非酒精性脂肪性肝病患者肝脏脂肪含量与冠状动脉狭窄的相关性研究

Study of the correlation between liver fat content and coronary artery stenosis in patients with non-alcoholic fatty liver disease

目的探讨非酒精性脂肪性肝病(NAFLD)患者肝脏脂肪含量(LFC)与冠状动脉狭窄(CAS)的相关性研究。方法选取2019年1月至2019年12月福建中医药大学附属人民医院(福建省人民医院)收治353例冠心病且同时行冠状动脉造影术及经腹部肝脏超声检查的患者,根据肝脏超声脂肪定量检查结果,将患者分为无NAFLD组(LFC<9.15%,n=137);NAFLD组(LFC≥9.15%,n=216)。根据Gensini评分标准将NAFLD组患者分为CAS亚组和无CAS亚组。对NAFLD患者发生CAS进行多因素分析,并比较不同LFC分级下胰岛素抵抗指数(HOMAIR)与Gensini评分相关性。结果NAFLD组患者BMI、高血压及糖尿病所占比例及均高于无NAFLD组;实验室指标中总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、LFC、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)均高于无NAFLD组;患者Gensini评分高于无NAFLD组(P<0.05)。CAS亚组患者BMI、高血压、糖尿病及吸烟者所占比例均高于无CAS亚组;实验室指标中TC、TG、HDL、FPG、FINS、HOMA-IR、LFC均高于无CAS亚组患者;Gensini评分也高于无CAS亚组患者。高血压、糖尿病、吸烟、BMI、TG、HOMA-IR、LFC是NAFLD患者发生CAS的独立危险因素(P<0.05);LFC>20.4%与血清HOMA-IR和Gensini具有相关性(P<0.05)。结论NAFLD患者中CAS患病率较高,LFC是NAFLD患者发生CAS的独立危险因素。

Objective To investigate the correlation between the liver fat content(LFC)and coronary artery stenosis(CAS)in patients with nonalcoholic fatty liver disease(NAFLD).Method Clinical data of 353 patients simultaneously undergoing coronary angiography and liver ultrasonography from January 2019 and December 2019 in People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine(The People’s Hospital of Fujian Province)were retrospectively analyzed.They were divided into NAFLD group(LFC≥9.15%,n=216)and NAFLD free group(LFC<9.15%,n=137).Patients in NAFLD group were divided into CAS subgroup and non CAS subgroup according to Gensini scoring standard.The relationship between insulin resistance index(HOMA-IR)and Gensini score in patients with NAFLD was compared.Result The proportion of BMI,hypertension and diabetes in NAFLD group was higher than that in NAFLD free group.The laboratory indexes included total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL),fasting blood glucose(FPG),fasting insulin(FINS),HOMA-IR,LFC,alanine aminotransferase(ALT),aspartate aminotransferase(AST)were all higher than those in NAFLD free group,and Gensini score was higher than those in NAFLD free group(P<0.05).The proportion of BMI,hypertension,diabetes and smokers in CAS subgroup was higher than that in non CAS subgroup;TC,TG,HDL,FPG,FINS,HOMA-IR and LFC in laboratory indexes were higher than those in non CAS subgroup;Gensini score was also higher than that in non CAS subgroup.Hypertension,diabetes,smoking,BMI,TG,HOMA-IR and LFC were independent risk factors of CAS in NAFLD patients(P<0.05);LFC>20.4%was correlated with HOMA-IR and Gensini in serum(P<0.05).Conclusion The prevalence of CAS was higher in NAFLD patients,LFC is an independent risk factor for CAS in patients with NAFLD.