肝脏脂肪变及肝纤维化与冠状动脉病变程度的关系

Relation of hepatic steatosis and fibrosis with the lesion extension of coronary artery

目的探讨肝脏脂肪变、肝纤维化与冠状动脉病变程度的关系。方法纳入243例首次接受冠状动脉造影的患者,收集患者一般资料及入院时的实验室检查指标。根据患者的冠状动脉造影结果,将患者分为冠心病组和非冠心病组。分别用Gensini评分、血管评分评估患者的冠状动脉病变程度;使用FibroTouch检测患者的脂肪衰减参数(FAP)和肝脏硬度测定(LSM)值以评估肝脏脂肪病变、肝纤维化情况。比较冠心病组和非冠心病组的临床特征、FAP值和LSM值,并比较不同临床特征患者的Gensini评分、血管评分。采用多元线性回归模型分析患者Gensini评分、血管评分的影响因素。结果(1)243例患者中,174例被诊断为冠心病。非冠心病组与冠心病组患者的年龄、性别、腰围、吸烟情况、合并糖尿病和高血压情况,空腹血糖水平、HbA1c水平、HDL水平、ALT水平、AST水平、谷氨酰转移酶(GGT)水平,以及FAP值、LSM值比较,差异均有统计学意义(均P<0.05)。(2)不同年龄、性别、腰围、吸烟情况、合并糖尿病和高血压情况、空腹血糖水平、HbA1c水平、HDL水平、ALT水平、AST水平、GGT水平、FAP值、LSM值的患者之间,Gensini评分和血管评分差异均有统计学意义(均P<0.05)。(3)多元线性回归分析结果显示,校正相关混杂因素后,FAP值是Gensini评分的影响因素,FAP值、LSM值均是血管评分的影响因素(均P<0.05)。结论肝脏脂肪变、肝纤维化与冠状动脉病变狭窄程度有关,较高的FAP值和LSM值意味着存在冠状动脉病变甚至严重的冠状动脉病变。

Objective To investigate the relation of hepatic steatosis and fibrosis with the lesion extension of coronary artery.Methods A total of 243 patients undergoing coronary angiography for the first time were enrolled.The general data and laboratory examination indices at admission were collected.The patients were assigned to coronary heart disease group or non-coronary heart disease group according to the results of coronary angiography.The lesion extension of coronary artery was evaluated by the Gensini and vascular scores,respectively.The FibroTouch was employed to detect fat attenuation parameter(FAP)and liver stiffness measurement(LSM)values for evaluating hepatic steatosis and fibrosis conditions.The clinical features,FAP and LSM values were compared between the coronary heart disease group and the non-coronary heart disease group,and the Gensini and vascular scores were compared between the patients with different clinical features.The influencing factors for patients′Gensini and vascular scores were analyzed by the multivariate linear regression model.Results(1)Among 243 patients,174 patients were diagnosed as coronary heart disease.There were statistically significant differences in ages,genders,waistlines,and conditions of smoking,concomitant diabetes mellitus and hypertension,as well as the levels of fasting blood glucose,HbA1c,HDL,ALT,AST,gamma-glutamyl transferase(GGT),and FAP and LSM values between the non-coronary heart disease group and coronary heart disease group(all P<0.05).(2)There were statistically significant differences in the Gensini and vascular scores between the patients with different ages,genders,waistlines,and conditions of smoking and concomitant diabetes mellitus and hypertension,as well as the levels of fasting blood glucose,HbA1c,HDL,ALT,AST and GGT,and FAP and LSM values(all P<0.05).(3)The results of multivariate linear regression analysis revealed that after adjusting for relevant confounding factors,FAP value was the influencing factor for the Gensini score,and FAP and LSM values were the influencing factors for vascular scores(all P<0.05).Conclusion Hepatic steatosis and fibrosis are related to the stenosis degree of coronary artery disease.High FAP and LSM values indicate the presence of coronary artery disease or even severe coronary artery disease.