非酒精性脂肪性肝病合并冠心病患者冠脉病变程度及其危险因素分析*

doi:10.3969/j.issn.1672-5069.2018.05.021

实用肝脏病杂志 ›› 2018, Vol. 21 ›› Issue (5): 737-740.doi: 10.3969/j.issn.1672-5069.2018.05.021

非酒精性脂肪性肝病合并冠心病患者冠脉病变程度及其危险因素分析^*

严晨丽, 王晶晶, 王军

430000武汉市华中科技大学同济医学院附属武汉市中心医院肝胆胰外科

收稿日期:2017-12-10 出版日期:2018-09-10 发布日期:2018-09-27
作者简介:严晨丽,女,33岁,大学本科。主要从事肝胆胰疾病诊治研究。E-mail:tzk970281744@163.com
基金资助:
湖北省教育厅重点科研项目(编号:D20142102)

Severity of coronary artery lesions and risk factors in patients with nonalcoholic fatty liver disease complicated by coronary heart disease

Yan Chenli, Wang Jingjing, Wang Jun.

Department of Hepatobiliary and Pancreatic Surgery,Central Hospital,Affiliated to Huazhong University of Science and Technology,Wuhan 430000,Hebei Province,China

Received:2017-12-10 Online:2018-09-10 Published:2018-09-27

摘要/Abstract

摘要： 目的分析非酒精性脂肪性肝病（NAFLD）合并冠心病（CHD）患者冠脉病变程度及其危险因素。方法 2015年1月~2017年1月我院收治的154例NAFLD患者,经冠脉造影诊断CHD 71例。使用超声和CT检查诊断脂肪肝程度,应用Gensini评分评判冠脉病变程度。采用Logistic多因素回归分析影响冠脉病变的因素。结果 71例CHD与83例非CHD患者在合并糖尿病、吸烟及FPG、TC、TG、ALT、AST、GGT、hs-CRP和HOMA -IR水平方面比较有显著性差异（t/x²=7.62、5.38、3.82、5.80、3.72、8.79、3.10、5.75、5.25、5.93,P<0.05或P<0.01）;多因素Logistic回归分析显示,合并糖尿病、FPG、TC、ALT、hs-CRP、HOMA-IR是NAFLD合并CHD的独立危险因素（P<0.05或P<0.01）;37例轻度、23例中度和11例重度NAFLD合并CHD患者单支、双支和三支冠状病变比例比较有显著性差异（x²=14.8,P<0.01）。结论 NAFLD合并CHD发病率较高,及时了解其发生的独立危险因素,做好重点监测和防治是减少CHD发生的积极措施。

关键词: 非酒精性脂肪性肝病, 冠心病, 危险因素, 冠脉病变程度

Abstract: Objectivee To analyze the severity of coronary artery lesions and risk factors in patients with nonalcoholic fatty liver disease （NAFLD） complicated by coronary heart disease （CHD）. Methods 154 patients with NAFLD were recruited in our hospital between January 2015 and January 2017,and 71 were found with CHD by coronary angiogram. The degree of fatty liver was determined by altrasonography and/or CT scan. Logistic analysis was applied to screen the risk factors for CHD occurrence. Results There were statistically significant differences between the two groups as respect to the percentages of diabetes and smoking,and serum levels of FPG,TC,TG,ALT,AST,GGT,hs-CRP and HOMA-IR （t/x²=7.62,5.38,3.82,5.80,3.72,8.79,3.10,5.75,5.25,5.93, P<0.05 or P<0.01）;multivariate Logistic regression analysis showed that diabetes,FPG,TC,ALT,hs-CRP and HOMA-IR were the independent risk factors of CHD in patients with NAFLD （P<0.05 or P<0.01）;among 71 patients with CHD,there were 37 cases with mild,23 with moderate and 11 with severe NAFLD,and there were statistically significant differences among the three groups as to the percentages of single,double and three branches coronary artery lesions （x²=14.8,P<0.01）. Conclusion The incidence of CHD in patients with NAFLD is relatively higher,and clinicians must take the risk factors into consideration in clinical practice in order to decrease the morbidity and mortality of heart diseases.

Key words: Nonalcoholic fatty liver disease, Coronary heart disease, Risk factors, Severity of coronary artery lesions

严晨丽, 王晶晶, 王军. 非酒精性脂肪性肝病合并冠心病患者冠脉病变程度及其危险因素分析^*[J]. 实用肝脏病杂志, 2018, 21(5): 737-740.

Yan Chenli, Wang Jingjing, Wang Jun.. Severity of coronary artery lesions and risk factors in patients with nonalcoholic fatty liver disease complicated by coronary heart disease[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 737-740.

参考文献

[1] 马振增,陆伦根. 非酒精性脂肪性肝病与肝硬化. 实用肝脏病杂志,2016,19(2):135-138.
[2] Goh GB,Mccullough AJ.Natural history of nonalcoholic fatty liver disease. Dig Dis Sci,2016,61(5):1226-1233.
[3] Xu X,Lu L,Dong Q,et al.Research advances in the relationship between nonalcoholic fatty liver disease and atherosclerosis. Lipid Health Dis,2015,14(1):158-162.
[4] Dogan S,Celikbilek M,Yilmaz YK,et al.Association between liver fibrosis and coronary heart disease risk in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol,2015,27(3):298-304.
[5] Puchner S B,Lu MT,Mayrhofer T,et al.High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease,independent of coronary plaque and stenosis burden:results from the ROMICAT II trial. Radiology,2015,274(3):693-701.
[6] 中华医学会肝脏病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南. 中华内科杂志,2010,49(3):1-3.
[7] Surmeli-Onay O,Korkmaz A,Yidit S,et al.Surfactant therapy in late preterm infants:respiratory distress syndrome and beyond. Turk J Pediatr,2012,54(3):239-246.
[8] 张琼,黄建华,熊三军,等. 老年男性冠心病患者抑郁评分、血清性激素水平与冠脉Gensini评分的相关性. 中华行为医学与脑科学杂志,2015,24(7):611-614.
[9] Simple steatosis. The pathogenesis of nonalcoholic fatty liver disease:Interplay between diet,gut microbiota,and genetic background. Gastroenterol Res Pract,2016,2016(6):1-13.
[10] Stolic R V,Trajkovic G Z,Kostic M M,et al.Correlation between nonalcoholic fatty liver and cardiovascular disease in elderly hemodialysis patients. Int Urol Nephrol,2016,48(6):1-7.
[11] Sinn DH,Kang D,Chang Y,et al.Non-alcoholic fatty liver disease and progression of coronary artery calcium score: a retrospective cohort study. Gut,2016,66(2):323-329.
[12] Vakalyuk II,Virstyuk NG,Kazmiruk VM.Progression of liver fibrosis in patients with stable coronary heart disease combined with non-alcoholic fatty liver disease. World J Gastroenterol,2016,50(62):27-31.
[13] Aronow WS.Nonalcoholic fatty liver disease is associated with coronary artery disease and subclinical atherosclerosis. Future Cardiol,2016,12(4):393-396.
[14] Ayonrinde OT,Oddy WH,Adams LA,et al.Infant nutrition and maternal obesity influence the risk of non-alcoholic fatty liver disease in adolescents. J Hepatol,2017,67(3):568-574.
[15] Torun E,Zgen I T,Gokce S,et al.Thyroid hormone levels in obese children and adolescents with non-alcoholic fatty liver disease. J Clin Res Pediat Endocrinol,2014,6(1):34-39.
[16] 谭可平,沈扬林,赵子粼. 非酒精性脂肪性肝病冠脉病变发生情况及其影响因素研究. 人民军医,2014,57(5):514-516.
[17] Kang SJ,Ko KJ,Baek UH.Effects of 12 weeks combined aerobic and resistance exercise on heart rate variability in type 2 diabetes mellitus patients. J Phys Ther Sci,2016,28(7):2088-2093.
[18] Vanwagner LB,Ning H,Lewis CE,et al.Associations between nonalcoholic fatty liver disease and subclinical atherosclerosis in middle-aged adults: The coronary artery risk development in young adults study. Atherosclerosis,2014,235(2):599-605.
[19] Bhuyan N,Gogoi M,Todi V,et al.Nonalcoholic fatty liver disease and its relationship with hsCRP in type 2 diabetes mellitus. Int J Res Med Sci,2014,2(4):1586-1591.
[20] Dogan S,Celikbilek M,Yilmaz Y K,et al.Association between liver fibrosis and coronary heart disease risk in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol, 2015, 27(3):298-304.
[21] 王磊,黄宏春,姜丽燕,等. 冠心病与非酒精性脂肪性肝病的相关性分析. 重庆医学,2016,45(4):492-494.

非酒精性脂肪性肝病合并冠心病患者冠脉病变程度及其危险因素分析^*

Severity of coronary artery lesions and risk factors in patients with nonalcoholic fatty liver disease complicated by coronary heart disease

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