颅内出血患者合并非酒精性脂肪性肝病情况分析

Prevalence of nonalcoholic fatty liver diseases in patients with intracerebral hemorrhage

目的回顾颅内出血(ICH)患者合并非酒精性脂肪性肝病(NAFLD)情况并分析其危险因素。方法2010年1月~2020年6月我院收治的ICH患者146例,使用超声检查诊断脂肪性肝病,采用单因素和多因素Logistic回归分析,明确合并NAFLD的危险因素。结果在本组146例ICH患者中,经超声检查发现NAFLD者52例(35.6%);合并NAFLD组2型糖尿病(T2DM)发生率为32.7%,显著高于非NAFLD组的12.8%(P<0.05),NAFLD组BMI为(25.4±2.4)kg/m 2,显著高于非NAFLD组【(23.1±2.7)kg/m 2,P<0.05】,NAFLD组血清高密度脂蛋白(HDL)为(1.4±0.5)mmol/L,甘油三酯(TG)为(4.2±1.6)mmol/L,与非NAFLD组【分别为(1.8±0.5)mmol/L和(2.2±1.1)mmol/L】比,差异具有统计学意义(P<0.05),NAFLD组血肿量>30ml的比率为75.0%,显著高于未合并NAFLD组的39.4%(P<0.05),NAFLD组格拉斯哥昏迷(GCS)评分≤10分的比率为67.3%,显著高于非NAFLD组的37.2%(P<0.05),而两组合并高血压、吸烟、心血管疾病、血管畸形、血清FPG、ALT、AST和感染的比率无统计学差异(P>0.05);多因素Logistic回归分析结果提示合并T2DM、血肿量大和GCS评分低是ICH患者伴有NAFLD的独立危险因素,而血清HDL则是ICH患者不伴有NAFLD的保护性因素(P<0.05)。结论NAFLD人群可能更容易发生ICH,可能与合并存在的高脂血症、糖尿病和血管病变有关。因此,应该加强对NAFLD人群的筛查和监测,以防止心脑血管疾病的发生,提高生存质量。

Objective The aim of this study was to investigate the prevalence of nonalcoholic fatty liver diseases(NAFLD)in patients with intracerebral hemorrhage(ICH).Methods A total of 146 patients with ICH were treated in our hospital between January 2010 and June 2020,and all underwent sonography for the diagnosis of NAFLD.The univariate and multivariate Logistic regression analysis was applied to confirm the factors for NAFLD coexistence.Results Out of our series,52 patients(35.6%)were found with underlying NAFLD;the percentage of type two diabetes mellitus(T2DM)in patients with NAFLD was 32.7%,significantly higher than 12.8%(P<0.05)in patients without NAFLD,the body mass index in patients with NAFLD was(25.4±2.4)kg/m 2,significantly higher than[(23.1±2.7)kg/m 2,P<0.05]in patients without NAFLD,the blood high-density lipoprotein(HDL)level in patients with NAFLD was(1.4±0.5)mmol/L,significantly lower than(1.8±0.5)mmol/L in patients without NAFLD,the blood triglyceride level was(4.2±1.6)mmol/L,significantly higher than[(2.2±1.1)mmol/L,P<0.05]in patients without NAFLD,the percentage of large intracerebral bleeding volume in patients with NAFLD was 75.0%,significantly higher than 39.4%(P<0.05)in patients without NAFLD,and the percentage of lowGlasgow coma score(GCS)in patients with NAFLD was 67.3%,significantly higher than 37.2%(P<0.05)in patients without NAFLD,while there were not significant differences as respect to the percentages of high blood pressure,smoking,cardiovascular diseases,vascular malformation,increased fasting plasma glucose,serum alanine aminotransferase and aspartate aminotransferase,and infection between the two groups(P>0.05);multivariate Logistic analysis showed that coincidence of T2DM,large intracerebral bleeding and lower GCS were the independent risk factors for underlying NAFLD in this circumstance,and normal blood HDL level was the protective factor for patients without NAFLD(P<0.05).Conclusions The presence of T2DM,intracerebral hematoma volume greater than 30 ml and GCS score less than 10 in patients with ICH might hints the presence of NAFLD,which remind the clinicians dealing appropriately with them in clinical practice.