血清游离脂肪酸水平与非酒精性脂肪性肝病及颈动脉内膜中层厚度的相关研究

Association of free fatty acid with non-alcoholic fatty liver disease and carotid artery intima-media thickness

目的 探讨血清游离脂肪酸水平与非酒精性脂肪性肝病（NAFLD）及颈动脉内膜中层厚度（CIMT）的关系。方法 入选402例具备完整的问卷、体格检查、血压、糖脂代谢、游离脂肪酸水平及肝脏超声、颈动脉超声结果的男性。以空腹游离脂肪酸水平四分位点将研究对象分为Q1-Q4四组，比较各组临床参数。NAFLD的诊断采用中华医学会肝病学分会2010年NAFLD诊疗指南的标准；代谢综合征采用2007年中国成人血脂异常防治指南的标准。结果 （1）与非NAFLD组比较，NAFLD组体重指数、腰围、血压、血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、肝酶、胰岛素、稳态模型评估的胰岛素抵抗指数（HOMA-IR）、CIMT及游离脂肪酸水平均明显升高（均P＜0.05），而高密度脂蛋白胆固醇降低（P＜0.01）。（2）与空腹游离脂肪酸水平处于Q1组比较，Q4组收缩压、血糖、总胆固醇、甘油三酯、肝酶、餐后2 h胰岛素、餐后2 h游离脂肪酸明显升高（均P＜0.05），NAFLD频率亦显著升高（P＜0.01）。（3）Logistic回归分析显示，空腹游离脂肪酸、HOMA-IR、体重指数及谷丙转氨酶是NAFLD的独立影响因素（β=0.001,0.253,0.312,0.043, 均P＜0.05）。结论 空腹游离脂肪酸水平与男性NAFLD独立相关，NAFLD患者CIMT增厚。

Objective To study the relationship of free fatty acid（FFA）with non-alcoholic fatty liver disease（NAFLD）and carotid intima-media thickness（CIMT）. Methods Four hundred and two male individuals with complete data on questionnaire, physical examination, blood pressure, plasma glucose, lipid profiles, and FFA underwent liver ultrasound scan and carotid ultrasound scan were divided into four groups according to fasting FFA quartile. NAFLD was diagnosed according to NAFLD clinic guide（2010）and metabolic syndrome was diagnosed according to the Guideline on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults（2007）. Results （1）Compared with non-NAFLD group, subjects in NAFLD group had significantly higher body mass index, waist circumference, blood pressure, fasting plasma glucose, and 2 h postprandial glucose, total cholesterol, triglycerides, low density lipoprotein-cholesterol, liver enzymes, fasting insulin, 2 h postprandial insulin, homeostasis model assessment for insulin resistance（HOMA-IR）, CIMT, fasting and 2 h postprandial FFA（all P〈0.05）, while the level of high density lipoprotein-cholesterol was decreased（P〈0.01）. （2）Compared with those in the lowest quartiles of fasting FFA, subjects in the highest quartile had significantly higher level of systolic blood pressure, fasting plasma glucose, 2 h postprandial glucose, total cholesterol, triglycerides, liver enzymes, 2 h postprandial insulin, 2 h postprandial FFA（all P〈0.05）, and frequency of NAFLD was also increased（P〈0.01）. （3）Logistic regression analysis showed that fasting FFA, HOMA-IR, body mass index, and alanine aminotransferase were independently correlated with NAFLD after adjustment of other parameters（β=0.001,0.253,0.312,0.043, respectively, all P〈0.05）. Conclusions Fasting FFA was independently and positively associated with NAFLD. CIMT level was higher in patients with NAFLD.