非酒精性脂肪肝与冠脉病变关系的研究

A correlation study of nonalcoholic fatty liver disease and coronary heart disease

目的探讨非酒精性脂肪肝(NAFLD)与冠脉病变的关系。方法广东省人民医院2009年12月1日至2011年12月1日行冠脉CT发现冠脉病变的患者142例,所有患者同时行肝脏超声,体格检查及相关血清学检测。其中合并NAFLD者57例作为观察组,不合并NAFLD者85例作为对照组。比较两组冠心病(CHD,一支或一支以上主要冠状动脉狭窄>50%)发生率,非钙化及钙化斑块发生率,代谢综合征(MS)及其具体组分的发生率,以及相关血清学指标的变化;其后用二分类Logistic回归分析冠心病的危险因素,评价NAFLD在其中的地位。结果 NAFLD组冠脉狭窄达CHD标准者,非钙化和钙化斑块发生率均比对照组明显升高,分别为53%vs13%(P<0.01),44%vs27%(P<0.05),53%vs34%(P<0.05);MS发生率也较对照组明显高(49%vs19%,P<0.01),有明显差异的具体指标包括HOMA-IR(3.06vs2.75,P<0.05),BMI(32.1vs27.5,P<0.05),TRIG(5.62vs4.28,P<0.01),ALT(47.2vs34.6,P<0.01),HS-CRP(12.02vs6.46,P<0.01);对CHD患者进行危险因素分析,影响因子由高到低依次为NAFLD,MS,TRIG,CRP,ALT(OR分别为31.21,14.02,2.54,1.85,1.08)。结论在冠脉CT发现冠脉病变的患者中,NAFLD患者的冠脉病变比非NAFLD患者更严重及活动度更高,一方面表现为更易伴发影响冠脉病变的疾病及危险因素,另一方面在排除其他因素影响后,NAFLD仍对冠脉病变有独立的影响。

Objective The aim of this study was to evaluate the correlation between nonalcoholic fatty liver disease （NAFLD） and coronary heart disease （CHD）. Methods Clinical data including physical examina- tion, liver ultrasonic scan and serum biomarkers of insulin resistance, lipotoxicity systemic inflammation and liver enzymes of 142 patients with coronary plaques and stenosis were collected from 1st Dec. 2009 to 1st Dec. 2012 in Guangdong General Hospital. All patients were diagnosed by multi-slice spiral CT. Indexes were compared between NAFLD and non-NAFLD patients. A logistic regression analysis was performed to evalu- ate the risk factors of CHD. Results When compared with non-NAFLD patients, NAFLD patients showed a higher prevalence of CHD, calcified and noncalcified coronary plaques （53% vs 13%, P 〈 0.01; 44% vs 27%, P 〈 0.05; 53% vs 34%, P 〈 0.05, respectively）, higher HOMA（3.06 vs 2.75, P 〈 0.05）, BMI（32.1 vs 27.5, P 〈 0.05）, TRIG（5.62 vs 4.28, P 〈 0.01）, ALT （47.2 vs 34.6, P 〈 0.01） and HS-CRP（12.02 vs 6.46, P 〈 0.01）. The risk factors of CHD ranked in descending order were NAFLD, MS, TRIG, CRP and ALT（OR = 31.21, 14.02, 2.54, 1.85 and 1.08, respectively）, Conclusion NAFLD might be a slrong independent predictor of CHD, which was often accompanied with severe atherosclerosis.