非酒精性脂肪性肝病合并代谢综合征患者血管内皮功能及其影响因素分析

Vascular endothelial function and related risk factors in patients with nonalcoholic fatty liver disease and metabolic syndrome

目的比较非酒精性脂肪性肝病(NAFLD)合并代谢综合征(MS)患者与单纯NAFLD患者内皮功能差异,并分析其影响因素。方法 2015年1月至2015年10月在新疆医科大学第一附属医院住院并诊断为NAFLD,除外合并动脉粥样硬化终末期脏器损伤后,91例患者被分为A组(单纯NAFLD组)和B组(NAFLD合并MS组),收集临床资料;采用Endo-PAT 2000检测仪无创测定指端反应性充血指数(RHI);采用二项Logistic多元回归分析影响内皮功能的因素。结果 52例A组与39例B组RHI差异有统计学意义(1.63±0.29对1.81±0.29,P<0.01);A组腰围(92.75±9.10)cm、体质指数(25.99±2.98)kg/m^2、收缩压(117.87±15.08)mm Hg、空腹血糖(5.08±0.89)mmol/L和甘油三脂(1.46±0.65)mmol/L均显著低于B组【(101.64±10.86)cm、(28.07±3.97)kg/m^2、(127.41±12.03)mm Hg、(6.87±2.90)mmol/L和(2.69±2.22)mmol/L,P<0.05】,而A组高密度脂蛋白胆固醇(1.26±0.34)mmol/L、天门冬氨酸氨基转移酶(62.48±9.79)U/L和丙氨酸氨基转移酶(93.04±19.56)U/L均显著高于B组【(0.93±0.30)mmol/L、(37.70±10.45)U/L和(55.39±15.59)U/L,P<0.01】;Logistic回归分析显示空腹血糖(OR=1.34)、游离脂肪酸(OR=5.58)和丙氨酸氨基转移酶(OR=1.04)为NAFLD患者内皮功能障碍的独立危险因素。结论 NAFLD合并MS患者与单纯NAFLD患者内皮功能存在差异,影响NAFLD患者内皮功能的多个因素与糖脂代谢和肝脏炎症相关。

Objective To compare the differences of vascular endothelial functions between patients with nonalcoholic fatty liver disease （NAFLD） and metabolic syndrome （MS） and with NAFLD without MS,and to analyze the related risk factors. Methods Clinical data of the hospitalized patients with NAFLD between January 2015 and October 2015 in the First Affiliated Hospital of Xinjiang Medical University were collected. 91 patients were divided into group A （NAFLD without MS） and group B （NAFLD with MS）. Reactive hyperemia index （RHI） in fingers was measured by Endo-PAT2000. A binary logistic regression analysis was performed to define the risk factors for the endothelial dysfunction in patients with NAFLD. Results The levels of RHI in group A （n=52） were lower than in group B （n=39）（1.63±0.29 vs. 1.81±0.29,P〈0.01）;The levels of waistline,BMI,systolie blood pressure,fasting plasma glucose and triglycerides in group A [（92.75±9.10） cm, （25.99±2.98） kg/m^2, （117.87±15.08） mmHg,（5.08±0.89） mmol/L and （1.46±0.65） mmol/L] were much lower than those [（101.64±10.86） cm, （28.07±3.97） kg/m^2, （127.41±12.03） mmHg,（6.87±2.90） mmol/L and （2.69±2.22） mmol/L] in group B （P〈0.05）;But the levels of high density lipoprotein cholesterol,aspartate aminotransferase and alanine aminotransferase in group A [（1.26±0.34） mmol/L,（62.48±9.79） U/L and （93.04±19.56） U/L] were higher than those [（0.93±0.30） mmol/L,（37.70±10.45） U/L and （55.39±15.59） U/L] in group B （P〈 0.05 ） ; Fasting plasma glucose, free fatty acid and alanine aminotransferase were the risk factors for endothelial dysfunction in patients with NAFLD （OR=1.34,OR= 5.58,OR=1.04）. Conclusion The RHI in patients with NAFLD is lower than in patients with NAFLD and MS. Several risk factors for the endothelial dysfunction in patients with NAFLD are associated with glucose and lipid metabolic disorders and liver inflammation.