非酒精性脂肪性肝病患者颈动脉内膜中层厚度、颈股动脉脉搏波传导速度分析

摘要/Abstract

摘要： 目的分析NAFLD患者颈动脉内膜中层厚度(CIMT)、颈股动脉脉搏波传导速度(cfPWV)情况,旨在评价NAFLD与亚临床动脉粥样硬化(SAS)的关系。方法回顾2019年1月—2021年3月河南省直第三人民医院收治NAFLD患者122例(男78例,女44例),年龄(43.3±12.0)岁。同时纳入同期健康体检患者120例作为对照组,比较NAFLD与对照组临床资料。结果比较NAFLD患者(NAFLD组)、健康体检患者(对照组)临床资料,NAFLD组、对照组BMI为(28.4±3.7)kg/m2、(24.1±3.0)kg/m²,差异具有统计学意义(t=2.138,P<0.05);NAFLD组、对照组腰围为(102.5±9.7)cm、(93.3±8.4)cm,差异具有统计学意义(t=2.498,P<0.05);NAFLD组ALT、AST、TG、TC、HDL、LDL为(38.0±6.7)U/L、(35.3±6.4)U/L、(2.2±0.6)mmol/L、(5.1±0.9)mmol/L、(1.0±0.2)mmol/L及(2.9±0.7)mmol/L,与对照组[(25.2±5.2)U/L、(22.8±4.8)U/L、(1.0±0.5)mmol/L、(4.6±0.8)mmol/L、(1.2±0.3)mmol/L及(2.4±0.5)mmol/L]相比,差异具有统计学意义(t=4.712,4.268,3.849,2.587,-2.181,2.028,P<0.05);NAFLD组空腹胰岛素为(8.1±2.2) U/mL显著高于对照组[(4.6±1.3) U/mL,t=6.015,P<0.05];NAFLD组、对照组HOMA-IR为(3.5±0.8)、(2.0±0.5),差异具有统计学意义(t=5.427,P<0.05)。与对照组相比,NAFLD组右CIMT显著增加[(0.66±0.12)mm比(0.58±0.10)mm,t=4.442,P<0.05];类似地,与对照组相比,NAFLD组左CIMT显著增加[(0.65±0.11)mm比(0.58±0.09)mm,t=4.126,P<0.05];NAFLD组右CIMT>75th、右CIMT>0.9 mm、左CIMT>75th及左CIMT>0.9 mm为95例(77.9%)、9例(7.4%)、 98例(80.3%)及11例(9.0%),与对照组[62例(51.7%)、2例(1.7%)、 69例(57.5%)及3例(2.5%)]比,差异具有统计学意义(χ²=18.227,4.547,14.740,4.713,P<0.05)。NAFLD组cfPWV、cfPWV>10m/s及、cfPWV>90th为(10.4±2.8)m/s、68例(55.7%)及77例(63.1%),与对照组[(8.2±2.5)m/s、28例(23.3%)及32例(26.7%)]比,差异具有统计学意义(P<0.05)。结论 NAFLD患者CIMT、cfPWV显著增高,易发生SAS,应尽早防治NAFLD,延缓SAS进程,避免心血管事件的发生。

关键词: 非酒精性脂肪性肝病, 亚临床动脉粥样硬化, 颈动脉内膜中层厚度, 颈股动脉脉搏波传导速度

Abstract: Objective To evaluate the correlation between nonalcoholic fatty liver disease (NAFLD), subclinical atherosclerosis (SAS), carotid intima-media thickness (CIMT), and carotid-femoral pulse wave velocity (cfPWV) in patients with NAFLD. Methods From January 2019 to March 2021, there were 122 patients with NAFLD were enrolled in this study as the NAFLD group, with 78 males and 44 females, and an average age of 43.3±12.0 years old. At the same period of time, 120 healthy people were included as the control group. The clinical data of SAS, CIMT and cfPWV between the NAFLD patients and the healthy controls were compared. Results The body mass index (BMI) of NAFLD group and control group was (28.4±3.7) kg/m² and (24.1±3.0) kg/m², respectively, which had statistically significant difference (t=2.138, P<0.05). The waist circumference of NAFLD group and control group was (102.5±9.7) cm and (93.3±8.4) cm, respectively, with significant difference (t=2.498, P<0.05). The levels of ALT, AST, TG, TC, HDL and LDL in NAFLD group were (38.0±6.7) U/L, (35.3±6.4) U/L, (2.2±0.6) mmol/L, (5.1±0.9) mmol/L, (1.0±0.2) mmol/L, respectively, which were significantly different with those of (25.2±5.2) U/L, (22.8±4.8) U/L, (1.0±0.5) mmol/L, (4.6±0.8) mmol/L, (1.2±0.3) mmol/L and (2.4±0.5) mmol/L in the control group (P<0.05). The fasting insulin levels in NAFLD group and control group were (102.5±9.7) μU/mL and (93.3±8.4) μU/mL, respectively, with significant difference (t=4.712, 4.268, 3.849, 2.587, -2.181, 2.028, P<0.05). The HOMA-IR of NAFLD group and control group were (3.5±0.8) and (2.0±0.5), with significant difference (t=5.427, P<0.05). The right CIMT of NAFLD group and control group were (0.66±0.12) mm and (0.58±0.10) mm, respectively, the differences were statistically significant (t=4.442, P<0.05). The left CIMT of NAFLD group and control group were (0.65±0.11) mm and (0.58±0.09) mm, the difference was statistically significant (P<0.05). In NAFLD group, right CIMT>75th, right CIMT>0.9 mm, left CIMT>75th and left CIMT>0.9 mm were 95 cases (77.9%), 9 cases (7.4%), 98 cases (80.3%) and 11 cases (9.0%), respectively, compared with those of 62 cases (51.7%), 2 cases (1.7%), 69 cases (57.5%) and 3 cases (2.5%) in the control group, the differences were statistically significant (χ²=18.227, 4.547, 14.740, 4.713, P<0.05). In NAFLD group, cfPWV, cfPWV>10 m/s and cfPWV>90th were (10.4±2.8) m/s, 68 cases (55.7%) and 77 cases (63.1%), respectively, compared with those of (8.2±2.5) m/s, 28 cases(23.3%) and 32 cases in the control group, the differences were statistically significant (P<0.05). Conclusion CIMT and cfPWV in patients with NAFLD are significantly increased, and the patients are prone to develop SAS. It is necessary to treat the NAFLD patients as soon as possible, in order to prevent the progression of SAS and avoid the occurrence of cardiovascular events.

Key words: Nonalcoholic fatty liver disease, Subclinical atherosclerosis, Carotid intima-media thickness, Carotid-femoral pulse wave velocity

赵建红, 李鸿彬, 程相超, 郭彦伟. 非酒精性脂肪性肝病患者颈动脉内膜中层厚度、颈股动脉脉搏波传导速度分析[J]. 肝脏, 2023, 28(2): 214-217.

ZHAO Jian-hong, LI Hong-bin, CHENG Xiang-chao, GUO Yan-wei. An analysis on carotid intima-media thickness and carotid-femoral pulse wave velocity in patients with nonalcoholic fatty liver disease[J]. Chinese Hepatolgy, 2023, 28(2): 214-217.

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