2018 年第 12 期 第 13 卷

冠状动脉粥样硬化病变与非酒精性脂肪性肝病相关性分析

Relation between coronary atherosclerosis and nonalcoholic fatty liver disease

作者：孟晓嵘代礼润余庆华黄昉萌郭思薇吴永希高原骆杰伟魏世超郑星宇

英文作者：

单位：100012北京，航空总医院中医科（孟晓嵘）；350001福州，福建省立医院中医科（代礼润、黄昉萌、郭思薇、吴永希、高原、骆杰伟、魏世超、郑星宇），放射科（余庆华）

英文单位：

关键词：冠状动脉粥样硬化；非酒精性脂肪性肝病；冠状动脉CT血管造影

英文关键词：

• 摘要：

• 【摘要】目的    探究冠状动脉粥样硬化（CAS）病变与非酒精性脂肪性肝病（NAFLD）之间的相关性，并分析CAS的相关风险因素。方法    回顾性分析福建省立医院2015年1—6月行冠状动脉CT血管造影（CTA）检查的283例患者的病历资料，分为NAFLD组（66例）和无脂肪肝组（217例）；同时无NAFLD及CAS患者77例，单纯CAS组140例，单纯NAFLD组15例，CAS合并NAFLD组51例。应用Spearman相关方法与多因素Logistic回归方法进行相关性和危险因素分析。结果    NAFLD组Gensini评分明显高于无脂肪肝组［7.5（2.1,19.0）分比2.5（0.0,9.8）分］（P＝0.001）；2组CTA钙化积分差异无统计学意义（P＞0.05）；NAFLD组合并冠状动脉粥样硬化性心脏病（冠心病）、高血压、心律失常、2型糖尿病比例均明显高于无脂肪肝组（均P＜0.01）。单纯CAS组、单纯NAFLD组、CAS合并NAFLD组CTA积分及Gensini评分比较，差异均有统计学意义［26.9(0.0,120.2)、0.0(0.0,0.0)分比23.9(0.0,188.1)分，6.5(2.5,12.4)、0.0(0.0,0.0)分比13.0(5.0,22.0)分］（均P＜0.05）；3组冠心病、高血压、心律失常、2型糖尿病比例比较，差异均有统计学意义(均P＜0.05)。CAS合并NAFLD组的中重度脂肪肝占比明显高于单纯NAFLD组［54.9%（28/51）比13.3%（2/15）］（P＜0.001）。Spearman相关分析显示，NAFLD的严重程度与Gensini评分、冠状动脉病变支数呈正相关（r＝0.232，P＜0.001； r＝0.323，P＜0.001）。多因素Logistic回归分析显示，以1支冠状动脉病变为参考系，NAFLD患者2支及3支冠状动脉病变的相对危险度（比值比）分别为4.832（95%置信区间：1.307～17.799）和5.820（95%置信区间：1.248～27.151）（均P＜0.05）。结论    NAFLD是CAS的独立危险因素。

• 【Abstract】Objective    To investigate the relation between coronary atherosclerosis(CAS) and nonalcoholic fatty liver disease(NAFLD), and to explore the risk factors of CAS. Methods    Clinical data of 283 patients who had coronary CT angiography（CTA） from January to June 2015 in Fujian Provincial Hospital were retrospectively analyzed. They were divided into NAFLD group（n＝66） and non-fatty liver group（n＝217）; 77 patients had no NAFLD or CAS; 140 patients had CAS; 15 patients had NAFLD; 51 patients had CAS and NAFLD. Spearman and multivariate Logistic regression were used to analyze the correlation and risk factors. Results    Gensini score in the NAFLD group was higher than that in the non-fatty liver group［7.5（2.1,19.0） vs 2.5（0.0,9.8）］（P＝0.001）. CTA calcification score was similar between the two groups(P＞0.05). Rates of coronary heart disease, hypertension, arrhythmia and type 2 diabetes in the NAFLD group were higher than those in the non-fatty liver group（P＜0.01）. CTA score and Gensini score showed significant differences among the CAS-alone, NAFLD-alone and CAS＋NAFLD groups［26.9(0.0,120.2), 0.0(0.0,0.0) vs 23.9(0.0,188.1); 6.5(2.5,12.4), 0.0(0.0,0.0) vs 13.0(5.0,22.0)］（all P＜0.05）. Rates of coronary heart disease, hypertension, arrhythmia and type 2 diabetes showed significant differences among the three groups(P＜0.05). Rate of moderate to severe fatty liver in the CAS＋NAFLD group was higher than that in the NAFLD-alone group［54.9%（28/51） vs 13.3%（2/15）］（P＜0.001）. Spearman analysis showed that the severity of NAFLD was positively correlated with Gensini score and the number of coronary lesions（r＝0.232， P＜0.001； r＝0.323， P＜0.001）. With single coronary artery lesion as the reference, multivariate Logistic regression analysis showed higher relative risks of double and triple coronary artery lesions in NAFLD patients（odds ratio＝4.832， 95% confidence interval： 1.307-17.799； odds ratio＝5.820， 95% confidence interval： 1.248-27.151; both P＜0.05）. Conclusion    NAFLD is an independent risk factor of CAS.