摘要：
目的 观察老年非酒精性脂肪性肝病(NAFLD)患者认知功能、临床指标和海马组织结构的变化.方法 纳入2014年12月至2016年6月在南京大学医学院附属鼓楼医院老年科住院的169例老年体检患者,分成NAFLD组与非NAFLD组.收集两组患者的病史资料,采用蒙特利尔认知评估量表(MoCA)进行认知功能障碍评估,检测血清可溶性转铁蛋白受体(sTfR)水平,进行肝脾比值测量和海马质子磁共振波谱(1H-MRS)检查.统计学方法采用t检验和线性回归分析.结果 169例老年患者中,NAFLD 100例,非NAFLD 69例.NAFLD组患者的BMI和腰臀比分别为(25.9±3.4) kg/m2和1.03±0.13,分别高于非NAFLD组的(24.2±3.7) kg/m2和0.95±0.06,差异均有统计学意义(t=-2.714、-3.605,P均＜0.01).NAFLD组患者的MoCA评分为(20.1±5.8)分,低于非NAFLD组的(22.1±4.4)分,差异有统计学意义(t=2.154,P=0.033).NAFLD组血清sTfR水平和肝脾CT比值分别为(8.78±4.31) mg/L和0.97±0.12,分别低于非NAFLD组的(12.66±3.93) mg/L和1.19±0.15,差异均有统计学意义(t=3.765、6.142,P均＜0.01).肝脾CT比值(β=7.597,95％ CI2.938～12.935)、sTfR(β=0.552,95％ CI 0.304～0.787)与老年患者认知功能呈正相关(P均＜0.01).NAFLD组右侧海马高度为(0.410±0.074) mm,低于非NAFLD组的(0.453±0.086) mm,差异有统计学意义(t=2.078,P =0.042).结论 老年NAFLD患者认知功能减退,这与铁负荷及肝脏脂肪密切相关.%Objective To observe the changes of cognitive function,clinical characteristics and hippocampal structure in elderly patients with non-alcoholic fatty liver disease (NAFLD).Methods From December 2014 to June 2016,at Department of Geriatrics,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,169 elderly hospitalized patients who underwent health checkups were enrolled and divided into NAFLD group and non-NAFLD group.The clinical data of two groups were collected,and the Montreal cognitive assessment scale (MoCA) was used for cognitive function assessment.The serum level of soluble transferrin receptor (sTfR) was detected,the liver-spleen ratio was measured and hippocampal proton magnetic resonance spectroscopy (1H-MRS) was performed.T test and linear regression analysis were used for statistical analysis.Results Among the 169 elderly patients,100 were NAFLD and 69 were non-NAFLD.The body mass index(BMI) and waist-to-hip ratio(WHR) of patients in NAFLD group were (25.9 ± 3.4) kg/m2 and 1.03 ± 0.13,respectively,which were higher than those in non-NAFLD group ((24.2 ± 3.7) kg/m2 and 0.95 ± 0.06),and the differences were statistically significant (t =-2.714 and-3.605,both P ＜0.01).MoCA score of the patients in NAFLD group was 20.1 ± 5.8,which was lower than that in non-NAFLD group (22.1 ± 4.4),and the difference was statistically significant(t =2.154,P =0.033).The serum sTfR level and liver-spleen computed tomography(CT) ratio of NAFLD group were (8.78 ± 4.31) mg/L and 0.97 ± 0.12,respectively,which were lower than those of non-NAFLD group ((12.66 ± 3.93) mg/L and 1.19 ± 0.15),and the differences were statistically significant(t =3.765 and 6.142,both P ＜ 0.01).The CT ratio of liver to spleen (β=7.597,95％ confidence interval(CI):2.938 to 12.935) and sTfR (β =0.552,95％ CI:0.304 to 0.787) were positively correlated with cognitive function in elderly patients (both P ＜ 0.01).The height of right hippocampus of NAFLD group was (0.410 ± 0.074) mm,which was lower than that of non-NAFLD group ((0.453 ± 0.086) ram),and the difference was statistically significant (t =2.078,P =0.042).Conclusion Cognitive impairment in elderly NAFLD patients is closely related to iron load and liver fat.
