Early Predictors of Cardiovascular Disease Risk in Nonalcoholic Fatty Liver Disease: Non-obese Versus Obese Patients
Early Predictors of Cardiovascular Disease Risk in Nonalcoholic Fatty Liver Disease: Non-obese Versus Obese Patients
复制标题
非酒精性脂肪性肝病心血管疾病风险的早期预测因素：非肥胖患者与肥胖患者
DOI：
10.1007/s10620-019-05926-7
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发表时间：
2019-11-13
影响因子：
3.1
通讯作者：
Zhong, Bihui
中科院分区：
文献类型：
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作者：
Shao, Congxiang;Ye, Junzhao;Zhong, Bihui
背景：非酒精性脂肪性肝病（NAFLD）被认为是心血管疾病（CVD）的危险因素。然而，非肥胖性NAFLD与CVD之间的关系尚未得到很好的证实。目的：比较非肥胖和肥胖NAFLD患者的心血管疾病风险，探讨亚临床动脉粥样硬化的相关因素。方法采用基于磁共振成像的质子密度脂肪分数（MRI-PDFF）评估连续NAFLD患者。采用MRI-PDFF和剪切波弹性成像分别测量肝脏脂肪含量（LFC）和肝脏刚度。通过动脉粥样硬化指数（AI）、颈动脉内膜-中膜厚度、颈动脉斑块和Framingham风险评分（FRS）来评估CVD风险。结果纳入543例NAFLD患者。非肥胖和肥胖患者的颈动脉内膜-中膜增厚和颈动脉斑块、FRS和AI的存在具有可比性。年龄每10年增加（OR 9.68， P< 0.001）和肝纤维化（肝硬度> 6.1 kPa, OR 4.42， P= 0.004）是非肥胖患者颈动脉内膜-中膜增厚的显著因素，而年龄每10年增加（OR 2.02， P< 0.001）、肝纤维化（OR 2.18， P= 0.039）和LFC > 10% （OR 2.29， P= 0.021）是肥胖患者颈动脉内膜-中膜增厚的独立预测因素。在非肥胖患者中，只有甘油三酯升高与颈动脉斑块显著相关（OR 2.42；P= 0.033），而在肥胖患者中，年龄每10年增加（OR 1.77；P= 0.002）和LFC > 10% （OR 2.83；P= 0.019）是显著的预测因子。结论：银硬度和年龄是所有NAFLD患者亚临床动脉粥样硬化的重要预测因素，而LFC是肥胖NAFLD患者的另一个预测因素。我们的研究结果强调，应根据不同的bmi为NAFLD患者建立早期CVD筛查策略。
BackgroundNonalcoholic fatty liver disease (NAFLD) is regarded as a risk factor of cardiovascular disease (CVD). However, the association between non-obese NAFLD and CVD has not been well established.AimWe aimed to compare the CVD risk between non-obese and obese NAFLD patients, and explored the factors associated with subclinical atherosclerosis.MethodConsecutive NAFLD patients estimated by magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) were recruited. Liver fat content (LFC) and liver stiffness were measured with MRI-PDFF and shear wave elastography, respectively. CVD risk was estimated by atherosclerosis index (AI), carotid intima-media thickness, carotid plaque, and Framingham risk score (FRS).ResultsThis study included 543 NAFLD patients. The presence of carotid intima-media thickening and carotid plaque, FRS, and AI were comparable between non-obese and obese patients. Age increased per 10 years (OR 9.68;P< 0.001) and liver fibrosis (liver stiffness > 6.1 kPa, OR 4.42;P= 0.004) were significant factors associated with carotid intima-media thickening in non-obese patients, while age increased per 10 years (OR 2.02;P< 0.001), liver fibrosis (OR 2.18;P= 0.039), and LFC > 10% (OR 2.29;P= 0.021) were independent predictors in obese patients. Only elevated triglyceride was significantly associated with carotid plaque in non-obese patients (OR 2.42;P= 0.033), while age increased per 10 years (OR 1.77;P= 0.002) and LFC > 10% (OR 2.83;P= 0.019) were significant predictors in obese patients.ConclusionsLiver stiffness and age were strongly predictive of subclinical atherosclerosis in all NAFLD, while LFC was an additional predictor in obese NAFLD patients. Our findings highlight that early CVD screening strategy should be established for NAFLD patients according to different BMIs.