心外膜脂肪组织（EAT）厚度与非酒精性脂肪性肝病中的心血管和肝脏损伤相关。
Epicardial Adipose Tissue (EAT) Thickness Is Associated with Cardiovascular and Liver Damage in Nonalcoholic Fatty Liver Disease.
作者信息
Fracanzani Anna Ludovica, Pisano Giuseppina, Consonni Dario, Tiraboschi Silvia, Baragetti Andrea, Bertelli Cristina, Norata Giuseppe Danilo, Dongiovanni Paola, Valenti Luca, Grigore Liliana, Tonella Tatiana, Catapano Alberico, Fargion Silvia
机构信息
Department of Pathophysiology and Transplantation, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy.
Epidemiology Unit, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy.
出版信息
PLoS One. 2016 Sep 14;11(9):e0162473. doi: 10.1371/journal.pone.0162473. eCollection 2016.
BACKGROUND AND AIMS
Epicardial adipose tissue (EAT) has been proposed as a cardiometabolic and hepatic fibrosis risk factor in patients with non alcoholic fatty liver disease (NAFLD). Aim of this study was to evaluate the role of EAT in NAFLD by analyzing 1) the association between EAT, the other metabolic parameters and the severity of steatosis 2) the relationship between cardiovascular (cIMT, cplaques, E/A), liver (presence of NASH and significant fibrosis) damage and metabolic risk factors including EAT 3) the relationship between EAT and genetic factors strongly influencing liver steatosis.
METHODS
In a cross-sectional study, we considered 512 consecutive patients with NAFLD (confirmed by biopsy in 100). EAT, severity of steatosis, carotid intima-media thickness (cIMT) and plaques were evaluated by ultrasonography and results analysed by multiple linear and logistic regression models. Variables independently associated with EAT (mm) were female gender (p = 0.003), age (p = 0.001), BMI (p = 0.01), diastolic blood pressure (p = 0.009), steatosis grade 2 (p = 0.01) and 3 (p = 0.04), fatty liver index (p = 0.001) and statin use (p = 0.03). Variables independently associated with carotid IMT were age (p = 0.0001), hypertension (p = 0.009), diabetes (p = 0.04), smoking habits (p = 0.04) and fatty liver index (p = 0.02), with carotid plaques age (p = 0.0001), BMI (p = 0.03), EAT (p = 0.02),) and hypertension (p = 0.02), and with E/A age (p = 0.0001), diabetes (p = 0.005), hypertension (p = 0.04) and fatty liver index (p = 0.004). In the 100 patients with available liver histology non alcoholic steatohepatitis (NASH) was independently associated with EAT (p = 0.04) and diabetes (p = 0.054) while significant fibrosis with EAT (p = 0.02), diabetes (p = 0.01) and waist circumference (p = 0.05). No association between EAT and PNPLA3 and TM6SF2 polymorphisms was found.
CONCLUSION
In patients with NAFLD, EAT is associated with the severity of liver and vascular damage besides with the known metabolic risk factors.
背景与目的
心外膜脂肪组织（EAT）被认为是非酒精性脂肪性肝病（NAFLD）患者发生心脏代谢和肝纤维化的危险因素。本研究的目的是通过分析以下内容来评估EAT在NAFLD中的作用：1）EAT、其他代谢参数与脂肪变性严重程度之间的关联；2）心血管（颈动脉内膜中层厚度、颈动脉斑块、E/A）、肝脏（非酒精性脂肪性肝炎和显著纤维化的存在）损害与包括EAT在内的代谢危险因素之间的关系；3）EAT与强烈影响肝脂肪变性的遗传因素之间的关系。
方法
在一项横断面研究中，我们纳入了512例连续的NAFLD患者（其中100例经活检确诊）。通过超声评估EAT、脂肪变性严重程度、颈动脉内膜中层厚度（cIMT）和斑块，并采用多元线性和逻辑回归模型分析结果。与EAT（mm）独立相关的变量有女性性别（p = 0.003）、年龄（p = 0.001）、体重指数（p = 0.01）、舒张压（p = 0.009）、2级（p = 0.01）和3级（p = 0.04）脂肪变性、脂肪肝指数（p = 0.001）和他汀类药物使用（p = 0.03）。与颈动脉IMT独立相关的变量有年龄（p = 0.0001）、高血压（p = 0.009）、糖尿病（p = 0.04）、吸烟习惯（p = 0.04）和脂肪肝指数（p = 0.02）；与颈动脉斑块相关的有年龄（p = 0.0001）、体重指数（p = 0.03）、EAT（p = 0.02）和高血压（p = 0.02）；与E/A相关的有年龄（p = 0.0001）、糖尿病（p = 0.005）、高血压（p = 0.04）和脂肪肝指数（p = 0.004）。在100例有肝脏组织学检查结果可用的患者中，非酒精性脂肪性肝炎（NASH）与EAT（p = 0.04）和糖尿病（p = 0.054）独立相关，而显著纤维化与EAT（p = 0.02）、糖尿病（p = 0.01）和腰围（p = 0.05）相关。未发现EAT与PNPLA3和TM6SF2基因多态性之间存在关联。
结论
在NAFLD患者中，EAT除了与已知的代谢危险因素相关外，还与肝脏和血管损害的严重程度相关。
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