肝脏脂肪变及肝纤维化与冠状动脉病变程度的关系_吴长亮.pdf

论著临床研究基金项目:广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20181004);广西医科大学大学生创新创业计划项目(2018114)作者简介:吴长亮(1980 )，男，硕士，副主任医师，研究方向:胃肠病及肝病。通信作者:黄杰安(1965 )，男，博士，主任医师，研究方向:胃肠病及肝病。肝脏脂肪变及肝纤维化与冠状动脉病变程度的关系吴长亮1，2兰小妍3吴江山4邹军1李霞3杨艳玲3招晓俊4黄杰安1(1 广西医科大学第二附属医院消化内科，广西南宁市530007;2 广西国际壮医医院脾胃肝病科，广西南宁市530201;3 广西医科大学，广西南宁市530021;4 广西医科大学第二附属医院心内科，广西南宁市530007)【摘要】目的探讨肝脏脂肪变、肝纤维化与冠状动脉病变程度的关系。方法纳入 243 例首次接受冠状动脉造影的患者，收集患者一般资料及入院时的实验室检查指标。根据患者的冠状动脉造影结果，将患者分为冠心病组和非冠心病组。分别用 Gensini 评分、血管评分评估患者的冠状动脉病变程度;使用 FibroTouch 检测患者的脂肪衰减参数(FAP)和肝脏硬度测定(LSM)值以评估肝脏脂肪病变、肝纤维化情况。比较冠心病组和非冠心病组的临床特征、FAP 值和 LSM 值，并比较不同临床特征患者的 Gensini 评分、血管评分。采用多元线性回归模型分析患者 Gensini 评分、血管评分的影响因素。结果(1)243 例患者中，174 例被诊断为冠心病。非冠心病组与冠心病组患者的年龄、性别、腰围、吸烟情况、合并糖尿病和高血压情况，空腹血糖水平、HbA1c 水平、HDL 水平、ALT 水平、AST 水平、谷氨酰转移酶(GGT)水平，以及 FAP 值、LSM 值比较，差异均有统计学意义(均P 005)。(2)不同年龄、性别、腰围、吸烟情况、合并糖尿病和高血压情况、空腹血糖水平、HbA1c 水平、HDL 水平、ALT 水平、AST 水平、GGT 水平、FAP 值、LSM 值的患者之间，Gensini 评分和血管评分差异均有统计学意义(均 P 005)。(3)多元线性回归分析结果显示，校正相关混杂因素后，FAP 值是 Gensini 评分的影响因素，FAP 值、LSM 值均是血管评分的影响因素(均 P 0 05)。结论肝脏脂肪变、肝纤维化与冠状动脉病变狭窄程度有关，较高的 FAP 值和 LSM 值意味着存在冠状动脉病变甚至严重的冠状动脉病变。【关键词】肝脏脂肪变;肝纤维化;冠状动脉病变;脂肪衰减参数;肝脏硬度测定值;Gensini 评分;血管评分;FibroTouch【中图分类号】575;543 3【文献标识码】A【文章编号】0253-4304(2022)23-2722-07DOI:10 11675/j issn 0253-4304 2022 23 04elation of hepatic steatosis and fibrosis with the lesion extension of coronary arteryWU Chang-liang1，2，LAN Xiao-yan3，WU Jiang-shan4，ZHOU Jun1，LI Xia3，YANG Yan-ling3，ZHAO Xiao-jun4，HUANG Jie-an1(1 Department of Gastroenterology，the Second Affiliated Hospital of Guangxi Medical University，Nanning 530007，Guangxi，China;2 Department of Spleen，Stomach and Liver Disease，Guangxi International Zhuang Medical Hospital，Nanning 530201，Guangxi，China;3 Guangxi Medical University，Nanning 530021，Guangxi，China;4 Department of Cardiology，the Second Affiliated Hospital ofGuangxi Medical University，Nanning 530007，Guangxi，China)【Abstract】ObjectiveTo investigate the relation of hepatic steatosis and fibrosis with the lesion extension ofcoronary artery MethodsA total of 243 patients undergoing coronary angiography for the first time were enrolledThe general data and laboratory examination indices at admission were collected The patients were assigned to coronaryheart disease group or non-coronary heart disease group according to the results of coronary angiography The lesionextension of coronary artery was evaluated by the Gensini and vascular scores，respectively The FibroTouch wasemployed to detect fat attenuation parameter(FAP)and liver stiffness measurement(LSM)values for evaluating2272Guangxi Medical Journal，Dec 2022，Vol 44，No 23hepatic steatosis and fibrosis conditions The clinical features，FAP and LSM values were compared between thecoronary heart disease group and the non-coronary heart disease group，and the Gensini and vascular scores werecompared between the patients with different clinical features The influencing factors for patients Gensini and vascularscores were analyzed by the multivariate linear regression model esults(1)Among 243 patients，174 patients werediagnosed as coronary heart disease There were statistically significant differences in ages，genders，waistlines，andconditions of smoking，concomitant diabetes mellitus and hypertension，as well as the levels of fasting blood glucose，HbA1c，HDL，ALT，AST，gamma-glutamyl transferase(GGT)，and FAP and LSM values between the non-coronaryheart disease group and coronary heart disease group(all P 005)(2)There were statistically significant differences inthe Gensini and vascular scores between the patients with different ages，genders，waistlines，and conditions of smoking andconcomitant diabetes mellitus and hypertension，as well as the levels of fasting blood glucose，HbA1c，HDL，ALT，ASTand GGT，and FAP and LSM values(all P 005)(3)The results of multivariate linear regression analysis revealedthat after adjusting for relevant confounding factors，FAP value was the influencing factor for the Gensini score，andFAP and LSM values were the influencing factors for vascular scores(all P 005)ConclusionHepatic steatosis andfibrosis are related to the stenosis degree of coronary artery disease High FAP and LSM values indicate the presence ofcoronary artery disease or even severe coronary artery disease【Key words】Hepatic steatosis，Hepatic fibrosis，Coronary artery disease，Fat attenuation parameter，Liverstiffness measurement value，Gensini score，Vascular score，FibroTouch非酒精性脂肪肝(non-alcoholic fatty liver disease，NAFLD)和冠心病均是影响人类 健 康 的 常 见 疾病1 4。NAFLD 是亚临床动脉粥样硬化或冠心病的独立危险因素，并与传统代谢危险因素有关5 6。FibroTouch 作为评估肝脏脂肪变性及肝纤维化的国产肝脏瞬时弹性成像检查产品，可在影像的引导下，自动调整探头以降低皮下脂肪导致的信号衰减。目前，有研究显示，以 MI 多回波水脂分离技术为金标准，FibroTouch 所测得的脂肪衰减参数(fat attenuationparameter，FAP)在脂肪肝的定性和定量诊断方面具有较高的价值7。另外，FibroTouch 对肝纤维化的诊断结果与 FibroScan 及肝穿病理诊断结果的一致性也较高8。目前，瞬时弹性成像技术已被广泛应用于评估慢性肝病患者，但关于应用该技术评估冠心病高危人群的肝脏脂肪变及肝纤维化的研究报告仍较少。本研究应用 FibroTouch 检测 FAP 与肝脏硬度测定(liver stiffness measurement，LSM)值，分析肝脏脂肪变、肝纤维化与冠状动脉病变程度的关系，以期为冠状动脉病变的筛查方法提供参考。1资料与方法11临床资料选取 2018 年 11 月至 2019 年 6 月期间因急性冠脉综合征、胸痛或心电图异常等原因在广西医科大学第二附属医院心内科首次接受冠状动脉造影的243 例患者作为研究对象，其中男性 166 例、女性77 例，年龄51 71(6218 7 54)岁。纳入标准:住