Fracanzani Anna Ludovica, Burdick Larry, Raselli Sara, Pedotti Paola, Grigore Liliana, Santorelli Gennaro, Valenti Luca, Maraschi Alessandra, Catapano Alberico, Fargion Silvia
Centro Malattie Metaboliche del Fegato, Dipartimento Medicina Interna, Università di Milano, Milano, Italy.
Am J Med. 2008 Jan;121(1):72-8. doi: 10.1016/j.amjmed.2007.08.041.
To evaluate, in patients with nonalcoholic fatty liver disease with no or mild alterations of liver function tests, carotid artery intima-media thickness and the presence of plaques and to define determinants of vascular damage.
A paired-sample case-control study: 125 patients with nonalcoholic fatty liver disease and 250 controls, without a prior diagnosis of diabetes, hypertension, and cardiovascular disease, matched for sex, age, and body mass index. B-mode ultrasound was used for evaluation of carotid intima-media thickness and presence of small plaques.
A significant difference in mean values of intima-media thickness (0.89+/-0.26 and 0.64+/-0.14 mm, P = .0001) and prevalence of plaques (26 [21%] and 15 [6%], P < .001) was observed in nonalcoholic fatty liver disease patients and controls. Variables significantly associated with intima-media thickness higher than 0.64 mm (median value in controls), in both patients and controls were: age (P = .0001), systolic blood pressure (P = .004), total and low-density lipoprotein cholesterol (P < or = .02 and P = .01, respectively), fasting glucose (P = .0001), and cardiovascular risk (P = .0001) and, only in controls, metabolic syndrome (P = .0001), HOMA-insulin resistance (P = .01), and body mass index (P = .0003). At multivariate logistic regression performed in the overall series of subjects, independent risk predictors of intima-media thickness higher than 0.64 mm were presence of steatosis (odds ratio [OR] = 6.9), age (OR 6.0), and systolic blood pressure (OR 2.3).
Patients with nonalcoholic fatty liver disease, even with no or mild alterations of liver tests, should be considered at high risk for cardiovascular complications.
评估肝功能检查无异常或仅有轻度改变的非酒精性脂肪性肝病患者的颈动脉内膜中层厚度及斑块情况，并确定血管损伤的决定因素。
一项配对样本病例对照研究：125例非酒精性脂肪性肝病患者和250例对照者，这些对照者既往无糖尿病、高血压和心血管疾病诊断，根据性别、年龄和体重指数进行匹配。采用B型超声评估颈动脉内膜中层厚度及小斑块的存在情况。
非酒精性脂肪性肝病患者和对照者在内膜中层厚度平均值（分别为0.89±0.26和0.64±0.14mm，P = 0.0001）和斑块患病率（分别为26例[21%]和15例[6%]，P < 0.001）方面存在显著差异。在患者和对照者中，与内膜中层厚度高于0.64mm（对照者的中位数）显著相关的变量有：年龄（P = 0.0001）、收缩压（P = 0.004）、总胆固醇和低密度脂蛋白胆固醇（分别为P≤0.02和P = 0.01）、空腹血糖（P = 0.0001）、心血管风险（P = 0.0001），且仅在对照者中，代谢综合征（P = 0.0001）、HOMA胰岛素抵抗（P = 0.01）和体重指数（P = 0.0003）与之相关。在整个研究对象系列中进行多因素逻辑回归分析时，内膜中层厚度高于0.64mm的独立风险预测因素为脂肪变性的存在（比值比[OR]=6.9）、年龄（OR 6.0）和收缩压（OR 2.3）。
非酒精性脂肪性肝病患者，即使肝功能检查无异常或仅有轻度改变，也应被视为心血管并发症的高危人群。
