非酒精性脂肪性肝病与冠脉斑块稳定性的关系及预后多因素分析

Relationship between nonalcoholic fatty liver disease and coronary plaque stability and risk factors for composite cardiovascular adverse events

背景心血管疾病是威胁人类生命健康的主要疾病,近年来,心血管疾病与非酒精性脂肪性肝病的关系成研究热点,非酒精性脂肪性肝病与冠心病严重程度密切相关,可用于初步评估冠心病心血管事件发生风险.目的探究非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)与冠脉斑块稳定性的关系及预后多因素分析.方法选取2019-01/2021-01于我院接受冠脉CT造影检查的患者320例,根据是否存在NAFLD分为NAFLD组(n=91)和非NAFLD组(n=229),统计比较两组一般资料、冠脉斑块存在情况(斑块存在率、斑块数量),并比较NAFLD组不同脂肪肝变性程度患者冠脉斑块稳定性(软斑块、混合斑块、硬斑块)、冠脉狭窄程度(Gensini评分),通过Spearman相关系数模型分析脂肪肝变性程度与冠脉斑块稳定性、Gensini评分的相关性,所有患者均随访12 mo,统计复合心血管不良事件(冠状动脉血运重建、心肌梗死、全因死亡、心源性死亡)发生情况,比较不同预后患者临床资料,通过Logistic多因素回归模型分析预后影响因素.结果NAFLD组存在冠脉斑块患者比例(76.92%)、冠脉斑块数量≥2个比例(12.09%)均高于非NAFLD组(58.08%、4.37%)(P<0.05);脂肪肝变性程度重度患者软斑块比例、Gensini评分均>中度患者>轻度患者(P<0.05);NAFLD组脂肪肝变性程度与冠脉斑块稳定性、Gensini评分呈正相关关系(P<0.05);发生复合心血管不良事件患者体重指数、糖尿病比例、甘油三酯(triglyceride,TG)水平、NAFLD比例、软斑块比例均高于未发生复合心血管不良事件患者(P<0.05);体重指数、糖尿病、TG水平、NAFLD、软斑块均为复合心血管不良事件发生的独立危险因素(P<0.05).结论NAFLD与心血管疾病(cardiovascular disease,CVD)患者冠脉斑块稳定性及冠脉狭窄程度密切相关,且NAFLD、冠脉斑块不稳定均是预后的危险因素.

BACKGROUND Cardiovascular disease is a major disease threatening human life and health.In recent years,the relationship between cardiovascular disease and non-alcoholic fatty liver disease has become a research hotspot.Non-alcoholic fatty liver disease is closely related to the severity of coronary heart disease,which can be used for preliminary assessment of the risk of cardiovascular events in coronary heart disease.AIM To explore the relationship between non-alcoholic fatty liver disease(NAFLD)and coronary plaque stability and the multivariate analysis of prognosis.METHODS A total of 320 patients who underwent coronary CT angiography at our hospital from January 2019 to January 2021 were selected and divided into an NAFLD group(n=91)and a non-NAFLD group(n=229)according to the presence or absence of NAFLD.The general data and coronary plaque presence(plaque presence rate and plaque number)were compared between the two groups,and coronary plaque stability(soft plaque,mixed plaque,and hard plaque)in NAFLD patients with different degrees of fatty liver degeneration were compared.Spearman correlation was used to analyze the correlation between the degree of fatty liver degeneration and coronary plaque stability and Gensini score.All patients were followed for 12 mo,and composite cardiovascular adverse events(coronary revascularization,myocardial infarction,all-cause death,and cardiac death)were counted.The clinical data of patients with different prognoses were compared,and the prognostic factors were analyzed by multivariate Logistic regression.RESULTS The proportion of patients with coronary plaques(76.92%)and the proportion of patients with≥2 coronary plaques(12.09%)in the NAFLD group were significantly higher than those in the non-NAFLD group(58.08%and 4.37%,respectively,P<0.05).Patients with severe fatty liver degeneration had the highest proportion of soft plaques and Gensini score followed by those with moderate and mild fatty liver degeneration(P<0.05);the degree of fatty liver degeneration in the NAFLD group was positively correlated with coronary plaque stability and Gensini score(P<0.05).Body mass index,proportion of patients with diabetes,TG level,proportion of patients with NAFLD,and proportion of soft plaques in patients with composite adverse cardiovascular events were higher than those in patients without(P<0.05).BMI,diabetes,TG level,NAFLD,and soft plaque were independent risk factors for compound cardiovascular adverse events(P<0.05).CONCLUSION NAFLD is closely related to the stability of coronary plaque and the degree of coronary stenosis in CVD patients,and both NAFLD and coronary plaque instability are prognostic risk factors for composite cardiovascular adverse events.