非酒精性脂肪性肝病患者动脉僵硬度的变化及其影响因素分析

Changes of arterial stiffness in patients with nonalcoholic fatty liver diseases

目的研究不同年龄段非酒精性脂肪性肝病（NAFLD）患者外周动脉僵硬度的变化,探讨影响动脉僵硬度增高的相关危险因素。方法根据超声检查是否存在脂肪肝将2382例健康体检者分为NAFLD组和无NAFLD组。使用欧姆龙BP-203RPE III动脉硬化检测装置同时检测左右两侧肱踝脉搏波传导速度（ba PWV）值。以ba PWV≥1400 cm/s为动脉僵硬度增高,采用Logistic回归分析影响动脉僵硬度增高的危险因素。结果在2382例体检者中,发现NAFLD患者935例（39.3%）,在1595例男性中,检出NAFLD患者726例（45.5%）,在787例女性中,检出NAFLD患者209例（26.6%,P〈0.001）;20～39岁年龄段NAFLD组ba PWV水平为（1340.0±180.7）cm/s,显著高于无NAFLD组【（1203.9±155.2）cm/s,P〈0.001】;40～59岁年龄段NAFLD组ba PWV水平为（1437.1±232.6）cm/s,显著高于无NAFLD组【（1355.8±217.9）cm/s,P〈0.001】;大于60岁年龄段NAFLD组ba PWV水平为（1885.8±404.0）cm/s,与无NAFLD组的ba PWV水平【（1830.2±430.6）cm/s】无统计学差别（P〉0.05）;不同性别NAFLD对ba PWV增高发生率的影响不同,以女性患NAFLD对ba PWV影响较大;在1643例血压正常者,采用二分类Logistic回归分析发现,年龄、性别、NAFLD和血清总胆固醇为ba PWV升高的独立危险因素。结论 NAFLD患者较无NAFLD人群动脉僵硬度增高,以青中年NAFLD患者增高更为明显。NAFLD为动脉僵硬度增高的独立危险因素。

Objective To investigate the changes and risk factors of arterial stiffness in patients with nonalcoholic fatty liver diseases（NAFLD）. Methods A total of 2,382 healthy persons were enrolled for physical examination,and the NAFLD was diagnosed by ultrasound monitoring. Brachial ankle pulse wave velocity（ba PWV）was determined by a domestic BP-203 RPE III arterial stiffness detector,and the ba PWV level≥1400 cm/s was arbitrarily believed as the increase of arterial stiffness. Risk factors of ba PWV elevation were assessed by using logistic regression analysis. Results Overall,The prevalence of NAFLD was 39.3% among 2382 subjects,45.5% in1595 men and 26.6% in 787 women,respectively;In individuals between 20 to 39 years old,the ba PWV level was significantly higher in NAFLD group than in those without NAFLD [（1340.0±180.7） cm/s vs（1203.9±155.2）cm/s,P〈0.001],and the increases ba PWV rate was 31.4% vs. 10.5%（P〈0.001）;In individuals between 40 to 59 years old,the ba PWV was also significantly different between NAFLD patients and non-NAFLD subjects [（1437.1±232.6） cm/s vs.（1355.8±217.9） cm/s,P〈0.001],and the increased ba PWV rate was 50.1% vs. 33.1%（P〈0.001）;However,such difference was not significant among 330 cases over 60 years old;In addition,the effect of NAFLD on ba PWV increase was higher in female patients than in males;Logistic analysis showed that NAFLD,age,gender and serum total cholesterol levels were independent risk factors for ba PWV increase in individuals with normal blood pressure. Conclusion The ba PWV level is higher in individuals with NAFLD,especially in middle-aged ones. NAFLD is an independent risk factor for the ba PWV elevation.