非酒精性脂肪性肝病患者动脉粥样硬化性心血管疾病的影响因素研究

Influencing Factors of Atherosclerotic Cardiovascular Disease in Patients with Non-alcoholic Fatty Liver Disease

背景动脉粥样硬化性心血管疾病(ASCVD)易导致非酒精性脂肪性肝病(NAFLD)患者预后不良、病死率升高等,因此探讨NAFLD患者ASCVD的影响因素具有重要意义。目的探讨NAFLD患者ASCVD的影响因素。方法选取2016年1月-2017年1月在南京中医药大学附属医院门诊就诊或住院的NAFLD患者405例,其中未合并ASCVD者269例(对照组)、合并ASCVD者136例(观察组)。比较两组患者一般资料和实验室检查指标;NAFLD患者ASCVD的影响因素分析采用多因素Logistic回归分析。结果(1)两组患者男性比例、年龄、体质指数(BMI)及血清碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、尿素氮、肌酐、总胆固醇(TC)、低密度脂蛋白(LDL)、铁蛋白水平比较,差异无统计学意义(P>0.05);观察组患者糖尿病发生率、高血压发生率、吸烟率及血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿酸、三酰甘油(TG)、超敏C反应蛋白(hs-CRP)水平高于对照组(P<0.05)。(2)多因素Logistic回归分析结果显示,糖尿病〔OR=1.982,95%CI(1.197,3.281)〕、高血压〔OR=1.679,95%CI(1.013,2.783)〕及血清ALT〔OR=1.020,95%CI(1.012,1.028)〕、尿酸〔OR=1.002,95%CI(1.000,1.005)〕、hs-CRP〔OR=1.012,95%CI(1.003,1.022)〕是NAFLD患者ASCVD的独立影响因素(P<0.05)。结论合并糖尿病、高血压及血清ALT、尿酸、hs-CRP水平升高的NAFLD患者易发生ASCVD,应引起临床重视。

Background Atherosclerotic cardiovascular disease(ASCVD)may lead to poor prognosis and increased mortality in patients with non-alcoholic fatty liver disease(NAFLD),therefore it is of important significance to investigate the influencing factors ASCVD in patients with NAFLD. Objective To investigate the influencing factors ASCVD in patients with NAFLD. Methods A total of 405 outpatients and inpatients with NAFLD were selected in the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2016 to January 2017,thereinto 269 cases did not merged with ASCVD were served as control group,the other 136 cases merged with ASCVD were served as observation group. General information and laboratory examination results were compared between the two groups,and multivariate Logistic regression analysis was used to analyze the influencing factors of ASCVD in patients with NAFLD. Results(1)There was no statistically significant difference in male ratio,age,BMI,serum levels of ALP,GGT,BUN,Cr,TC,LDL or ferritin between the two groups(P>0.05),while incidence of diabetes mellitus,hypertension,smoking rate,serum levels of ALT,AST,UA,TG and hs-CRP in observation group were statistically significantly higher than those in control group(P<0.05).(2)Multivariate Logistic regression analysis results showed that,diabetes mellitus〔OR=1.982,95%CI(1.197,3.281)〕,hypertension〔OR=1.679,95%CI(1.013,2.783)],serum levels of ALT[OR=1.020,95%CI(1.012,1.028)],UA[OR=1.002,95%CI(1.000,1.005)]and hs-CRP[OR=1.012,95%CI(1.003,1.022)]were independent influencing factors of ASCVD in patients NAFLD(P<0.05). Conclusion Risk of ASCVD is relatively high in NAFLD patients merged with diabetes mellitus and hypertension,with elevated serum levels of ALT,UA and hs-CRP,which should be pay more clinical attentions to.