脂肪肝纤维化评分系统在非酒精性脂肪性肝病人群高风险冠状动脉斑块预测中的价值

NAFLD fibrosis score is associated with high-risk coronary plaque in patients with NAFLD

目的探讨脂肪肝纤维化评分(NFS)系统在非酒精性脂肪性肝病(NAFLD)患者高风险冠状动脉斑块的预测价值。方法回顾性分析2012年1月至2017年12月期间的447名体检者。通过彩超检查诊断脂肪肝;通过计算NFS评价体检者的肝脏纤维化风险;利用冠状动脉计算机断层血管造影评估冠状动脉狭窄程度和高风险斑块。结果223名体检者(46.8%)患有NAFLD。在NAFLD组人群中,中-高NFS组比低NFS组更易出现高风险冠状动脉斑块(62.5%比24.0%)(P<0.001),NFS的最高四分位数(区间4)相比最低四分位数(区间1),高风险冠状动脉斑块风险增加2.24倍(P=0.016);在非NAFLD人群中,NFS和冠状动脉高风险斑块之间无显著关联(P>0.05)。在NAFLD组中,NFS可增加传统心血管疾病风险模型的预测水平,模型曲线下面积由0.679增至0.739(P=0.031);在非NAFLD组中,NFS对传统心血管风险预测模型无改善作用(有、无NFS的模型曲线下面积分别为0.766与0.764,P=0.715)。结论NFS可作为NAFLD患者冠状动脉斑块风险的预测指标。

Objective To investigate the possible role of non-invasive fibrosis scoring systems for detecting high-risk plaque among patients with non-alcoholic fatty liver disease(NAFLD).Methods A total of 477 consecutive asymptomatic subjects underwent a health checkup including coronary computed tomography angiography(CTA)and abdominal ultrasonography.Fatty liver was evaluated using ultrasonography,and the NAFLD fibrosis score(NFS)was calculated.Coronary stenosis and plaque were evaluated using coronary CTA.Results Of the study population,223 had NAFLD.Among the NAFLD patients,high-risk coronary plaque was more frequent in patients with high or intermediate NFS than those with low NFS(62.5%versus 24.0%,P<0.001).The adjusted odds ratio with 95%confidence interval of high-risk plaque was 3.24(1.11-9.40)for the highest versus lowest quartile of NFS(P=0.016).Among those without NAFLD,NFS was not associated with high-risk coronary plaque(C-statistic with NFS versus without NFS,0.766 versus 0.764,P=0.715).Adding NFS to the traditional cardiovascular disease(CVD)risk model increased the C-statistics by 0.679 to 0.739(P=0.031).Conclusions There was an independent association of NFS with high-risk coronary plaque in patients with NAFLD,suggesting its potential use to optimize management of patients with NAFLD.