Department of Internal Medicine, University of Pisa, Pisa, Italy.
Hepatology. 2012 May;55(5):1406-15. doi: 10.1002/hep.25555.
An association between fatty liver and carotid atherosclerosis has been established; however, it is not clear whether this relationship is a consequence of shared conventional risk factors or whether it is determined by specific circulating factors originating from liver or adipose tissue. To identify the factors possibly linking fatty liver and atherosclerosis, we assessed, in 1,012 subjects free of confounding diseases (e.g., hypertension, diabetes, cardiovascular diseases, and dyslipidemia) and metabolic syndrome, the relationship between the presence of early plaques at carotid bifurcation and fatty liver index (FLI; a validated surrogate marker of fatty liver), as well as the associations between carotid plaque presence and established atherosclerotic risk factors, family history of cardiovascular disease (FH-CVD) or diabetes, insulin sensitivity, serum liver enzymes, adipokines, fatty free acids, and high-sensitivity C-reactive protein (hsCRP). A total of 55 of 1,012 subjects (5.4%) had small plaque at carotid bifurcation. Subjects with plaque were older and had higher prevalence of FLI ≥60 and FH-CVD, higher blood pressure, plasma low-density lipoprotein cholesterol, glucose, gamma-glutamyltransferase (GGT), and hsCRP, as compared to subjects without plaques (P < 0.05). In a logistic regression model, adjusted for sex, liver transaminase, and alcohol consumption, the independent predictors of plaque presence were age (P < 0.0005), FLI ≥60 (P < 0.0005), and current smoking (P < 0.05). When FLI in the model was replaced by variables used in its equation (e.g., body mass index, waist circumference, plasma triglycerides, and GGT), the independent determinants of plaque presence were age (P < 0.001), GGT (P = 0.001), and current smoking (P < 0.05).
Our cross-sectional study suggests that subjects with FLI ≥60 are at higher risk of atherosclerotic lesions, independently of established risk factors, and that serum GGT may represent a link between fatty liver and the development of early atherosclerosis.
本研究旨在评估颈动脉分叉处早期斑块与脂肪肝指数（FLI；一种验证的脂肪肝替代标志物）之间的关系，以及颈动脉斑块与已确立的动脉粥样硬化危险因素、心血管疾病家族史（FH-CVD）或糖尿病、胰岛素敏感性、血清肝酶、脂联素、游离脂肪酸和高敏 C 反应蛋白（hsCRP）之间的关系，以确定可能将脂肪肝与动脉粥样硬化联系起来的因素。
在 1012 例无混杂疾病（如高血压、糖尿病、心血管疾病和血脂异常）和代谢综合征的受试者中，我们评估了颈动脉分叉处早期斑块的存在与脂肪肝之间的关系，并评估了颈动脉斑块与已确立的动脉粥样硬化危险因素、心血管疾病家族史（FH-CVD）或糖尿病、胰岛素敏感性、血清肝酶、脂联素、游离脂肪酸和高敏 C 反应蛋白（hsCRP）之间的关系。
1012 例受试者中，有 55 例（5.4%）存在颈动脉分叉处小斑块。与无斑块的受试者相比，有斑块的受试者年龄较大，FLI≥60 和 FH-CVD 的患病率较高，血压、血浆低密度脂蛋白胆固醇、血糖、γ-谷氨酰转移酶（GGT）和 hsCRP 也较高（均 P＜0.05）。在校正性别、肝转氨酶和饮酒后，Logistic 回归模型显示斑块存在的独立预测因子为年龄（P＜0.0005）、FLI≥60（P＜0.0005）和当前吸烟（P＜0.05）。在模型中用其方程中使用的变量（如体重指数、腰围、血浆甘油三酯和 GGT）替代 FLI 时，斑块存在的独立决定因素为年龄（P＜0.001）、GGT（P=0.001）和当前吸烟（P＜0.05）。
本横断面研究表明，FLI≥60 的受试者发生动脉粥样硬化病变的风险较高，这与已确立的危险因素无关，而血清 GGT 可能是脂肪肝与早期动脉粥样硬化发展之间的联系。
