Kumar Mavidi Sunil, Singh Akanksha, Jaryal Ashok Kumar, Ranjan Piyush, Deepak K K, Sharma Sanjay, Lakshmy R, Pandey R M, Vikram Naval K
Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India.
Int J Hepatol. 2016;2016:5160754. doi: 10.1155/2016/5160754. Epub 2016 Dec 8.
The present study was designed to evaluate the heart rate variability (HRV) in nonalcoholic fatty liver disease (NAFLD) and to assess the effect of grade of NAFLD and diabetic status on HRV. This cross-sectional study included 75 subjects (25 NAFLD without diabetes, 25 NAFLD with diabetes, and 25 controls). Measurements included anthropometry, body composition analysis, estimation of plasma glucose, serum lipids, hsCRP, and serum insulin. HRV analysis was performed in both time and frequency domains. The time and frequency domain indices of overall variability (SDNN, total power) were significantly lower in NAFLD with diabetes as compared to the controls. However, the LF : HF ratio did not differ among the three groups. The variables related to obesity, lipid profile, and glucose metabolism were also higher in NAFLD with diabetes and those with Grade II NAFLD without diabetes, as compared to controls. Multivariate stepwise regression analysis showed a negative correlation between HRV and total cholesterol and fat percentage. The grade of NAFLD as well as diabetic status contributes to the decrease in the cardiovascular autonomic function, with diabetic status rather than grade of NAFLD playing a critical role. Serum lipids and adiposity may also contribute to cardiac autonomic dysfunction.
本研究旨在评估非酒精性脂肪性肝病（NAFLD）患者的心率变异性（HRV），并评估NAFLD分级和糖尿病状态对HRV的影响。这项横断面研究纳入了75名受试者（25名无糖尿病的NAFLD患者、25名合并糖尿病的NAFLD患者和25名对照者）。测量指标包括人体测量学、身体成分分析、血浆葡萄糖、血脂、高敏C反应蛋白（hsCRP）和血清胰岛素的测定。在时域和频域进行HRV分析。与对照组相比，合并糖尿病的NAFLD患者总体变异性的时域和频域指标（SDNN、总功率）显著降低。然而，三组间的低频与高频比值无差异。与对照组相比，合并糖尿病的NAFLD患者以及无糖尿病的II级NAFLD患者中，与肥胖、血脂谱和糖代谢相关的变量也更高。多因素逐步回归分析显示HRV与总胆固醇和脂肪百分比呈负相关。NAFLD分级以及糖尿病状态均导致心血管自主神经功能下降，其中糖尿病状态而非NAFLD分级起关键作用。血脂和肥胖也可能导致心脏自主神经功能障碍。
