University of Modena and Reggio Emilia, Italy; Azienda USL MODENA, Italy.
University of Bologna, Italy.
Atherosclerosis. 2014 Jan;232(1):99-109. doi: 10.1016/j.atherosclerosis.2013.10.030. Epub 2013 Nov 6.
Liver regulates lipid metabolism in health and disease states. Nevertheless, the entity of cardiovascular risk (CVR) resulting from dysregulation of lipid metabolism secondary to liver disease is poorly characterized.
To review, based on a PubMed literature search, the features and the determinants of serum lipid phenotype and its correlation with hepatic steatosis, insulin resistance (IR) and CVR across the wide spectrum of the most common chronic liver diseases due to different etiologies.
Alcoholic liver disease (ALD) is associated with steatosis, IR and a typical lipid profile. The relationship between alcohol intake, incident type 2 diabetes (T2D) and CVR describes a J-shaped curve. Non-alcoholic fatty liver disease (NAFLD), and probably nonalcoholic steatohepatitis (NASH) in particular, is associated with IR, atherogenic dyslipidemia and increased CVR independent of traditional risk factors. Moreover, NASH-cirrhosis and T2D contribute to increasing CVR in liver transplant recipients. HBV infection is generally free from IR, steatosis and CVR. HCV-associated dysmetabolic syndrome, featuring steatosis, hypocholesterolemia and IR, appears to be associated with substantially increased CVR. Hyperlipidemia is an almost universal finding in primary biliary cirrhosis, a condition typically spared from steatosis and associated with neither subclinical atherosclerosis nor excess CVR. Finally, little is known on CVR in patients with hepatocellular carcinoma.
CVR is increased in ALD, NAFLD and chronic HCV infection, all conditions featuring IR and steatosis. Therefore, irrespective of serum lipid phenotype, hepatic steatosis and IR may be major shared determinants in amplifying CVR in common liver disease due to varying etiology.
肝脏在健康和疾病状态下调节脂质代谢。然而，由于肝脏疾病导致脂质代谢失调而引起的心血管风险（CVR）的程度尚未得到充分描述。
基于PubMed 文献检索，综述了最常见的慢性肝脏疾病（由于不同病因）中血脂表型的特征和决定因素及其与肝脂肪变性、胰岛素抵抗（IR）和 CVR 的相关性。
酒精性肝病（ALD）与脂肪变性、IR 和典型的血脂谱相关。饮酒、新发 2 型糖尿病（T2D）和 CVR 之间的关系描述为 J 形曲线。非酒精性脂肪性肝病（NAFLD），特别是非酒精性脂肪性肝炎（NASH），与 IR、动脉粥样硬化性血脂异常和 CVR 增加相关，而与传统危险因素无关。此外，NASH 肝硬化和 T2D 导致肝移植受者的 CVR 增加。HBV 感染通常无 IR、脂肪变性和 CVR。HCV 相关的代谢综合征，表现为脂肪变性、低胆固醇血症和 IR，似乎与 CVR 显著增加相关。原发性胆汁性肝硬化几乎普遍存在高脂血症，这种情况通常没有脂肪变性，也没有亚临床动脉粥样硬化或 CVR 增加。最后，对于肝细胞癌患者的 CVR 知之甚少。
ALD、NAFLD 和慢性 HCV 感染均可增加 CVR，这些疾病均伴有 IR 和脂肪变性。因此，无论血清脂质表型如何，肝脂肪变性和 IR 可能是不同病因引起的常见肝脏疾病中增加 CVR 的主要共同决定因素。
