冠心病患者伴非酒精性脂肪性肝病的临床特征分析

Clinical characteristics of coronary artery disease in patients with nonalcoholic fatty liver disease

目的 分析冠心病（CAD）伴非酒精性脂肪性肝病（NAFLD）患者的临床特征.方法 234例接受冠状动脉造影检查的患者,并有糖、脂代谢指标及腹部超声检查结果,男性148例,女性86例,平均年龄66.6岁.应用冠脉狭窄指数（CSI）评价冠状动脉病变严重程度,代谢综合征采用2007年中国成人血脂异常防治指南中关于代谢综合征的诊断标准.结果 234例研究对象中,62例患者为NAFLD.与无NAFLD组相比,NAFLD患者中心性肥胖的患病率明显升高（75.8%对50.0%,P〈0.01）.CAD伴NAFLD在60岁以下患者中的发生率显著高于60岁以上者（27.4%对13.7%,P=0.005）.尽管CAD亚组与CAD合并NAFLD亚组的CSI评分差异无统计学意义（P〉0.05）,但后者的年龄明显低于CAD亚组（P=0.006）.Logistic回归分析显示中心性肥胖为NAFLD的独立危险因子（β：1.701,P〈0.001）.Logistic回归与多元逐步回归分析发现,年龄分别是影响冠脉病变的独立危险因素（β=0.032,P=0.027）以及影响CSI评分的主要因素（β=0.125,P=0.022）.结论 中年肥胖及脂肪肝人群应当重视冠心病的筛查.

Objective To analyze the clinical characteristics of coronary artery disease （CAD） in patients with nonalcoholic fatty liver disease （ NAFLD）. Methods Totally 234 subjects underwent coronary angiography, including 148 men and 86 women with complete data on metabolic syndrome （ MS） and abdominal ultrasonography; the mean age was 66. 6 years. The severity of CAD was assessed by coronary stenosis index （CSI）. Metabolic syndrome was diagnosed according to the Guideline on Prevention and Treatment of Blood lipid Abnormality in Chinese Adults. Results Ultrasonography revealed that 62 patients had NAFLD （26. 5%）. In patients with NAFLD, the prevalence of central obesity was higher than those without NAFLD （75. 8% vs 50. 0% , P〈 0.01）. With regards to age, CAD patients with NAFLD were more common in patients under 60 years （27.4% vs 13.7% , P=0.005）. CSI score was similar in CAD subgroup and CAD ＆ NAFLD subgroup （P〉0.05）, however the age of patients in CAD ＆ NAFLD subgroup was significantly lower compared to CAD subgroup （ P = 0.006）. According to the results of logistic regression, central obesity was the independent risk factor of NAFLD （β= 1.701, P〈0.001）. Logistic regression demonstrated that age was independently associated with CAD （β = 0.032, P=0.027）. Further more, multiple stepwise regression analysis showed that age was the single parameter that best predicted CSI score （β= 0. 125, P = 0. 022）. Conclusions It is important to screen coronary artery disease in middle aged patients with central obesity or NAFLD.