非酒精性脂肪性肝病与冠状动脉易损斑块的关系研究  

Relationship between Nonalcoholic Fatty Liver Disease and Vulnerable Coronary Artery Plaques

作　　者：杨小艳[1] 杨勇 张旭[1] 钟玉全[1] 陈希奎[3] 王康[3] 唐贵超[3] 林德智[4] 郭传勇 YANG Xiaoyan;YANG Yong;ZHANG Xu;ZHONG Yuquan;CHEN Xikui;WANG Kang;TANG Guichao;LIN Dezhi;GUO Chuanyong(Gastroenterology Department,the First People's Hospital of Neijiang,Neijiang 641000,China;Cardiovascular Department,Sichuan Provincial Fourth People's Hospital,Chengdu 610000,China;Radiology Department,the First People's Hospital of Neijiang,Neijiang 641000,China;Cardiovascular Department,the First People's Hospital of Neijiang,Neijiang 641000,China;Department of Gastroenterology,Shanghai Tenth People's Hospital,Shanghai 200072,China)

机构地区：[1]四川省内江市第一人民医院消化内科,641000 [2]四川省第四人民医院心内科,四川省成都市610000 [3]四川省内江市第一人民医院放射科,641000 [4]四川省内江市第一人民医院心内科,641000 [5]上海第十人民医院消化内科,上海市200072

出　　处：《中国全科医学》2018年第31期3827-3831,共5页Chinese General Practice

基　　金：四川省卫生和计划生育委员会科研课题(17PJ017)

摘　　要：目的探讨非酒精性脂肪性肝病(NAFLD)是否是冠状动脉易损斑块的高危人群。方法连续纳入2011-01-01至2015-01-30四川省内江市第一人民医院住院期间曾行冠状动脉CT造影并且3个月内曾行腹部CT的患者,记录基线资料、临床诊断,根据病史及影像学指标分为NAFLD组与非NAFLD组,根据2016美国冠状动脉CT专家共识分析冠状动脉,判断有无易损斑块,记录易损斑块的数量和狭窄评分。结果纳入本研究的患者有603例,其中NAFLD组124例,非NAFLD组479例,185(30.7%)例患者冠状动脉CT造影有易损斑块。NAFLD组易损斑块的比例高于非NAFLD组(46.0%比26.7%,P<0.001);NAFLD组有≥2个易损斑块的患者比例高于非NAFLD组(12.9%比5.4%,P=0.004);NAFLD组狭窄≥50%的易损斑块比例高于非NAFLD组(29.0%比13.6%,P<0.001)。多因素Logistic回归分析结果显示NAFLD是冠状动脉易损斑块的危险因素[OR(95%CI)=2.12(1.37,3.26),P=0.001)]。结论 NAFLD患者是冠状动脉易损斑块的高危人群。Objective To determine whether nonalcoholic fatty liver disease(NAFLD)patients are at high risk of vulnerable coronary artery plaques.Methods We enrolled the consecutive inpatients who underwent coronary artery CT angiography(CCTA)and abdominal CT(within 3 months before or after CCTA)in the First People's Hospital of Neijiang from January 1,2011 to January 30,2015.We collected their baseline and clinical data(including diagnosis and imaging results)and divided them into NAFLD and non-NAFLD groups according to the medical history and imaging findings.We performed an analysis of the CCTA results based on CAD-RADS(an expert consensus document issued by SCCT,ACR and NASCI in 2016).Vulnerable plaques were determined,counted and recorded,and the CAD-RADS score was recorded.Results Totals of 603 cases were included in the study,including 124 with NAFLD and 479 without.185(30.7%of the total)presented vulnerable plaques in CCTA.Compared with non-NAFLD patients,NAFLD patients had a higher prevalence of vulnerable plaque(s 46.0%vs 26.7%,P<0.001),and a higher prevalence of multiple(≥2)vulnerable plaques(12.9%vs 5.4%,P=0.004),as well as a higher prevalence of carotid stenosis of≥50%(caused by vulnerable plaques)(29.0%vs 13.6%,P<0.001).Multivariate Logistic regression analysis suggested that NAFLD is a risk factor for vulnerable coronary artery plaques〔OR(95%CI)=2.12(1.37,3.26),P=0.001)〕.Conclusion NAFLD patients are a high-risk group for vulnerable coronary artery plaques.

关 键 词：冠状动脉疾病 非酒精性脂肪性肝病 易损斑块 冠状动脉CT造影 

分 类 号：R575.5[医药卫生—消化系统]