Association of coronary artery calcification with liver fibrosis in Japanese patients with non-alcoholic fatty liver disease
Association of coronary artery calcification with liver fibrosis in Japanese patients with non-alcoholic fatty liver disease
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DOI：
10.1111/hepr.12665
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发表时间：
2016-10-01
影响因子：
4.2
通讯作者：
Itoh, Yoshito
中科院分区：
文献类型：
--
作者：
Ishiba, Hiroshi;Sumida, Yoshio;Itoh, Yoshito
目的心血管事件是非酒精性脂肪性肝病(NAFLD)患者死亡的主要原因，但它们之间的关系尚不清楚。本研究以冠状动脉钙化(CAC)积分和非侵入性纤维化标志物为代表，探讨冠状动脉粥样硬化与肝纤维化的关系。方法2006年4月至2010年3月，698例有胸痛或心电图异常的患者接受冠状动脉计算机断层扫描(CT)检查，排除已知肝病或有急诊冠状动脉成形术病史的患者，剩下366名患者进入本研究。NAFLD的诊断基于腹部CT和饮酒史。CAC在100AU或以上的受试者被归类为心血管事件的高危人群。检查患者的临床记录，包括CAC评分和非侵入性纤维化标志物FIB-4指数。结果94名患者(25.7%)患有NAFLD。单因素分析确定高龄、高舒张压、高肝脾比和高FIB-4指数为心血管事件的危险因素，多因素分析确定年龄在66岁或以上、FIB-4指数在2.09或以上为有意义的危险因素。在截至2014年8月的观察期内，FIB-4>2.09的患者的累积介入治疗比例显著高于FIB-4<2.09的患者。结论NAFLD患者的动脉硬化和肝纤维化的进展可能与其相关。FIB-4指数易于测定，可作为预测NAFLD患者心血管事件的有用指标。
AimsCardiovascular events are the leading cause of death among patients with non-alcoholic fatty liver disease (NAFLD), but their relationship remains unclear. This study examined the association between coronary atherosclerosis and liver fibrosis, represented by the coronary artery calcification (CAC) score and non-invasive fibrosis markers, respectively.MethodsAmong 698 patients with chest pain or electrocardiographic abnormalities who underwent coronary computed tomography (CT) between April 2006 and March 2010, those with known liver disorders or history of emergency coronary angioplasty were excluded, leaving 366 patients for this study. Diagnosis of NAFLD was based on abdominal CT and history of alcohol consumption. Subjects with CAC of 100AU or more were categorized into the high-risk group for cardiovascular events. Patient records were examined for clinical parameters including CAC score and non-invasive fibrosis marker FIB-4 index.ResultsNinety-four patients (25.7%) had NAFLD. In this group, univariate analysis identified old age, high diastolic blood pressure, high liver to spleen ratio and high FIB-4 index as risk factors for cardiovascular events and multivariate analysis identified age of 66years or older and FIB-4 index of 2.09 or more as the significant risk factors. For the observation period until August 2014, the cumulative proportion of PCI performance was significantly higher in patients with FIB-4 of 2.09 or more than those with FIB-4 of less than 2.09.ConclusionThe progression of arteriosclerosis and that of liver fibrosis may be associated in NAFLD patients. The FIB-4 index can be easily determined and thus can be a useful marker for predicting cardiovascular events in NAFLD patients.