Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Faculty of Health Sciences, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
J Hepatol. 2019 Jun;70(6):1203-1213. doi: 10.1016/j.jhep.2019.01.035. Epub 2019 Feb 13.
BACKGROUND & AIMS: Cardiovascular disease is the principle cause of death in patients with elevated liver fat unrelated to alcohol consumption, more so than liver-related morbidity and mortality. The aim of this study was to evaluate the relationship between liver fat and cardiac and autonomic function, as well as to assess how impairment in cardiac and autonomic function is influenced by metabolic risk factors.
Cardiovascular and autonomic function were assessed in 96 sedentary individuals: i) non-alcoholic fatty liver disease (NAFLD) (n = 46, hepatic steatosis >5% by magnetic resonance spectroscopy), ii) Hepatic steatosis and alcohol (dual aetiology fatty liver disease [DAFLD]) (n = 16, hepatic steatosis >5%, consuming >20 g/day of alcohol) and iii) CONTROL (n = 34, no cardiac, liver or metabolic disorders, <20 g/day of alcohol).
Patients with NAFLD and DAFLD had significantly impaired cardiac and autonomic function when compared with controls. Diastolic variability and systolic variability (LF/HF-sBP [n/1]; 2.3 (1.7) and 2.3 (1.5) vs. 3.4 (1.5), p <0.01) were impaired in patients with NAFLD and DAFLD when compared to controls, with DAFLD individuals showing a decrease in diastolic variability relative to NAFLD patients. Hepatic steatosis and fasting glucose were negatively correlated with stroke volume index. Fibrosis stage was significantly negatively associated with mean blood pressure (r = -0.47, p = 0.02), diastolic variability (r = -0.58, p ≤0.01) and systolic variability (r = -0.42, p = 0.04). Hepatic steatosis was independently associated with cardiac function (p ≤0.01); TNF-α (p ≤0.05) and CK-18 (p ≤0.05) were independently associated with autonomic function.
Cardiac and autonomic impairments appear to be dependent on level of liver fat, metabolic dysfunction, inflammation and fibrosis staging, and to a lesser extent alcohol intake. Interventions should be sought to moderate the excess cardiovascular risk in patients with NAFLD or DAFLD.
Increased levels of fat in the liver impair the ability of the cardiovascular system to work properly. The amount of fat in the liver, metabolic control, inflammation and alcohol are all linked to the degree that the cardiovascular system is affected.
与酒精无关的肝脂肪升高的患者，心血管疾病是其主要死亡原因，其导致的肝脏相关发病率和死亡率高于肝脂肪。本研究旨在评估肝脂肪与心脏和自主功能之间的关系，并评估心脏和自主功能障碍受代谢危险因素的影响程度。
评估了 96 名久坐不动的个体的心血管和自主功能：i）非酒精性脂肪性肝病（NAFLD）（n=46，磁共振波谱检查肝脂肪>5%），ii）肝脂肪和酒精双重病因性脂肪性肝病（DAFLD）（n=16，肝脂肪>5%，每日饮酒>20g）和 iii）对照组（n=34，无心脏、肝脏或代谢疾病，每日饮酒<20g）。
与对照组相比，NAFLD 和 DAFLD 患者的心脏和自主功能明显受损。与对照组相比，NAFLD 和 DAFLD 患者的舒张压变异性和收缩压变异性（LF/HF-sBP[n/1]；2.3（1.7）和 2.3（1.5）比 3.4（1.5），p<0.01）受损，DAFLD 患者的舒张压变异性较 NAFLD 患者下降。肝脂肪和空腹血糖与每搏量指数呈负相关。纤维化分期与平均血压（r=-0.47，p=0.02）、舒张压变异性（r=-0.58，p≤0.01）和收缩压变异性（r=-0.42，p=0.04）显著负相关。肝脂肪与心脏功能独立相关（p≤0.01）；TNF-α（p≤0.05）和 CK-18（p≤0.05）与自主功能独立相关。
心脏和自主功能障碍似乎取决于肝脂肪水平、代谢功能障碍、炎症和纤维化分期，以及酒精摄入的影响较小。应寻求干预措施来减轻 NAFLD 或 DAFLD 患者的心血管风险。
肝脏脂肪含量增加会损害心血管系统的正常工作能力。肝脏脂肪含量、代谢控制、炎症和酒精都与心血管系统受影响的程度有关。
