Targher Giovanni, Bertolini Lorenzo, Padovani Roberto, Rodella Stefano, Zoppini Giacomo, Zenari Luciano, Cigolini Massimo, Falezza Giancarlo, Arcaro Guido
Division of Internal Medicine and Diabetes Unit, Ospedale Sacro Cuore-don Calabria, Via Sempreboni 5, 37024 Negrar (VR), Italy.
Diabetes Care. 2006 Jun;29(6):1325-30. doi: 10.2337/dc06-0135.
Nonalcoholic fatty liver disease (NAFLD) is closely associated with several metabolic syndrome features. We assessed whether NAFLD is associated with carotid artery intima-media thickness (IMT) as a marker of subclinical atherosclerosis and whether such an association is independent of classical risk factors, insulin resistance, and metabolic syndrome features.
We compared carotid IMT, as assessed by ultrasonography, in 85 consecutive patients with biopsy-proven NAFLD and 160 age-, sex-, and BMI-matched healthy control subjects.
NAFLD patients had a markedly greater carotid IMT (1.14 +/- 0.20 vs. 0.82 +/- 0.12 mm; P < 0.001) than control subjects. The metabolic syndrome (according to Adult Treatment Panel III criteria) and its individual components were more frequent in those with NAFLD (P < 0.001). The marked differences in carotid IMT observed between the groups were only slightly weakened after adjustment for age, sex, BMI, smoking history, LDL cholesterol, insulin resistance (by homeostasis model assessment), and metabolic syndrome components. Notably, carotid IMT was strongly associated with degree of hepatic steatosis, necroinflammation, and fibrosis among NAFLD patients (P < 0.001 for all). Similarly, by logistic regression analysis, the severity of histological features of NAFLD independently predicted carotid IMT (P < 0.001) after adjustment for all potential confounders.
These results suggest that the severity of liver histopathology among NAFLD patients is strongly associated with early carotid atherosclerosis, independent of classical risk factors, insulin resistance, and the presence of metabolic syndrome.
非酒精性脂肪性肝病（NAFLD）与多种代谢综合征特征密切相关。我们评估了NAFLD是否与作为亚临床动脉粥样硬化标志物的颈动脉内膜中层厚度（IMT）相关，以及这种关联是否独立于经典危险因素、胰岛素抵抗和代谢综合征特征。
我们比较了连续85例经活检证实为NAFLD的患者与160例年龄、性别和BMI匹配的健康对照者通过超声检查评估的颈动脉IMT。
NAFLD患者的颈动脉IMT（1.14±0.20 vs. 0.82±0.12 mm；P<0.001）明显高于对照者。NAFLD患者中代谢综合征（根据成人治疗小组III标准）及其各个组成部分更为常见（P<0.001）。在对年龄、性别、BMI、吸烟史、低密度脂蛋白胆固醇、胰岛素抵抗（通过稳态模型评估）和代谢综合征组成部分进行调整后，两组间观察到的颈动脉IMT的显著差异仅略有减弱。值得注意的是，NAFLD患者的颈动脉IMT与肝脂肪变性、坏死性炎症和纤维化程度密切相关（所有P<0.001）。同样，通过逻辑回归分析，在对所有潜在混杂因素进行调整后，NAFLD组织学特征的严重程度独立预测颈动脉IMT（P<0.001）。
这些结果表明，NAFLD患者肝脏组织病理学的严重程度与早期颈动脉粥样硬化密切相关，独立于经典危险因素、胰岛素抵抗和代谢综合征的存在。
