Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
PLoS One. 2013 Apr 23;8(4):e61803. doi: 10.1371/journal.pone.0061803. Print 2013.
Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular atherosclerosis independent of classical risk factors. This study investigated the influence of NAFLD on autonomic changes, which is currently unknown.
Subjects without an overt history of cardiovascular disease were enrolled during health checkups. The subjects diagnosed for NAFLD using ultrasonography underwent 5-min heart rate variability (HRV) measurements that was analyzed using the following indices: (1) the time domain with the standard deviation of N-N (SDNN) intervals and root mean square of successive differences between adjacent N-N intervals (rMSSD); (2) the frequency domain with low frequency (LF) and high frequency (HF) components; and (3) symbolic dynamics analysis. Routine blood biochemistry data and serum leptin levels were analyzed. Homeostasis model assessment of insulin resistance (HOMA-IR) was measured.
Of the 497 subjects (mean age, 46.2 years), 176 (35.4%) had NAFLD. The HRV indices (Ln SDNN, Ln rMSSD, Ln LF, and Ln HF) were significantly decreased in the NAFLD group (3.51 vs 3.62 ms, 3.06 vs 3.22 ms, 5.26 vs 5.49 ms(2), 4.49 vs 5.21 ms(2), respectively, all P<0.05). Ln SDNN was significantly lower in the NAFLD group after adjustment for age, sex, hypertension, dyslipidemia, metabolic syndrome, body mass index, smoking, estimated glomerular filtration rate, HOMA-IR, and leptin (P<0.05). In the symbolic dynamic analysis, 0 V percentage was significantly higher in the NAFLD group (33.8% vs 28.7%, P = 0.001) and significantly correlated with linear HRV indices (Ln SDNN, Ln rMSSD, and Ln HF).
NAFLD is associated with decreased Ln SDNN and increased 0 V percentage. The former association was independent of conventional cardiovascular risk factors and serum biomarkers (insulin resistance and leptin). Further risk stratification of autonomic dysfunction with falls or cardiovascular diseases by these HRV parameters is required in patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）与心血管动脉粥样硬化有关，独立于经典的危险因素。本研究旨在探讨目前未知的 NAFLD 对自主神经变化的影响。
在健康检查期间，招募无明显心血管疾病病史的受试者。通过超声诊断为 NAFLD 的受试者进行了 5 分钟的心率变异性（HRV）测量，使用以下指标进行分析：（1）时域指标，包括正常窦性 R-R 间期标准差（SDNN）和相邻窦性 R-R 间期差值的均方根（rMSSD）；（2）频域指标，包括低频（LF）和高频（HF）成分；以及（3）符号动力学分析。分析常规血液生化数据和血清瘦素水平。测量胰岛素抵抗的稳态模型评估（HOMA-IR）。
在 497 名受试者（平均年龄 46.2 岁）中，176 名（35.4%）患有 NAFLD。NAFLD 组的 HRV 指标（Ln SDNN、Ln rMSSD、Ln LF 和 Ln HF）明显降低（3.51 对 3.62 ms、3.06 对 3.22 ms、5.26 对 5.49 ms（2）、4.49 对 5.21 ms（2），均 P<0.05）。在校正年龄、性别、高血压、血脂异常、代谢综合征、体重指数、吸烟、估算肾小球滤过率、HOMA-IR 和瘦素后，NAFLD 组的 Ln SDNN 明显降低（P<0.05）。在符号动力学分析中，NAFLD 组 0 V 百分比明显升高（33.8%对 28.7%，P = 0.001），与线性 HRV 指标（Ln SDNN、Ln rMSSD 和 Ln HF）显著相关。
NAFLD 与 Ln SDNN 降低和 0 V 百分比增加有关。前者的相关性独立于传统心血管危险因素和血清生物标志物（胰岛素抵抗和瘦素）。NAFLD 患者需要通过这些 HRV 参数进一步分层自主神经功能障碍与跌倒或心血管疾病的风险。
