1.上海中医药大学上海中医健康服务协同创新中心(上海 201203)
2.上海市浦东新区北蔡社区卫生服务中心(上海 201204)
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
王睿瑞,副研究员;E-mail:wangrr_tcm@126.com
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岳思冉,谭宜云,谢峰等.上海社区老年人非酒精性脂肪性肝病、高血压共病机制及中医体质分布规律研究[J].上海中医药杂志,2022,56(05):39-43.
YUE Siran,TAN Yiyun,XIE Feng,et al.Comorbidity mechanism of non⁃alcoholic fatty liver disease and hypertension and the distribution characteristics of TCM body constitutions among the elderly in Shanghai communities[J].Shanghai Journal of Traditional Chinese Medicine,2022,56(05):39-43.
岳思冉,谭宜云,谢峰等.上海社区老年人非酒精性脂肪性肝病、高血压共病机制及中医体质分布规律研究[J].上海中医药杂志,2022,56(05):39-43. DOI: 10.16305/j.1007-1334.2022.2109082.
YUE Siran,TAN Yiyun,XIE Feng,et al.Comorbidity mechanism of non⁃alcoholic fatty liver disease and hypertension and the distribution characteristics of TCM body constitutions among the elderly in Shanghai communities[J].Shanghai Journal of Traditional Chinese Medicine,2022,56(05):39-43. DOI: 10.16305/j.1007-1334.2022.2109082.
目的,2,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,2,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,2,①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)。④Logistic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,2,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,2,To analyze the comorbidity mechanism of non-alcoholic 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,2,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,2,①A 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. ②Compared 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. ③In 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). ④Logistic 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. ⑤According 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,2,The comorbidity mechanism of NAFLD and hypertension may be related to 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.
非酒精性脂肪性肝病高血压老年人中医体质
non-alcoholic fatty liver diseasehypertensionelderly peopletraditional Chinese medicine constitution
BYRNE C D, TARGHER G. NAFLD: a multisystem disease[J]. J Hepatol, 2015, 62(1 Suppl): S47-S64.
ZHU J Z, ZHOU Q Y, WANG Y M, et al. Prevalence of fatty liver disease and the economy in China: A systematic review[J]. World J Gastroenterol, 2015, 21(18): 5695-5706.
MILLS K T, STEFANESCU A, HE J. The global epidemiology of hypertension[J]. Nat Rev Nephrol, 2020, 16(4): 223-237.
RINELLA M E,SANYAL A J. Management of NAFLD: a stage-based approach[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(4): 196-205.
LONARDO A, NASCIMBENI F, MANTOVANI A, et al. Hypertension, diabetes, atherosclerosis and NASH: Cause or consequence?[J]. J Hepatol, 2018, 68(2): 335-352.
Global BMI Mortality Collaboration, DI ANGELANTONIO E, BHUPATHIRAJU S, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents[J]. Lancet, 2016, 388(10046): 776-786.
中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 实用肝脏病杂志,2018, 21(2): 30-39.
UNGER T, BORGHI C, CHARCHAR F, et al. 2020 international society of hypertension global hypertension practice guidelines[J]. Hypertension, 2020, 75(6): 1334-1357.
柳璇.《老年版中医体质分类与判定》量表研制与初步应用分析[D]. 北京:北京中医药大学,2013.
ZHAO Y C, ZHAO G J, CHEN Z, et al. Nonalcoholic fatty liver disease: An emerging driver of hypertension[J]. Hypertension, 2020, 75(2): 275-284.
王欣,胡义扬,刘平,等. 高血压与非酒精性脂肪性肝病的关系[J]. 临床肝胆病杂志,2020, 36(11): 194-198.
SERAVALLE G, GRASSI G. Obesity and hypertension[J]. Pharmacol Res, 2017, 122: 1-7.
MUSSO G, GAMBINO R, CASSADER M. Gut microbiota as a regulator of energy homeostasis and ectopic fat deposition: mechanisms and implications for metabolic disorders[J]. Curr Opin Lipidol, 2010, 21(1): 76-83.
BÄCKHED F, MANCHESTER J K, SEMENKOVICH C F, et al. Mechanisms underlying the resistance to diet-induced obesity in germ-free mice[J]. Proc Natl Acad Sci U S A, 2007, 104(3): 979-984.
郑剑勇,吴文秀,苏依所,等. 成人血脂异常与高血压的相关性分析[J]. 中国慢性病预防与控制,2015, 23(12): 915-918.
SEMLITSCH T, JEITLER K,BERGHOLD A, et al. Long-term effects of weight-reducing diets in people with hypertension[J].Cochrane Database Syst Rev, 2016,3(3): CD008274.
YOUNOSSI Z M,COREY K E,LIM J K. AGA clinical practice update on lifestyle modification using diet and exercise to achieve weight loss in the management of nonalcoholic fatty liver disease: expert review[J]. Gastroenterology, 2021, 160(3): 912-918.
WU N, YUAN F, YUE S R, et al. Effect of exercise and diet intervention in NAFLD and NASH via GAB2 methylation[J]. Cell Biosci, 2021, 11(1): 189.
CORPELEIJN E, SARIS W H M, BLAAK E E. Metabolic flexibility in the development of insulin resistance and type 2 diabetes: effects of lifestyle[J]. Obes Rev, 2009, 10(2): 178-193.
ROSENSON R S, BREWER H B, BARTER P J, et al. HDL and atherosclerotic cardiovascular disease: genetic insights into complex biology[J]. Nat Rev Cardiol, 2018, 15(1):9-19.
RAMIREZ A J, CHRISTEN A I, SANCHEZ R A. Serum uric acid elevation is associated to arterial stiffness in hypertensive patients with metabolic disturbances[J]. Curr Hypertens Rev, 2018, 14(2): 154-160.
YANG H, LI D, SONG X, et al. Joint associations of serum uric acid and ALT with NAFLD in elderly men and women: a Chinese cross-sectional study[J]. J Transl Med, 2018, 16(1): 285.
王琦,朱燕波,折笠秀树,等. 中医痰湿体质相关影响因素的研究[J]. 北京中医药大学学报,2008, 31(1): 10-13.
罗嘉莉,张晓霞,鲍欣雨,等. 社区老年人中医体质分型及组合与2型糖尿病的关系研究[J]. 中国全科医学,2019, 22(5): 29-34.
李灿东,李思汉,詹杰. 中医健康认知与健康管理[J]. 中华中医药杂志,2019, 34(1): 202-205.
陈燕,刘莎莎,洪净. 老年人慢性疾病预防的中医健康管理[J]. 中医药导报,2016, 22(24): 80-83.
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