酒精性肝病患者单纯性脂肪变性的预测因素

Predictive factors for pure steatosis in alcoholic patients.

作者信息

Naveau Sylvie, Thaury Juliette, Barri-Ova Nadège, Balian Axel, Dauvois Barbara, Njiké-Nakseu Micheline, Prévot Sophie, Agostini Hélène, Perlemuter Gabriel

机构信息

AP-HP, Hôpital Antoine Béclère, Service d'Hépato-gastroenterologie, 157 rue de la Porte de Trivaux, Clamart, France.

出版信息

Alcohol Clin Exp Res. 2009 Jun;33(6):1104-10. doi: 10.1111/j.1530-0277.2009.00932.x. Epub 2009 Mar 23.

DOI:10.1111/j.1530-0277.2009.00932.x

PMID:19382900

Abstract

BACKGROUND

Bearing in mind the mechanisms involved in nonalcoholic fatty liver disease, this study aims to verify whether metabolic syndrome or its various individual components are independent predictive factors for steatosis > or =10% in alcoholic patients.

METHODS

This study included 281 consecutive alcoholic patients with abnormal liver tests and either normal liver histology or steatosis <10% (n = 119) or steatosis > or =10% (n = 162). Logistic regression analysis was used to study the relationship between metabolic syndrome components and various risk factors and the presence of steatosis > or =10%. We assessed apolipoprotein A1 (ApoA-1) levels, a major protein component of plasma high-density lipoprotein (HDL), rather than HDL-cholesterol levels.

RESULTS

Plasma ApoA-1 levels (p < 0.01), body mass index (BMI) (p < 0.01), and waist circumference (p < 0.05) were significantly higher in patients with steatosis > or =10% than in patients with normal liver histology or steatosis <10%. A higher percentage of patients with steatosis > or =10% had high blood pressure (p = 0.003) than patients with normal liver histology or steatosis <10%. In the logistic regression, ApoA-1 [odds ratio (OR) = 1.57 (1.10-2.22)], BMI [OR = 1.10 (1.01-1.23)], and high blood pressure [OR = 1.84 (1.10-3.06)] were positively and independently correlated with the presence of steatosis > or =10%. In the multivariate regression high blood pressure was independently and positively correlated with steatosis score (r = 0.55 +/- 0.26; p < 0.05). On the other hand, when the presence of high blood pressure was the dependent variable, the presence of steatosis > or =10% positively and independently correlated with it [OR = 1.82 (1.05-3.15)].

CONCLUSION

In alcoholic patients without fibrosis, ApoA-1, BMI, and high blood pressure on the next morning after the admission were predictive of steatosis > or =10%. High blood pressure was the only metabolic syndrome component associated with the presence of alcoholic steatosis >/=10% and was not correlated with other metabolic syndrome components. These findings suggest that steatosis mechanisms are different in alcoholic and nonalcoholic fatty liver.

摘要

背景

考虑到非酒精性脂肪性肝病的发病机制，本研究旨在验证代谢综合征或其各个单独组分是否为酒精性肝病患者中脂肪变性≥10%的独立预测因素。

方法

本研究纳入了281例连续的酒精性肝病患者，这些患者肝功能检查异常，肝组织学正常或脂肪变性<10%（n = 119）或脂肪变性≥10%（n = 162）。采用逻辑回归分析研究代谢综合征组分与各种危险因素和脂肪变性≥10%之间的关系。我们评估的是载脂蛋白A1（ApoA-1）水平，其为血浆高密度脂蛋白（HDL）的主要蛋白质成分，而非HDL胆固醇水平。

结果

脂肪变性≥10%的患者血浆ApoA-1水平（p < 0.01）、体重指数（BMI）（p < 0.01）和腰围（p < 0.05）显著高于肝组织学正常或脂肪变性<10%的患者。脂肪变性≥10%的患者中高血压患者的比例高于肝组织学正常或脂肪变性<10%的患者（p = 0.003）。在逻辑回归中，ApoA-1[比值比（OR）= 1.57（1.10 - 2.22）]、BMI[OR = 1.10（1.01 - 1.23）]和高血压[OR = 1.84（1.10 - 3.06）]与脂肪变性≥10%呈正相关且独立相关。在多变量回归中，高血压与脂肪变性评分独立正相关（r = 0.55 ± 0.26；p < 0.05）。另一方面，当以高血压的存在作为因变量时，脂肪变性≥10%的存在与高血压呈正相关且独立相关[OR = 1.82（1.05 - 3.15）]。