Chen Qian, Li Qing, Li Dan, Chen Xuechen, Liu Zhaomin, Hu Gang, Wang Jingfeng, Ling Wenhua
Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China.
Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, 510080, China.
Atherosclerosis. 2020 Apr;299:45-52. doi: 10.1016/j.atherosclerosis.2020.03.010. Epub 2020 Mar 14.
Fatty liver diseases are highly prevalent in patients with coronary artery disease (CAD) and might progress to irreversible liver fibrosis. Whether baseline liver fibrosis (LF) scores are associated with long-term mortality among patients with CAD requires investigation.
The analysis was conducted based on a prospective cohort study among 3263 patients with CAD in China. Cox models were used to assess the association of baseline levels of LF scores, including non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis 4 score (FIB-4), aspartate aminotransferase to platelet ratio index (APRI), gamma-glutamyltransferase to platelet ratio (GPR), and Forns score, with the risk of all-cause and cardiovascular mortality among CAD patients.
During a median follow-up period of 7.56 (inter-quartile range: 6.86-8.31) years, 538 deaths were identified, 319 of those were due to cardiovascular diseases. Compared with patients with lowest score levels, multivariable-adjusted HRs (95% CI) for those with highest levels of NFS, FIB-4, APRI, GPR and Forns score were 2.89 (2.14-3.91), 2.84 (2.14-3.76), 1.77 (1.33-2.36), 1.47 (1.19-1.83) and 3.10 (1.88-5.11) for all-cause mortality, 3.02 (2.05-4.45), 3.34 (2.29-4.86), 1.99 (1.40-2.83), 1.80 (1.36-2.39) and 2.43 (1.28-4.61) for cardiovascular mortality, respectively. These associations were consistent when we excluded those who died within the first year of follow-up or stratified patients by different sex, age, BMI, diabetes status, metabolic syndrome status, CAD type and hsCRP level.
Higher LF scores are associated with increased risks of all-cause and cardiovascular mortality among CAD patients. LF scores might play a potential role in CAD prognosis prediction.
脂肪性肝病在冠状动脉疾病（CAD）患者中高度流行，且可能进展为不可逆的肝纤维化。CAD患者的基线肝纤维化（LF）评分是否与长期死亡率相关尚需研究。
基于对中国3263例CAD患者的前瞻性队列研究进行分析。采用Cox模型评估LF评分的基线水平，包括非酒精性脂肪性肝病纤维化评分（NFS）、纤维化4评分（FIB-4）、天冬氨酸氨基转移酶与血小板比值指数（APRI）、γ-谷氨酰转移酶与血小板比值（GPR）和Forns评分，与CAD患者全因死亡和心血管死亡风险的关联。
在中位随访期7.56（四分位间距：6.86 - 8.31）年期间，共确定538例死亡，其中319例死于心血管疾病。与评分水平最低的患者相比，NFS、FIB-4、APRI、GPR和Forns评分最高水平的患者全因死亡的多变量调整HR（95%CI）分别为2.89（范围2.14 - 3.91）、2.84（2.14 - 3.76）、1.77（1.33 - 2.36）、1.47（1.19 - 1.83）和3.10（1.88 - 5.11），心血管死亡的多变量调整HR（95%CI）分别为3.02（2.05 - 4.45）、3.34（2.29 - 4.86）、1.99（1.40 - 2.83）、1.80（1.36 - 2.39）和2.43（1.28 - 4.61）。当我们排除随访第一年内死亡的患者或按不同性别、年龄、BMI、糖尿病状态、代谢综合征状态、CAD类型和hsCRP水平对患者进行分层时，这些关联是一致的。
较高的LF评分与CAD患者全因死亡和心血管死亡风险增加相关。LF评分可能在CAD预后预测中发挥潜在作用。
