摘要
目的分析新诊断的轻、中度非酒精性脂肪性肝病(NAFLD)的危险因素,探讨其与血管病变相关性。方法选择体检发现的单纯轻、中度NAFLD患者202例为脂肪肝组,同期健康体检者91例为对照组。采用彩色多普勒超声检查,检测颈动脉内膜中膜厚度(IMT)及内皮舒张功能[包括内皮依赖性舒张功能(FMD)和内皮非依赖性舒张功能(NMD)]。并分析两组临床生化指标。结果 (1)与对照组相比,脂肪肝组体质指数、腰臀比、收缩压、舒张压、低密度脂蛋白胆固醇、总胆固、甘油三酯、谷丙转氨酶、谷草转氨酶、尿酸、高敏C反应蛋白、胰岛素抵抗指数均增高,高密度脂蛋白胆固醇降低,差异有统计学意义(P<0.01)。(2)Logistic回归分析发现,NAFLD的独立危险因素有胰岛素抵抗指数、高敏C反应蛋白、谷丙转氨酶,OR值分别为2.725、1.623、1.054(P<0.05)。(3)完成彩超检查的脂肪肝组45例(其中轻度23例,中度22例),对照组40例。与对照组比较,脂肪肝组颈动脉IMT增高[0.92(0.80,1.02)比0.87(0.74,0.99)],FMD、NMD均降低[4.7%(2.2%,6.8%)比5.2%(2.4%,7.7%);18.5%(12.2%,25.3%)比20.5%(12.2%,28.7%)],但两组差异无统计学意义。与对照组比较,轻度脂肪肝组及中度脂肪肝组IMT、FMD、NMD差异亦无统计学意义。单因素相关分析表明IMT、FMD、NMD与是否NAFLD无显著相关性。结论胰岛素抵抗指数、高敏C反应蛋白、谷丙转氨酶增高是NAFLD的独立危险因素。新诊断的轻、中度NAFLD患者血管病变与健康者无显著差异,NAFLD与动脉硬化确切相关性有待进一步研究。
Aim To analyze the risk factors of new diagnosed mild or moderate nonalcoholic fatty liver disease（ NAFLD）,and investigate the vascular damage and endothelial function in patients with NAFLD. Methods 202 new diagnosed patients with mild or moderate NAFLD and 91 healthy controls were selected in the Health Center of the Eighth Hospital of Changsha. Intima-media thickness（ IMT） of carotid artery,flow-mediated dilation（ FMD） and nitrate-mediated dilation（ NMD） in brachial artery were measured by high-resolution ultrasound. The clinical and biochemical characteristics were analyzed between the two groups. Results（ 1） Compared with the controls,body mass index,waist circumference,hip circumference,waist-hip ratio,systolic blood pressure,diastolic blood pressure,fasting insulin,fasting plasma glucose,low density lipoprotein,total cholesterol,triglycerides,alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,uric acid,high sensitivity C-reactive protein,HOMA-insulin resistance index were higher,and high density lipoprotein was lower in NAFLD group（ P 0. 01）.（ 2） Multi-factor logistic regression analysis demonstrated that NAFLD was independently correlated with HOMA-insulin resistance index,high sensitivity C-reactive protein,ALT（ OR =2.725,1.623,1.054,P〈 0.05）.（ 3） Compared with the controls,NAFLD group had higher IMT（ 0.92（ 0.80,1.02） vs0. 87（ 0.74,0.99））,lower FMD（ 4.7%（ 2.2%,6.8%） vs 5.2%（ 2.4%,7.7%）） and NMD（ 18.5%（ 12.2%,25.3%） vs20.5%（ 12.2%,28.7%））,but this differences had no statistical significance. The differences of IMT,FMD,NMD between the mild and moderate NAFLD groups had also no statistical significance. Bivariate correlation analysis between IMT,FND,NMD and NAFLD had no statistical significance. Conclusion HOMA-insulin resistance index,high sensitivity C-reactive protein,body mass index are independent risk factors for NAFLD. There was no significant differences in vascular damage between patients with mild or moderate NAFLD and healthers,the exact association between vascular damage and NAFLD need further research.
出处
《中国动脉硬化杂志》
CAS
北大核心
2016年第5期479-484,共6页
Chinese Journal of Arteriosclerosis
基金
湖南省科技厅科技计划项目(2012SK3006)
