原发性高血压患者合并脂肪肝与动脉粥样硬化的关系

The Association between Nonalcoholic Fatty Liver Disease and Atherosclerosis in Patients with Essential Hypertension

目的:探讨原发性高血压患者非酒精性脂肪肝与颈动脉粥样硬化及冠心病发病的相关性。方法:入选原发性高血压患者66例,按是否合并脂肪肝分组(脂肪肝组37例,非脂肪肝组29例)。记录所有患者的血压、体重指数、生化指标、颈动脉B超和冠状动脉造影结果。结果:两组的年龄、性别、高血压病程、血压水平相近(P>0.05),血总胆固醇、高密度脂蛋白、尿酸、尿微量白蛋白无显著差异(P>0.05)。脂肪肝组的空腹血糖、甘油三脂、体重指数高于非脂肪肝组(P<0.05),颈动脉内膜中层厚度显著增加(1.13±0.25 vs 0.96±0.24mm;P<0.01)。颈动脉斑块及冠心病发生率在脂肪肝组显著增加(P<0.05),脂肪肝组冠心病患者的血管病变重于非脂肪肝组冠心病患者(P<0.05)。结论:合并脂肪肝的原发性高血压患者更易发生颈动脉粥样硬化,且冠心病发病率增加,提示脂肪肝的并存增加原发性高血压患者动脉粥样硬化疾病的风险。

Objective To explore the relationship between nonalcoholic fatty liver disease（NAFLD） and the prevalence of carotid atherosclerosis and coronary heart disease（CHD）.Methods 66 patients with essential hypertension（EHT） were included in this study.Among them,37 EHT patients had NAFLD and 29 EHT patients without NAFLD.Clinical characteristics,ultrasound of carotid arteres and coronary angiography were assessed in all patients.Results Age,gender,systolic and diastolic blood pressure were similar between two groups（P〉0.05）.There was no significantly difference in blood total cholesterol,high-density lipoprotein,uric acid and urinary microalbuminuria between two groups（P〉0.05）.The fasting blood-glucose,triglycerides,body mass index（BMI） were higher in NAFLD patients than in EHT patients without NAFLD（P〈0.05）.NAFLD patients showed more carotid atherosclerosis than the patients without NAFLD,with mean intima-media thickness（IMT） of 1.13±0.25mm and 0.96±0.24mm（P〈0.01） and plaque prevalence of 32.4% and 10.3%（P〈0.05）,respectively.There was significant difference in the prevalence of CHD in patients with and without NAFLD（67.6% vs 41.4%,respectively,P〈0.05）.Conclusions EHT patients with NAFLD show advanced carotid atherosclerosis and higher prevalence of CHD compared with patients without NAFLD.NAFLD should alert to the existence of an increased cardiovascular risk in EHT patients.