肥胖症患者的非酒精性脂肪性肝病纤维化评分与临床前血管损伤

Non-alcoholic fatty liver disease fibrosis score and preclinical vascular damage in morbidly obese patients.

作者信息

Gentili Alessandra, Daviddi Giulia, De Vuono Stefano, Ricci Maria Anastasia, Di Filippo Francesco, Alaeddin Abdalkader, Mannarino Massimo R, Boni Marcello, Vaudo Gaetano, Lupattelli Graziana

机构信息

Internal Medicine, Angiology and Atherosclerosis, Department of Medicine, "Santa Maria della Misericordia" Hospital, University of Perugia, Italy.

出版信息

Dig Liver Dis. 2016 Aug;48(8):904-8. doi: 10.1016/j.dld.2016.04.004. Epub 2016 Apr 19.

DOI:10.1016/j.dld.2016.04.004

PMID:27160697

Abstract

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is strongly related with enhanced morbidity and mortality from cardiovascular disease. In obese patients with both NAFLD and features of the metabolic syndrome, the cardiovascular risk is further increased.

AIM

The aim of this study is to investigate the relationship between severity of liver fibrosis evaluated by NAFLD fibrosis score (NAFLD-FS), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), other obesity-related markers and preclinical atherosclerosis in morbidly obese patients with previously diagnosed NAFLD.

METHODS

Laboratory parameters, visceral fat area (VFA), flow-mediated dilatation (FMD), intima-media thickness (IMT), HOMA-IR and NAFLD-FS were determined in 196 morbidly obese patients.

RESULTS

Patients with higher NAFLD-FS or HOMA-IR show higher left max-IMT and lower FMD (p<0.001). VFA and NAFLD-FS, but not HOMA-IR, were independent predictors of reduced FMD (respectively β -0.268, p=0.001 and β -0.165, p=0.039, p of the model<0.001) and increased left max-IMT (respectively β 0.165, p=0.031 and β 0.301, p<0.001, p of the model<0.001).

CONCLUSIONS

In morbidly obese patients, NAFLD-FS correlates with markers of early vascular damage. NAFLD-FS, easier to obtain than VFA, seems to be a better score than HOMA-IR to categorize such subjects who are potentially at risk of future cardiovascular events.

摘要

背景

非酒精性脂肪性肝病（NAFLD）与心血管疾病发病率和死亡率的增加密切相关。在患有NAFLD且具有代谢综合征特征的肥胖患者中，心血管风险进一步升高。

目的

本研究旨在探讨通过NAFLD纤维化评分（NAFLD-FS）评估的肝纤维化严重程度、胰岛素抵抗稳态模型评估（HOMA-IR）、其他肥胖相关标志物与先前诊断为NAFLD的病态肥胖患者临床前期动脉粥样硬化之间的关系。

方法

测定了196例病态肥胖患者的实验室参数、内脏脂肪面积（VFA）、血流介导的血管舒张（FMD）、内膜中层厚度（IMT）、HOMA-IR和NAFLD-FS。

结果

NAFLD-FS或HOMA-IR较高的患者左最大IMT较高，FMD较低（p<0.001）。VFA和NAFLD-FS是FMD降低（分别为β -0.268，p=0.001和β -0.165，p=0.039，模型p<0.001）和左最大IMT增加（分别为β 0.165，p=0.031和β 0.301，p<0.001，模型p<0.001）的独立预测因素，但HOMA-IR不是。