非酒精性脂肪性肝病男性患者的冠心病发病风险与血管紧张素Ⅱ水平的相关性研究

Relationship between coronary heart disease risk and serum angiotensin Ⅱ concentration in male patients with nonalcoholic fatty liver disease

目的:探讨非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)男性患者的冠心病(coronary heart disease,CHD)发病风险与血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)水平的相关性。方法:受试者均为不吸烟男性。正常对照组35名,病例组85名。测定其血清AngⅡ浓度,胰岛素抵抗指数稳态模型(homeostasis model assessment of insulin resistance,HOMA-IR)评估其胰岛素抵抗程度,Framingham风险评分(Framingham risk score,FRS)预测其未来10年CHD发病风险。病例组按有无合并代谢综合征(metabolic syndrome,MS)分为MS(+)组和MS(-)组,按FRS是否小于0分为FRS<0组和FRS≥0组。结果:AngⅡ浓度在MS(-)组显著高于正常对照组(P<0.001),而在MS(+)组较MS(-)组无统计学差异。FRS在MS(-)组显著高于正常对照组(P=0.035),且MS(+)组亦显著高于MS(-)组(P=0.042)。AngⅡ浓度在FRS≥0组显著高于FRS<0组(P=0.017)。10年CHD发病率与空腹胰岛素、HOMA-IR和AngⅡ浓度呈显著正相关(r’=0.248、0.335、0.222,P’=0.009、<0.001、0.02)。结论:NAFLD男性患者未来10年CHD发病风险明显增高,与胰岛素抵抗程度及AngⅡ浓度呈正相关。抑制AngⅡ可能有助于降低NAFLD男性患者的CHD发病风险。

Objective：To investigate the relationship between coronary heart disease（CHD）risk and serum angiotensinⅡ（AngⅡ）concentration in male patients with nonalcoholic fatty liver disease（NAFLD）.Methods：All participants were non-smoking males,including 35 normal controls and 85 NAFLD patients.Fasting serum Ang Ⅱ concentration was measured,insulin resistance（IR）was estimated by homeostasis model assessment of insulin resistance（HOMA-IR）and 10-year CHD risk was assessed by Framingham risk score（FRS）.According to the international diabetes federation criteria for metabolic syndrome（MS）,NAFLD patients were subdivided into MS（＋）and MS（-）groups.According to FRS,NAFLD patients were divided into FRS0 and FRS≥0 groups.Results：Serum AngⅡ concentration was significantly higher in MS（-）and FRS≥0 groups than in control group（P〈0.001）and FRS0 group（P= 0.017）,respectively.There was no significant difference in Ang Ⅱ concentration between MS（＋）and MS（-）groups.FRS was significantly higher in MS（-）than in control group（P=0.035）,significantly higher in MS（＋）group than in MS（-）group（P=0.042）.Ten-year CHD incidence risk ratio was positively associated with fasting plasma insulin,HOMA-IR and serum AngⅡ concentration（r’=0.248,0.335,0.222,P’=0.009,0.001,0.02）.Conclusions：Increased 10-year CHD risk in male NAFLD patients is positively associated with IR and serum AngⅡ concentration.Inhibition of AngⅡ may decrease CHD risk in male NAFLD patients.