非酒精性脂肪性肝病肝纤维化与左心室舒张功能和运动耐量的关系。
Relation of Hepatic Fibrosis in Nonalcoholic Fatty Liver Disease to Left Ventricular Diastolic Function and Exercise Tolerance.
机构信息
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Kinesiology & Health Sciences, Virginia Commonwealth University, Richmond, Virginia.
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
出版信息
Am J Cardiol. 2019 Feb 1;123(3):466-473. doi: 10.1016/j.amjcard.2018.10.027. Epub 2018 Nov 6.
The purpose of this study was to determine the relation between liver histology, exercise tolerance, and diastolic function in patients with nonalcoholic fatty liver disease (NAFLD). Myocardial remodeling and diastolic dysfunction have been associated with NAFLD. However, its physiological impact and relationship to the histological severity of NAFLD is not known. Cardiopulmonary exercise testing and stress echocardiography was performed in subjects with biopsy-confirmed NAFLD. Maximal aerobic exercise capacity (peak oxygen consumption [VO]) was related to diastolic function (mitral annulus Doppler velocity e' and ratio of early diastolic filling pressure [E] to e' [E/e']) at rest and peak exercise. Autonomic dysfunction was determined from heart rate recovery after exercise. Independent predictors of cardiac function and exercise capacity were identified by multivariable regression. Thirty-six subjects (nonalcoholic fatty liver [NAFL = 15], nonalcoholic steatohepatitis [NASH = 21]) were enrolled. NASH was associated with impaired exercise capacity compared with NAFL (median peak VO 17.0 [15.4, 18.9] vs 19.9 [17.4, 26.0], p = 001); pVO declined with increasing fibrosis (F0 = 22.5, F1 = 19.9, F2 = 19.0, F3 = 16.6 ml·kg·min; p = 0.01). Similarly, E/e' during exercise increased progressively with increasing fibrosis (F0 = 5.6, F1 = 6.5, F2 = 8.7, F3 = 9.8; P = 0.02). Finally, heart rate recovery, a marker of autonomic function, was blunted in those with higher fibrosis stages (F0 = 25 [20, 30], F1 = 23 [17.5, 27.0], F2 = 17 [11.8, 21.5], F3 = 11 [8.5, 18.0] beats per minute; p <0.01). Fibrosis was an independent predictor of these functional outcomes. In conclusion, NASH is associated with impaired exercise capacity and diastolic dysfunction compared with NAFL. The severity of impairment is directly related to the severity of fibrosis stage in precirrhotic stages of NAFLD.
本研究旨在探讨非酒精性脂肪性肝病（NAFLD）患者的肝组织学、运动耐量和舒张功能之间的关系。心肌重构和舒张功能障碍与 NAFLD 有关。然而，其生理影响及其与 NAFLD 组织学严重程度的关系尚不清楚。对经活检证实为 NAFLD 的患者进行心肺运动试验和应激超声心动图检查。最大有氧运动能力（峰值耗氧量[VO]）与舒张功能（二尖瓣环多普勒速度 e'和舒张早期充盈压[E]与 e'的比值[E/e']）在静息和峰值运动时相关。自主神经功能障碍通过运动后心率恢复来确定。通过多元回归确定心功能和运动能力的独立预测因素。共纳入 36 例患者（非酒精性脂肪肝[NAFL=15]，非酒精性脂肪性肝炎[NASH=21]）。与 NAFL 相比，NASH 与运动能力受损相关（中位数峰值 VO 17.0[15.4，18.9] vs 19.9[17.4，26.0]，p=0.01）；随着纤维化程度的增加，pVO 下降（F0=22.5，F1=19.9，F2=19.0，F3=16.6 ml·kg·min；p=0.01）。同样，运动时 E/e'逐渐增加纤维化程度（F0=5.6，F1=6.5，F2=8.7，F3=9.8；P=0.02）。最后，纤维化程度较高的患者心率恢复（自主神经功能的标志物）减弱（F0=25[20，30]，F1=23[17.5，27.0]，F2=17[11.8，21.5]，F3=11[8.5，18.0]次/分钟；p<0.01）。纤维化是这些功能结果的独立预测因素。总之，与 NAFL 相比，NASH 与运动能力受损和舒张功能障碍有关。在非肝硬化阶段的 NAFLD，损伤的严重程度与纤维化分期的严重程度直接相关。
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