非酒精性脂肪性肝病与急性脑梗塞相关性临床分析

Risk of acute ischemic stroke in patients with non-alcoholic fatty liver diseases

目的探讨非酒精性脂肪性肝病（NAFLD）与急性缺血性脑卒中（脑梗塞）的相互关系及其影响因素。方法选择2013年1月-11月在上海交通大学医学院附属新华医院进行头颅磁共振和扩散加权成像（DWI）,以及腹部超声检查的住院患者481例,年龄13-93岁（66.5±13.5）岁,其中NAFLD患者225例,急性脑梗塞患者218例。使用GE H Dx twin speed 3.0 T磁共振仪行头颅MRI/DWI检查。通过生化指标、颈部血管超声、采用美国国立卫生研究院卒中神经功能缺损评分量表（NIHSS）等评估,分析NAFLD与急性脑梗塞的相关性。结果 NAFLD合并与未合并脑梗塞患者年龄分别为（68.49±10.88）岁和（62.83±11.68）岁,24 h平均收缩压为（152.11±14.69）mm Hg和（139.76±20.19）mm Hg,ALT为（23.69±14.8）U/L和（29.34±17.89）U/L,糖化血红蛋白为（7.03±1.86）%和（6.33±1.35）%,空腹血糖为（7.14±2.61）mmol/L和（6.15±1.89）mmol/L,餐后两小时血糖为（11.33±4.45）mmol/L和（8.7±3.24）mmol/L,两组间差异均有统计学意义（P〈0.05）;采用二项Logistic多元回归分析发现24 h平均收缩压（OR 1.028,95%CI 1.005-1.052）、年龄（OR 1.054,95%CI 1.013-1.097）、空腹血糖（OR 1.338,95%CI 1.039-1.723）与NAFLD患者发生脑梗塞独立相关;急性脑梗塞合并与未合并NAFLD患者GGT分别为（34.75±30.98）U/L和（26.21±16.62）U/L,总胆固醇为（12.26±7.72）mmol/L和（4.43±1.03）mmol/L,甘油三酯为（1.82±0.92）mmol/L和（1.26±0.6）mmol/L,低密度脂蛋白为（2.97±0.79）mmol/L和（2.73±0.71）mmol/L,糖化血红蛋白为（7.03±1.86）%和（6.32±1.34）%,空腹血糖为（7.14±2.61）mmol/L和（6.38±2.13）mmol/L,餐后2小时血糖为（11.33±4.45）mmol/L和（9.66±4.23）mmol/L,两组间差异有统计学意义（P〈0.05）;采用二项Logistic多元回归分析显示血液糖化血红蛋白（OR 1.468,95%CI 1.057-2.04）和甘油三酯水平（OR 2.479,95%CI 1.375-4.468）是脑梗塞患者合并NAFLD的独立危险因素。结论收缩压、年龄、空腹血糖升高为NAFLD患者发生脑梗塞的危险因素,而高甘油三酯血症和高血糖为急性脑梗塞患者合并NAFLD的危险因素。

Objective To explore the relationship between non-alcoholic fatty liver diseases （NAFLD） and acute ischemic stroke and their risk factors. Method A total of 481 in-hospital patients without alcohol abuse at the Xinhua Hospital affiliated to Shanghai Jiaotong University from January 2013 to November 2013,who had gone through both cranial magnetic resonance image （MRI） plus diffusion weighted imaging （DWI） and abdominal ul-trasonography,were enrolled. Among them,225 patients had NAFLD and 218 were diagnosed with acute ischemic stroke. Correlation analysis of the association between NAFLD and acute ischemic stroke was carried out by study-ing fasting plasma biochemical indexes,results of carotid vascular ultrasonography and American National Institutes of Health Stroke Scale （NIHSS） scores. Results In our study,the mean age of NAFLD patients with or without acute ischemic stroke were （68.49 ±10.88） yr and （62.83±11.68） yr,respectively. There existed statistic difference between the two groups in 24-hour average systolic pressure[（152.11±14.69）mmHg vs（. 139.76± 20.19） mmHg],ALT[（23.69±14.8） U/L vs. （29.34± 17.89）U/L],HbA1c[（7.03±1.86）vs（. 6.33±1.35）%], fasting blood glucose levels[（7.14±2.61） vs. （6.15± 1.89） mmol/L] and 2 h postprandial blood glucose [（11.33±4.45）vs. （9.66±4.23） mmol/L],P〈0.05 for all. Binomial Logistic multivariate regression analysis identified 24-hour average systolic pressure （OR 1.028,95% CI 1.005-1.052）,age （OR 1.054,95%CI 1.013-1.097）,and fasting blood glucose （OR 1.338,95%CI 1.039-1. 723） were independently associated with the occurrence of acute ischemic stroke in NAFLD patients. Differences existed between acute ischemic stroke patients with or without NAFLD in serum levels of GGT [（34.75±30.98） U/L vs.（26.21±16.62）U/L],total cholesterol [（12.26±7.72）mmol/L vs（. 4.43±1.03）mmol/L],triglycerides[（1.82± 0.92） mmol/L vs. （1.26±0.6）mmol/L],LDL-C[（2.97±0.79） mmol/L vs.（2.73±0.71） mmol/L],HbA1c[（7.03±1.86） vs.（6.32±1.34）%],fasting blood glucose [（7.14±2.61） mmol/L vs.（6.38±2.13） mmol/L] and 2 h postprandial blood glucose [（11.33±4.45） mmol/L vs.（9.66±4.23） mmol/L],P〈0.05 for all. Binomial Logistic multivariate regression analysis revealed HbA1c （OR 1.468,95%CI 1.057-2.04） and triglycerides （OR 2.479,95%CI 1.375-4.468） were independent risk factors for the occurrence of NAFLD in acute ischemic stroke patients. Conclusion This study suggests that advanced age,elevated systolic pressure and fasting blood glucose are risk factors for NAFLD patients developing acute ischemic stroke,and hypertriglyceridemia and hyperglycemia are risk factors for acute ischemic stroke patients with underlying NAFLD.