冠状动脉造影患者超声检查脂肪肝、冠状动脉粥样硬化严重程度及肥胖情况的评估

Evaluation of ultrasonographic fatty liver and severity of coronary atherosclerosis, and obesity in patients undergoing coronary angiography.

作者信息

Açikel Mahmut, Sunay Sadik, Koplay Mustafa, Gündoğdu Fuat, Karakelleoğlu Sule

机构信息

Department of Cardiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.

出版信息

Anadolu Kardiyol Derg. 2009 Aug;9(4):273-9.

PMID:19666428

Abstract

OBJECTIVE

Aims were to examine associations (1) between non-alcoholic fatty liver disease (NAFLD) and the presence and severity of coronary artery disease (CAD) and obesity, (2) between CAD and NAFLD with aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamiltransferase (GGT) levels.

METHODS

In this cross-sectional study, the study group consisted of 355 patients (mean age: 57.5+/-11.4 years), that comply with inclusion criteria and selected of 414 consecutive patients who underwent coronary angiographies. Coronary artery disease was defined as a stenosis at least 50% in at least one major coronary artery. Modified Gensini scoring was used to determine the severity of coronary atherosclerosis. Fatty liver was diagnosed by abdominal ultrasonography (4 stages: Grades 0, 1, 2 and 3). Obesity was defined as body mass index (BMI) >or=30 kg/m2. Statistical evaluations were performed using Student's t test, ANOVA, Chi- square, kappa tests and logistic regression analysis.

RESULTS

There were significant differences among Grades 0, 1 and 2-3 according to presence of CAD and Gensini score. In univariate analysis, age (OR=1.03, p=0.004), gender (OR=3.05, p<0.0001), dyslipidemia (OR=4.40, p<0.0001), diabetes mellitus (OR=2.15, p=0.048), smoking (OR=3.19, p<0.0001), AST (OR=1.01, p=0.042), GGT (OR=1.04, p<0.0001), NAFLD (OR=1.87, p=0.036) and obesity+NAFLD (OR: 2.1, p=0.018) have effects on presence of CAD. In multivariate model, age (OR=1.04, p<0.001), AST (OR=1.01, p<0.05), GGT (OR=1.04, p<0.001), NAFLD (OR=2.58, p<0.01) have independent effects on CAD; however BMI and obesity were ineffective. Non-alcoholic fatty liver disease has an independent effect on Gensini score (OR=2.02, p<0.05).

CONCLUSION

Ultrasonographic fatty liver have independent effects on both the presence of CAD and severity of coronary atherosclerosis. In addition, increased serum AST and GGT levels may be independently associated with CAD.

摘要

目的

旨在研究（1）非酒精性脂肪性肝病（NAFLD）与冠状动脉疾病（CAD）的存在及严重程度和肥胖之间的关联；（2）CAD与NAFLD以及天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和γ-谷氨酰转移酶（GGT）水平之间的关联。

方法

在这项横断面研究中，研究组由355例患者（平均年龄：57.5±11.4岁）组成，这些患者符合纳入标准，是从414例连续接受冠状动脉造影的患者中挑选出来的。冠状动脉疾病定义为至少一条主要冠状动脉狭窄至少50%。采用改良的Gensini评分来确定冠状动脉粥样硬化的严重程度。通过腹部超声检查诊断脂肪肝（4个阶段：0级、1级、2级和3级）。肥胖定义为体重指数（BMI）≥30kg/m²。使用学生t检验、方差分析、卡方检验、kappa检验和逻辑回归分析进行统计评估。

结果

根据CAD的存在情况和Gensini评分，0级、1级与2 - 3级之间存在显著差异。在单因素分析中，年龄（OR = 1.03，p = 0.004）、性别（OR = 3.05，p < 0.0001）、血脂异常（OR = 4.40，p < 0.0001）、糖尿病（OR = 2.15，p = 0.048）、吸烟（OR = 3.19，p < 0.0001）、AST（OR = 1.01，p = 0.042）、GGT（OR = 1.04，p < 0.0001）、NAFLD（OR = 1.87，p = 0.036）和肥胖 + NAFLD（OR：2.1，p = 0.018）对CAD 的存在有影响。在多变量模型中，年龄（OR = 1.04，p < 0.001）、AST（OR = 1.01，p < 0.05）、GGT（OR = 1.04，p < 0.001）、NAFLD（OR = 2.58，p < 0.01）对CAD有独立影响；然而BMI和肥胖无影响。非酒精性脂肪性肝病对Gensini评分有独立影响（OR = 2.02，p < 0.05）。