非酒精性脂肪性肝病与2型糖尿病患者主动脉瓣硬化的关系研究

Relationship between Non-alcoholic Fatty Liver Disease and Aortic Valve Sclerosis in Patients with Type 2 Diabetes Mellitus

目的探讨非酒精性脂肪性肝病(NAFLD)与2型糖尿病(T2DM)患者主动脉瓣硬化(AVS)的关系。方法选取延安大学附属东关分院2013年5月—2015年12月收治的T2DM患者176例,根据主动脉瓣超声检查结果分为无AVS患者124例和AVS患者52例,根据肝脏超声检查结果分为无NAFLD患者59例、轻度NAFLD患者41例和中重度NAFLD患者76例。比较有无AVS患者一般资料、实验室检查指标、心功能指标、NAFLD发生率及药物使用情况,比较不同严重程度NAFLD患者AVS发生率;采用多因素logistic回归模型分析T2DM患者AVS的影响因素。结果有无AVS患者年龄、性别、体质指数(BMI)、吸烟率、腰围、糖尿病病程、收缩压、舒张压、血清低密度脂蛋白胆固醇(LDL-C)水平、血清丙氨酸氨基转移酶(ALT)水平、血清γ-谷氨酰转移酶(GGT)水平、左心室质量指数、左心室射血分数及左心室舒张早期峰值血流速度/舒张晚期峰值血流速度比值(E/A比值)比较,差异无统计学意义(P>0.05);AVS患者高血压发生率、血清Hb A1c和三酰甘油(TG)水平、左房室瓣环钙化(MAC)发生率及NAFLD发生率高于无AVS患者,血清高密度脂蛋白胆固醇(HDL-C)低于无AVS患者(P<0.05)。中重度NAFLD和轻度NAFLD患者AVS发生率高于无NAFLD患者,中重度NAFLD患者AVS发生率高于轻度NAFLD患者(P<0.05)。多因素logistic回归分析结果显示,TG〔OR=8.34,95%CI(1.49,46.53)〕、NAFLD〔OR=3.11,95%CI(4.55,50.30)〕是T2DM患者AVS的危险因素,HDL-C〔OR=0.22,95%CI(0.05,0.94)〕是T2DM患者AVS的保护因素(P<0.05)。结论 NAFLD是T2DM患者AVS的危险因素,临床应加以重视并采用积极、有效的防治措施。

Objective To investigate the relationship between non -alcoholic fatty liver disease （NAFLD） and aortic valve sclerosis （AVS） in patients with type2 diabetes mellitus （T2DM）. Methods A total of 176 patients with T2DM were selected in Dongguan Branch Hospieal Affiliated to Yan＇an University from May 2013 to December 2015, and they were divided into A1 group （did not complicate with AVS, n = 124） and A2 group （ complicated with AVS, n = 52） according to aortic ultrasound examination results, into B1 group （ without NAFLD, n = 59 ）, B2 group （ with mild NAFLD, n = 41 ） and B3 group （with moderate to severe NAFLD, n = 76 ） according to liver ultrasound examination results. General information, laboratory examination results, index of cardiac function, incidence of NAFLD and medication situation were compared between A1 group and A2 group; incidence of VAS was compared among B1 group, B2 group and B3 group; influencing factors of VAS in patients with T2DM were analyzed by multivariate logistic analysis. Results No statistically significant differences of age, gender, BMI, smoking rate, waistline, course of diabetes, SBP, DBP, serum level of LDL-C, ALT or GGT, LVMI, LVEF or E/A ratio was found between A1 group and A2 group （P 〉 0. 05） ; incidence of hypertension, mitral annulus calcification （MAC） and NAFLD, serum levels of HbAlo and TG of A1 group were statistically significantly higher than those of A2 group, while serum HDL-C level of A1 group was statistically significantly lower than that of A2 group （P 〈 0. 05 ）. The incidence of AVS of B3 group and B2 group was statistically significantly higher than that of B1 group, respectively, meanwhile incidence ofAVS of B3 group was statistically significantly higher than that of B2 group （P 〈 0. 05 ）. Multivariate logistic regression analysis results showed that, TG [ OR = 8.34, 95% CI （ 1.49, 46. 53 ） ] and NAFLD [ OR = 3. 11, 95% CI （4. 55, 50. 30） ] are risk factors of AVS in patients with T2DM, while HDL-C [ OR = 0. 22, 95% CI （0. 05, 0. 94） ] was the protective factor （ P 〈 0.05）. Conclusion NAFLD is one of risk factors of AVS in patients with T2DM, which should be pay more attention to and take effective prevention and treatment measures. [