Nonalcoholic Fatty Liver Disease in Primary Aldosteronism: A Pilot Study
Nonalcoholic Fatty Liver Disease in Primary Aldosteronism: A Pilot Study
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DOI：
10.1038/ajh.2009.206
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发表时间：
2010-01-01
影响因子：
3.2
通讯作者：
Sechi, Leonardo A.
中科院分区：
文献类型：
--
作者：
Fallo, Francesco;Dalla Pozza, Anna;Sechi, Leonardo A.
背景原发性醛固酮增多症（PA）患者存在葡萄糖代谢障碍，导致心血管风险增加。胰岛素抵抗与非酒精性脂肪性肝病（NAFLD）相关，并可能在其病理生理学中发挥作用。本研究的目的是调查NAFLD和PA之间的关联，并确定NAFLD的决定因素，在这种condition.METHODSA共40例RA患者，40例性别，年龄和体重指数匹配的低肾素原发性高血压（LREH）患者和40名血压正常者进行了研究。根据超声检测脂肪肝，每组又分为两个亚组：NAFLD和非NAFLD。结果PA中NAFLD的患病率与LREH患者相似，但高于血压正常的对照组（P < 0.01）。PA组血清钾水平低于LREH伴NAFLD组（P < 0.001），而PA组与LREH不伴NAFLD组血清钾水平相似。单因素分析显示，血浆醛固酮、HOMA指数和低钾血症是PA组NAFLD的危险因素（P < 0.05），而HOMA指数与LREH组NAFLD相关（P < 0.05）。在多变量分析中，只有低钾血症仍然与PA的NAFLD相关（P = 0.02）。结论这项初步研究的结果表明，在没有肝脏疾病的主要危险因素的情况下，NAFLD是PA的常见发现。PA和低钾血症患者胰岛素抵抗程度更高，NAFLD的患病率高于正常钾血症患者，表明该亚组中代谢和肝脏疾病的风险更高。
BACKGROUNDAn impairment of glucose metabolism, contributing to the increased cardiovascular risk, has been shown in primary aldosteronism (PA). Insulin resistance is associated with nonalcoholic fatty liver disease (NAFLD) and may play a role in its pathophysiology. The aim of this study was to investigate the association between NAFLD and PA, and to identify determinants of NAFLD in this condition.METHODSA total of 40 patients with RA, 40 sex-, age-, and body mass index matched patients with low-renin essential hypertension (LREH) and 40 normotensive subjects were studied. According to ultrasound detection of fatty liver, each group was subdivided in two subsets: with NAFLD and without NAFLD. Patients with diabetes, obesity, and hyperlipidemia were excluded.RESULTSPrevalence of NAFLD in PA was similar to that observed in LREH patients, and higher (P < 0.01) than in normotensive controls. Serum potassium was lower in PA than in LREH patients with NAFLD (P < 0.001), while it was similar in PA and LREH patients without NAFLD. At univariate analysis, plasma aldosterone, homeostasis model assessment (HOMA) index and hypokalemia were determinants of NAFLD in PA (P < 0.05), while HOMA index was associated with NAFLD in LREH (P < 0.05). At multivariable analysis, only hypokalemia remained associated with NAFLD in PA (P = 0.02).CONCLUSIONSThe results of this pilot study suggest that, in the absence of major risk factors for liver disease, NAFLD is a frequent finding in PA. Patients with PA and hypokalemia are more insulin resistant and have higher prevalence of NAFLD than those with normokalemia, indicating greater risk for metabolic and liver disease in this subgroup.