2型糖尿病合并非酒精性脂肪性肝病患者的心脏瓣膜钙化

Heart valve calcification in patients with type 2 diabetes and nonalcoholic fatty liver disease.

作者信息

Mantovani Alessandro, Pernigo Matteo, Bergamini Corinna, Bonapace Stefano, Lipari Paola, Valbusa Filippo, Bertolini Lorenzo, Zenari Luciano, Pichiri Isabella, Dauriz Marco, Zoppini Giacomo, Barbieri Enrico, Byrne Christopher D, Bonora Enzo, Targher Giovanni

机构信息

Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

出版信息

Metabolism. 2015 Aug;64(8):879-87. doi: 10.1016/j.metabol.2015.04.003. Epub 2015 May 1.

DOI:10.1016/j.metabol.2015.04.003

PMID:25957758

Abstract

PURPOSE

Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are two powerful predictors of adverse cardiovascular outcomes in patients with type 2 diabetes, but the etiology of valvular calcification is uncertain. Nonalcoholic fatty liver disease (NAFLD) is an emerging cardiovascular risk factor and is very common in type 2 diabetes, but whether NAFLD is associated with valvular calcification in this group of patients is presently unknown.

METHODS

We undertook a cross-sectional study of 247 consecutive type 2 diabetic outpatients with no previous history of heart failure, valvular heart diseases (aortic stenosis, mitral stenosis, moderate or severe aortic and mitral regurgitation) or hepatic diseases. Presence of MAC and AVS was detected by echocardiography. NAFLD was diagnosed by ultrasonography.

RESULTS

Overall, 139 (56.3%) patients had no heart valve calcification (HVC-0), 65 (26.3%) patients had one valve affected (HVC-1) and 43 (17.4%) patients had both valves affected (HVC-2). 175 (70.8%) patients had NAFLD and the prevalence of this disease markedly increased in patients with HVC-2 compared with either HVC-1 or HVC-0 (86.1% vs. 83.1% vs. 60.4%, respectively; p < 0.001). NAFLD was significantly associated with AVS and/or MAC (unadjusted-odds ratio 3.51, 95% CI 1.89-6.51, p < 0.001). Adjustments for age, sex, waist circumference, smoking, blood pressure, hemoglobin A1c, LDL-cholesterol, kidney function parameters, medication use and echocardiographic variables did not appreciably weaken this association (adjusted-odds ratio 2.70, 95% CI 1.23-7.38, p < 0.01).

CONCLUSIONS

Our results show that NAFLD is an independent predictor of cardiac calcification in both the aortic and mitral valves in patients with type 2 diabetes.

摘要

目的

主动脉瓣硬化（AVS）和二尖瓣环钙化（MAC）是2型糖尿病患者不良心血管结局的两个有力预测指标，但瓣膜钙化的病因尚不确定。非酒精性脂肪性肝病（NAFLD）是一种新出现的心血管危险因素，在2型糖尿病中非常常见，但NAFLD是否与该组患者的瓣膜钙化相关目前尚不清楚。

方法

我们对247例既往无心力衰竭、瓣膜性心脏病（主动脉狭窄、二尖瓣狭窄、中度或重度主动脉瓣和二尖瓣反流）或肝脏疾病病史的2型糖尿病门诊患者进行了一项横断面研究。通过超声心动图检测MAC和AVS的存在情况。通过超声检查诊断NAFLD。

结果

总体而言，139例（56.3%）患者无心脏瓣膜钙化（HVC-0），65例（26.3%）患者有一个瓣膜受累（HVC-1），43例（17.4%）患者两个瓣膜均受累（HVC-2）。175例（70.8%）患者患有NAFLD，与HVC-1或HVC-0患者相比，HVC-2患者中该疾病的患病率显著增加（分别为86.1%对83.1%对60.4%；p<0.001）。NAFLD与AVS和/或MAC显著相关（未调整优势比3.51，95%CI 1.89-6.51，p<0.001）。对年龄、性别、腰围、吸烟、血压、糖化血红蛋白、低密度脂蛋白胆固醇、肾功能参数、药物使用和超声心动图变量进行调整后，这种关联并未明显减弱（调整后优势比2.70，95%CI 1.23-7.38，p<0.01）。