关键词: 脂肪性肝病, 骨质疏松, 非酒精性, 骨密度, 影响因素

Abstract: Objective To explore the prevalence of osteoporosis in non-alcoholic and non-obese patients with fatty liver disease, and analyze the relevant influencing factors.Methods 1172 patients with non-alcoholic fatty liver disease (NAFLD) who underwent physical examinations in our hospital from January 2021 to April 2024 were selected. Patients were divided into three groups based on the lumbar L1-4 bone density T value: osteoporosis (382 cases), bone loss (379 cases), and normal bone mass (412 cases). The incidence of bone loss and osteoporosis in non-obese fatty liver patients was analyzed, and the clinical data of three groups were compared to analyze the relevant factors affecting lumbar spine bone density.Results The incidence of bone loss in this group was 32.34%, and the incidence of osteoporosis was 32.59%. There was no statistically significant difference in BMI, waist circumference, SBP, DBP, drinking history, and previous medical history (hypertension, heart disease, diabetes) among the three groups (P>0.05). Compared with the group with normal bone mass, the proportion of women (65.17%,68.06% vs 51.94%) and those with a history of smoking (31.13%, 37.70% vs 25.49%)in the group with decreased bone mass and the group with osteoporosis were higher, and the average age [(61.52±7.94) years,(65.32±8.51) years vs (58.17±8.73) years]was older. The pairwise differences were statistically significant (P<0.05). The levels of TBIL, GGT, ALB, BUN, CR, TC, TG, HDL-C, LDL-C, TSH, FT3, FT4 and HbAlc in the three groups were similar (P>0.05). Compared with the group with normal bone mass, the ALT[(36.65±12.06)U/L,(38.31±13.26)U/L vs (33.86±10.36)U/L], AST[(34.71±10.32)U/L, (35.84±9.67)U/L vs (30.94±9.65)U/L], UA[(420.65±68.73)μmol/L, (378.54±73.52)μmol/L vs (459.25±72.70)μmol/L], FPG[(6.04±0.94)mmol/L, (6.27±1.04)mmol/L vs (5.31±1.08)mmol/L] levels were higher in the osteoporosis group and bone loss groups, while the 25-OH-D3 [(8.41±0.77)μg/L, (3.95±0.92)μg/L vs (3.95±0.92)μg/L] level was lower (P<0.05). Multivariate analysis showed that age, gender, smoking history, ALT, UA, FPG, and 25-OH-D3 were all influencing factors for the occurrence of bone loss/osteoporosis in non-alcoholic and non-obese fatty liver patients (OR=2.248,2.599,1.627,1.567,0.818,1.505,0.819,P<0.05).Conclusion Non-alcoholic non-obese fatty liver disease patients have a higher incidence of osteoporosis, and gender, age, vitamin D, ALT, and UA levels are all influencing factors for the occurrence of bone loss/osteoporosis in patients.

Key words: Fatty liver disease, Osteoporosis, Non-alcoholic, Bone density, Influence factor