代谢综合征与脂肪肝对老年人亚临床动脉粥样硬化相关指标的影响

Effects of metabolic syndrome with non-alcoholic fatty liver disease on subclinical atherosclerosis in elderly patients

目的：探讨代谢综合征（ MS）和非酒精性脂肪肝（ NAFLD）对老年患者颈动脉中层厚度（ CIMT）、肱踝脉搏波传导速度（ baPWV ）、踝臂指数（ ABI ）等亚临床动脉粥样硬化指标的影响。方法针对235例住院非冠心病老年患者（年龄≥60岁）的横断面研究。设计标准化的问卷调查及体格检查采集年龄、性别、身高、体重、腰围、血压和生活方式等指标，使用全自动生化分析仪检测空腹血糖（FBG）、血脂、同型半胱氨酸（Hcy）、胱抑素C、尿酸等生化指标，通过超声检测脂肪肝、CIMT，采用动脉硬化检测仪测定baPWV、ABI。结果患者年龄、性别、肝功能、吸烟、饮酒和运动情况等基线临床资料的组间差异无统计学意义。MS组与对照组比较，CIMT、baPWV差异有统计学意义[（1．10±0．02）mm比（0．99±0．01）mm，P＜0．01；（1630±34）cm／s比（1480±23）cm／s，P＜0．01]；NAFLD组与对照组比较，CIMT、baPWV及ABI差异有统计学意义[（1．10±0．02）mm比（1．00±0．01）mm，P＜0．01；（1665±40）cm／s比（1475±20）cm／s，P＜0．01；1．07±0．02比1．13±0．01，P＜0．01]。相关分析显示，CIMT与BMI、收缩压（ SBP）、FBG、Hcy、胱抑素C及尿酸等多个心血管危险因素相关，baPWV与BMI、SBP、FBG相关，而ABI仅与血脂指标相关。多元Logistic回归分析结果提示，校正混杂因素后，MS或NAFLD不是 baPWV 的独立危险因素，而MS 合并 NAFLD既是 CIMT 的危险因素（ OR：3．72，95％CI：1．42～9．70），又是baPWV的危险因素（OR＝3．43，95％CI：1．31～9．01）。结论 MS与NAFLD对非冠心病老年患者亚临床动脉粥样硬化有协同作用，MS合并NAFLD的老年患者需加强心血管疾病预防。

Objective To explore the relationship between metabolic syndrome （ MS ） with non-alcoholic fatty liver disease（NAFLD）and markers of subclinical atherosclerosis in elderly patients ,including carotid intima-media thickness （ CIMT ） , brachial-ankle pulse wave velocity （ baPWV ） and ankle-brachial pressure index（ABI）. Methods A total of 235 elderly participants without coronary artery disease were enrolled in this cross-sectional study.The indexes such as age, gender, height, weight, body mass index （ BMI ） , waist circumference and blood pressure were collected through standardized questionnaire and physical examination.The biochemical indicators including serum fasting blood glucose （FBG）,blood lipids, homocysteine（Hcy）,cystatin C and uric acid were measured by biochemical analyzer .CIMT and NAFLD were detected by ultrasound and baPWV ,and ABI was determined by automatic arteriosclerosis measurement system.The association between MS , NAFLD and markers of subclinical atherosclerosis was assessed using multiple logistic regression analysis after adjusting for multiple cardiometabolic risk variables . Results There were no significant differences in baseline clinical data including age , gender , lifestyle information（smoking and alcohol consumption ）,physical activity etc.between groups.The differences in CIMT and baPWV were statistically significant between MS group and control group [（1.10 ±0.02）mm vs. （0.99 ±0.01）mm,（1 630 ±34）cm/s vs.（1 480 ±23）cm/s,both P〈0.01].The differences in CIMT, baPWV and ABI were statistically significant between NAFLD group and control group [（1.10 ±0.02）mm vs.（1.00 ±0.01）mm,（1 665 ±40）cm/s vs.（1 475 ±20）cm/s,1.07 ±0.02 vs.1.13 ±0.01,both P〈0.01] .CIMT and baPWV were found to be significantly correlated with multiple cardiometabolic risk variables,whereas ABI was only associated with blood lipids parameters .Multivariate logistic regression analysis suggested that after adjusting for potential confounding factors ,MS or NAFLD was not associated with subclinical atherosclerosis as defined by baPWV .However, individuals with both MS and NAFLD had a significantly higher risk of subclinical atherosclerosis as defined by CIMT （OR：3.72,95%CI：1.42-9.70）or baPWV（ OR：3.43, 95%CI：1.31-9.01 ） compared to normal subjects , even after adjusting for potential confounders. Conclusions The results show that MS and NAFLD have a synergistic impact on the subclinical atherosclerosis .Cardiovascular disease prevention should be strengthened in elderly patients with MS combined with NAFLD.