.6±0.6)比(0.8±0.3)mmol/L]、高敏C反应蛋白[(14.2±2.9)比(3.3±1.6)mg/L]、胰岛素抵抗指数[(4.06±1.35)比(2.01±1.16)]、丙氨酸氨基转移酶、天冬氨酸氨基转移酶和γ谷氨酰转肽酶升高水平(均P<0.05)。总胆固醇、低密度脂蛋白胆固醇两组水平相似;老年NAFLD患者原发性高血压的发生率高于非脂肪肝组(P<0.05)。经多变量Logistic分析发现,老年NAFLD和原发性高血压呈相关性(OR1.471,95%CI1.195～1.821,P<0.05)。结论老年NAFLD为原发性高血压的危险因素,机制可能与内脏性肥胖、胰岛素抵抗有关。
Objective To explore the relationship between elderly non-alcoholic fatty liver disease (NAFLD) and essential hypertension and its possible mechanism. Methods Sixty patients with non-fatty liver were enrolled in our hospital from April 2008 to April 2009, including 19 patients with essential hypertension (group A) and 41 patients with non-essential hypertension (group B) ), 94 inpatients with geriatric inpatients diagnosed with NAFLD according to the results of two-dimensional liver ultrasound examination, including 62 patients with essential hypertension (group C) and 32 patients with simple non-alcoholic fatty liver (group D). Determination of blood lipids, liver function, kidney function, blood glucose, insulin concentration, high-sensitivity C-reactive protein. Results Compared with group B, the body mass index [(31.6 ± 5.0) vs (25.4 ± 3.2) kg / m2], the ratio of waist to hip (0.93 ± 0.06 vs 0.81 ± 0.07) and fasting blood glucose [(6.3 ± 1.6) (5.2 ± 0.5) mmol / L, insulin concentration 17.8 ± 9.5, 7.5 ± 4.0 U / L, triglyceride 1.6 ± 0.6 0.8 ± 0.3 mmol / L, (14.2 ± 2.9) vs (3.3 ± 1.6) mg / L], insulin resistance index [(4.06 ± 1.35) vs (2.01 ± 1.16)], alanine aminotransferase, aspartate amino Transglutaminase and γ-glutamyl transpeptidase elevated levels (both P <0.05). The levels of total cholesterol and low density lipoprotein cholesterol were similar in both groups. The incidence of essential hypertension in elderly patients with NAFLD was higher than that in non-fatty liver group (P <0.05). Multivariate Logistic analysis found that elderly NAFLD and essential hypertension was correlated (OR1.471, 95% CI 1.198 ~ 1.821, P <0.05). Conclusion Elderly NAFLD is a risk factor for essential hypertension. The mechanism may be related to visceral obesity and insulin resistance.