脂肪肝诊断标准更名后饮酒在临床分层管理中的价值  

Value analysis of alcohol drinking in clinical stratification management after the renaming of diagnostic criteria for fatty liver

作　　者：张志娇 姜梓萌 陈宇航 黄华[1] 赵公芳[1] ZHANG Zhi-jiao;CHEN Yu-hang;JIANG Zi-meng;HUANG Hua;ZHAO Gong-fang(The Second Affiliated Hospital of Kunming Medical University,Department of Gastroenterology,Kunming city,650000,China)

机构地区：[1]昆明医科大学第二附属医院消化内科,650000

出　　处：《现代消化及介入诊疗》2022年第12期1519-1522,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：云南省“万人计划”名医人才专项(YNWR-MY-2019-074)。

摘　　要：目的本研究的目的是基于最近提出的MAFLD定义来描述患者,比较两种定义(NAFLD和MAFLD)的诊断能力,同时比较MAFLD合并饮酒情况下的基本特征及冠状动脉CT造影结果差异。方法选取2021年3月至2022年1月昆明医科大学第二附属医院收治的经超声检查诊断为脂肪肝,并接受冠状动脉CT血管造影(coronary computed tomography angiography,CCTA)的患者680例,收集基线资料、吸烟、饮酒、用药史、慢性疾病病史如高血压、2型糖尿病(T2DM)实验室指标等,根据NAFLD与MAFLD诊断标准进行分组,其中符合NAFLD诊断标准者作为NAFLD组(522例),符合MAFLD诊断标准者作为MAFLD组(648例),再将MAFLD组患者分为有无饮酒组,比较各组基线资料及冠状动脉CT血管造影结果。结果本研究选取超声诊断为脂肪肝的患者680例,其中符合NAFLD诊断有522例(76.8%),符合MAFLD诊断有648例(95.3%)。除性别及饮酒史外,其余特征差异无统计学意义。MAFLD合并饮酒118例,不饮酒530例。MAFLD合并饮酒组的男性、吸烟、甘油三酯及尿酸水平高于不饮酒组,差异有统计学意义(P<0.05)。高密度脂蛋白胆固醇和年龄低于不饮酒组,差异有统计学意义(P<0.05)。饮酒组冠状动脉CT血管造影发现非钙化斑和混合斑比例明显高于非饮酒组,差异有统计学意义(P<0.05)。与饮酒组相比,不饮酒组无冠脉动脉狭窄比例明显较高(7.63%vs 16.98%),差异有统计学意义(P<0.05)。结论使用MAFLD诊断标准基本可以涵盖NAFLD,MAFLD合并饮酒患者更易出现代谢异常及冠状动脉粥样硬化,应该对这一部分患者进行针对性的预防管理。Objective The aim of this study was to describe patients based on the recently proposed definition of MAFLD,to compare the diagnostic power of the two definitions(NAFLD and MAFLD),and compare the basic features of MAFLD in combination with alcohol consumption and differences in coronary CT findings.Methods A total of 680 patients admitted to the Second Affiliated Hospital of Kunming Medical University from March 2021 to January 2022 who were diagnosed with fatty liver by ultrasound examination and completed coronary computed tomography angiography(CCTA)were enrolled,and laboratory indicators of baseline data,smoking,drinking,drug history,and chronic disease history[hypertension,type 2 diabetes mellitus(T2DM)]were collected.According to the diagnostic criteria of NAFLD and MAFLD,those who met the diagnostic criteria of NAFLD were grouped as the NAFLD group(522 cases),those who met the diagnostic criteria of MAFLD were used as the MAFLD group(648 cases),Patients in the MAFLD group were divided into drinking and non-drinking groups,and baseline data and coronary CT angiography results were compared between the two groups.Results In this study,680 patients with fatty liver diagnosed by ultrasound were selected,including 522(76.8%)with NAFLD and 648(95.3%)with MAFLD.There was no significant difference in other characteristics except gender and drinking history.There were 118 cases of MAFLD combined with alcohol consumption and 530 cases of non-alcohol consumption.The levels of male,smoking,triglyceride and uric acid in the MAFLD combined with alcohol drinking group were significantly higher than those in the non-alcohol drinking group(P<0.05).High density lipoprotein cholesterol and age were significantly lower than those of the non-drinking group(P<0.05).The proportion of non-calcified plaque and mixed plaque found by coronary artery CT angiography in drinking group was significantly higher than that in non-drinking group(P<0.05).Compared with the drinking group,the proportion of non-drinking group without coronary a

关 键 词：非酒精性脂肪肝 代谢相关脂肪性肝病 饮酒 冠状动脉粥样硬化 

分 类 号：R575.5[医药卫生—消化系统]