非酒精性脂肪性肝病与动脉粥样硬化的关系

Relationship between nonalcoholic fatty liver disease and artherosclerosis

目的探讨非酒精性脂肪性肝病与动脉粥样硬化的关系及可能机制。方法122例门诊及住院患者根据B超检查结果分为2组，非酒精性脂肪性肝病组62例和正常对照组60例，对2组患者的动脉粥样硬化情况及其相关因素进行分析。结果非酒精性脂肪性肝病组BMI、腰臀比值、收缩压、舒张压、空腹血糖、胰岛素浓度、高密度脂蛋白、廿油三酯、高敏C反应蛋白、胰岛素抵抗指数及比例、谷丙转氨酶、谷草转氨酶和γ-氨酰转肽酶水平与对照组比较差异有统计学意义（P〈0．001）；总胆固醇、低密度脂蛋白、脂蛋白A两组水平相似；非酒精性脂肪性肝病组颈动脉斑块检出率和颈动脉内膜中层厚度均高于正常对照组，差异有统计学意义（P〈0．05）。经多变量分析发现，非酒精性脂肪性肝病和IMT及斑块呈显著相关（OR8．3，95％CI1．2～7．7，P=0．001）。结论非酒精性脂肪性肝病患者动脉粥样硬化的患病率高于正常对照组，非酒精性脂肪性肝病为动脉粥样硬化的危险因素，机制可能与内脏性肥胖、胰岛素抵抗和非酒精性脂肪性肝病状态下增加的氧化应激特性及血脂紊乱、炎症反应有关。

Objective To investigate the relationship and pathogenesis between nonalcoholic fatty liver disease and atherosclerosis. Methods 122 cases of outpatient and inpatient were divided into nonalcoholic fatty liver disease group （ n = 62） and normal control group（ n =60） according to the results of B - ultrasound. The correlation between atheroscl - erosis and related factors were studied. Results In the nonalcoholic fatty liver disease group the BMI, waist - hip ratio, systolic blood pressure, diastolic blood pressure, fasting glucose,insulin levels, high density lipoprotein, triglyceride, high sensitive C - reactive protein, insulin resistance index and ratio, alanine aminotransferase, aspartate aminotransferase and γ- GGT glutamyl compared with the control group was significantly （P 〈 0. 001 ） ;total cholesterol,low density lipoprotein lipoprotein A levels were similar in both groups ;The common carotid artery intima - media thickness and the rate of carotid artery plaque of nonalcoholic fatty liver disease group were significantly higher than those of normal control group （ P 〈 0. 05 ）. After multivariate analysis, non- alcoholic fatty liver disease and the IMT and plaque was significantly correlated （OR 8. 3,95% CI 1.2 - 7.7, P = 0. 001 ）. Conclusion The risk of atherosclerosis is higher in patients with nonalcoholic fatty liver disease than the patients without nonalcoholic fatty liver disease. Nonalcoholic fatty liver disease is a risk factor of atherosclerosis. The pathogenesis may be related to visceral obesity,insulin resistance and nonalcoholic fatty liver disease state characteristics of the increased oxidative stress and lipid disorders,inflammatory reaction.