非肥胖人群中非酒精性脂肪性肝病与动脉僵硬度的关系研究  

Study on the correlation between non-alcoholic fatty liver disease and arterial stiffness in non-obese population

作　　者：李培瑛 陈明明 余馨妍 LI Pei-ying;CHEN Ming-ming;YU Xin-yan(Health Management Center,Second Affiliated Hospital of Zhejiang University Medical College,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院体检中心,310009 [2]浙江大学医学院附属第二医院全科医学科,310009

出　　处：《中国实用医药》2023年第10期17-21,共5页China Practical Medicine

摘　　要：目的 探讨非肥胖人群中非酒精性脂肪性肝病(NAFLD)与动脉僵硬度的关系。方法 回顾性分析进行瞬时弹性成像仪检查和臂踝脉搏波传导速度(baPWV)测定的健康体检者临床资料,以受控衰减参数(CAP)评价脂肪肝,baPWV评价动脉僵硬度,最终纳入3049例非肥胖体检者进行研究,分析纳入非肥胖人群的临床资料,多因素分析影响非肥胖人群高动脉僵硬度的危险因素,评估CAP对高动脉僵硬度的预测价值。结果 3049例非肥胖体检者中NAFLD患者1135例,占37.2%,其中轻度、中度、重度NAFLD患者分别为445例(14.6%)、406例(13.3%)和284例(9.3%)。高动脉僵硬度900例,占29.5%,其中轻度、中度、重度高动脉僵硬度人群分别为555例(18.2%)、199例(6.5%)和146例(4.8%)。NAFLD人群的收缩压、舒张压、baPWV均高于正常人群,高动脉僵硬度百分比均大于正常人群,差异有统计学意义(P<0.05)。高动脉僵硬度人群的年龄、男性比例、收缩压、舒张压、体质量指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血尿酸(sUA)、空腹血糖(FPG)、空腹胰岛素(FPI)、糖化血红蛋白(HbA1c)和CAP均高于正常动脉僵硬度人群,高密度脂蛋白胆固醇(HDL-C)低于正常人群,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示:年龄、收缩压、BMI、ALT、sUA、FPG、FPI和NAFLD是非肥胖人群高动脉僵硬度的独立危险因素,其中NAFLD发生高动脉僵硬度的OR为1.291[95%CI=(1.030,1.618),P<0.05]。CAP预测高动脉僵硬度的受试者工作特征曲线(ROC)下面积为0.610[95%CI=(0.588,0.632),P<0.05],最佳界值为239.5 dB/m,敏感性和特异性分别为0.477和0.683。结论 非肥胖人群中,不同程度NAFLD患者的动脉僵硬度均高于正常人群。NAFLD是独立于常见心血管疾病危险因素之外的高动脉僵硬度的危险因素,临床可通过干预NAFLD降低非肥胖人群出现高动脉�Objective To discuss the correlation between non-alcoholic fatty liver disease(NAFLD)and arterial stiffness in non-obese population.Methods The clinical data of healthy subjects who underwent instantaneous elastic imager and brachial-ankle pulse wave velocity(baPWV)were retrospectively analyzed.Controlled attenuation parameter(CAP)was used to evaluate fatty liver,and baPWV was used to evaluate arterial stiffness.Finally,3049 non-obese subjects were included in the study,and clinical data of non-obese population were analyzed.Multifactorial analysis of risk factors affecting high arterial stiffness in non-obese population to assess the predictive value of CAP for high arterial stiffness.Results Among 3049 non-obese subjects,1135 cases(37.2%)had NAFLD,accounting for 37.2%,including 445 cases(14.6%),406 cases(13.3%)and 284 cases(9.3%)of mild,moderate and severe NAFLD,respectively.900 cases(29.5%)had high arterial stiffness,among which 555 cases(18.2%),199 cases(6.5%)and 146 cases(4.8%)had mild,moderate and severe high arterial stiffness,respectively.The systolic blood pressure,diastolic blood pressure and baPWV in NAFLD population were higher than those in normal population,and the percentage of high arterial stiffness was higher than that in normal population.The differences were statistically significant(P<0.05).The age,male proportion,systolic blood pressure,diastolic blood pressure,body mass index(BMI),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum uric acid(sUA),fasting plasma glucose(FPG),fasting plasma insulin(FPI),glycosylated hemoglobin(HbA1c)and CAP in high arterial stiffness population were higher than those with normal arterial stiffness;the high density lipoprotein cholesterol(HDL-C)in high arterial stiffness population was lower than those with normal arterial stiffness;the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that age,systolic blood press

关 键 词：非酒精性脂肪性肝病 动脉僵硬度 脉搏波传播速度 受控衰减参数 非肥胖人群 

分 类 号：R575.5[医药卫生—消化系统]