老年非酒精性脂肪性肝病患者进展为显著肝纤维化的危险因素观察

摘要/Abstract

摘要： 目的探究老年非酒精性脂肪性肝病(NAFLD)患者进展为肝纤维化F3～F4期的危险因素。方法选择2022年1月至2025年10月解放军联勤保障部队第九〇四医院诊断为NAFLD的老年患者110例,以FibroScan检测的肝硬度值(LSM)为依据,将患者分为F0～F2期组(无-中度肝纤维化)和F3～F4期组(显著肝纤维化)。比较两组临床资料,并经多因素logistic回归分析筛选进展为肝纤维化F3～F4期的独立危险因素。结果 F3～F4期组合并糖尿病患者占比(59.52% vs. 32.35%)及腰围[(97.63±8.51)cm vs. (92.10±7.92)cm]、BMI[(28.02±3.25)kg/m² vs. (26.11±2.84)kg/m²]、空腹血糖[(7.55±1.83)mmol/L vs. (6.23±1.34)mmol/L]、糖化血红蛋白[(6.93±1.22)% vs. (6.10±0.82)%]、甘油三酯[(2.40±0.72)mmol/L vs. (1.81±0.56)mmol/L]、丙氨酸氨基转移酶(ALT)[(55.26±17.95)U/L vs. (38.45±12.28)U/L]、天冬氨酸氨基转移酶(AST)[(48.56±15.24)U/L vs. (30.22±10.07)U/L]、γ-谷氨酰转移酶(GGT)[(85.42±24.53)U/L vs. (50.76±18.18)U/L]、纤维化-4指数(FIB-4)[(3.62±1.04) vs. (1.90±0.53)]、尿素氮[(6.30±1.79)mmol/L vs. (5.44±1.36)mmol/L]、受控衰减参数[(310.42±44.57)dB/m vs. (285.35±38.71)dB/m]、血尿酸/高密度脂蛋白胆固醇(UHR)[(6.84±2.01) vs. (5.03±1.46)]均高于F0～F2期组,高密度脂蛋白胆固醇[(1.03±0.21)mmol/L vs. (1.22±0.31)mmol/L]、巨噬细胞介导的炎症消退因子1(MaR1)[(59.13±4.74)pg/mL vs. (77.56±5.42)pg/mL]均低于F0～F2期组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,合并糖尿病、AST升高、高FIB-4、低MaR1水平及高UHR是老年NAFLD患者进展为肝纤维化F3～F4期的独立危险因素(P<0.05)。ROC曲线分析显示,AST、FIB-4、MaR1、UHR用于预测老年NAFLD患者进展为肝纤维化F3～F4期的AUC分别为0.773、0.787、0.818、0.743。将四者联合构建预测因子,其AUC提高至0.880。结论合并糖尿病、AST升高、FIB-4升高、MaR1降低、UHR升高均为老年NAFLD患者进展为肝纤维化F3～F4期的独立危险因素,而联合AST、FIB-4、MaR1、UHR构成的模型,可显著提高预测效能。

关键词: 非酒精性脂肪性肝病, 老年人群, 肝纤维化, 危险因素

Abstract: Objective To explore the risk factors for the progression of liver fibrosis to stages F3-F4 in elderly patients with non-alcoholic fatty liver disease (NAFLD). Methods 110 elderly patients diagnosed with NAFLD at the 904th Hospital of the Joint Logistics Support Force from January 2022 to October 2025 were selected. Based on the LSM values detected by FibroScan, the patients were divided into F0~F2 stage group (no moderate fibrosis) and F3~F4 stage group (significant fibrosis). Compare two sets of clinical data and screen independent risk factors for progression to liver fibrosis stages F3~F4 through multiple logistic regression analysis. Results The proportion of patients combined with diabetes mellitus was significantly higher in the F3~F4 group than in the F0~F2 group (59.52% vs. 32.35%). Additionally, waist circumference (97.63±8.51 cm vs. 92.10±7.92 cm), BMI (28.02±3.25 kg/m² vs. 26.11±2.84 kg/m²), fasting blood glucose (7.55±1.83 mmol/L vs. 6.23±1.34 mmol/L), glycosylated hemoglobin (6.93%±1.22% vs. 6.10%±0.82%), triglycerides (2.40±0.72 mmol/L vs. 1.81±0.56 mmol/L), alanine aminotransferase (ALT) (55.26±17.95 U/L vs. 38.45±12.28 U/L), aspartate aminotransferase (AST) (48.56±15.24 U/L vs. 30.22±10.07 U/L), gamma-glutamyl transferase (85.42±24.53 U/L vs. 50.76±18.18 U/L), fibrosis-4 index (FIB-4) (3.62±1.04 vs. 1.90±0.53), blood urea nitrogen (6.30±1.79 mmol/L vs. 5.44±1.36 mmol/L), controlled attenuation parameter (310.42±44.57 dB/m vs. 285.35±38.71 dB/m), and the uric acid to high-density lipoprotein cholesterol ratio (UHR) (6.84±2.01 vs. 5.03±1.46) were all significantly higher in the F3~F4 group. Conversely, high-density lipoprotein cholesterol (1.03±0.21 mmol/L vs. 1.22±0.31 mmol/L) and maresin 1 (MaR1) (59.13±4.74 pg/mL vs. 77.56±5.42 pg/mL) were significantly lower in the F3~F4 group. All differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the combination of diabetes, elevated AST, high FIB-4, low MaR1 level and high UHR were independent risk factors for elderly NAFLD patients to progress to phase F3 to F4 of liver fibrosis (P<0.05). ROC curve analysis showed that the AUC values of AST, FIB-4, MaR1, and UHR for predicting the progression of liver fibrosis in elderly NAFLD patients to stages F3~F4 were 0.773, 0.787, 0.818, and 0.743, respectively. By combining the four factors to construct a predictive factor, the AUC was increased to 0.880. Conclusion The combination of diabetes, elevated AST, elevated FIB-4, decreased MaR1, and elevated UHR are independent risk factors for the progression of elderly NAFLD patients to phase F3 to F4 of liver fibrosis. The combination of AST, FIB-4, MaR1, and UHR can significantly improve the prediction efficiency.

Key words: Non-alcoholic fatty liver disease, Elderly population, Liver fibrosis, Risk factor

苗瑞田, 刘敏, 周赟, 刘春芳. 老年非酒精性脂肪性肝病患者进展为显著肝纤维化的危险因素观察[J]. 肝脏, 2026, 31(5): 687-692.

MIAO Rui-tian, LIU Min, ZHOU Yun, LIU Chun-fang. Observation of risk factors for the progression of significant liver fibrosis F3~F4 in elderly patients with non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2026, 31(5): 687-692.

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