无症状普通人群中非酒精性脂肪性肝病与心血管风险之间的相互作用。
Interplay between non-alcoholic fatty liver disease and cardiovascular risk in an asymptomatic general population.
作者信息
Pennisi Grazia, Di Marco Vito, Buscemi Carola, Mazzola Giovanni, Randazzo Cristiana, Spatola Federica, Craxì Antonio, Buscemi Silvio, Petta Salvatore
机构信息
Section of Gastroenterology and Hepatology, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy.
Infectious Diseases Unit, Department of Health Promotion Sciences and Mother Child Care "Giuseppe D'Alessandro", University of Palermo, Palermo, Italy.
出版信息
J Gastroenterol Hepatol. 2021 Sep;36(9):2389-2396. doi: 10.1111/jgh.15523. Epub 2021 May 16.
BACKGROUND AND AIMS
Non-alcoholic fatty liver (NAFLD) is a major cause of liver disease worldwide leading also to a higher risk of cardiovascular events. We aimed to evaluate the impact of fatty liver and fibrosis on cardiovascular risk in a general population.
METHODS
Five hundred and forty-two subjects included in the community-based ABCD (Alimentazione, Benessere Cardiovascolare e Diabete) study were recruited. Steatosis (controlled attenuation parameter > 288 dB/m) and severe fibrosis (low risk, liver stiffness measurement [LSM] < 7.9 KPa with M probe and < 5.7 KPa with XL probe; intermediate risk, LSM 7.9-9.5 KPa with M probe and 5.7-9.2 KPa with XL probe; high risk, LSM ≥ 9.6 KPa with M probe and ≥ 9.3 KPa with XL probe) were assessed with FibroScan. Cardiovascular risk was evaluated by the atherosclerotic cardiovascular disease (ASCVD) risk estimator and defined low if < 5%, borderline if 5-7.4%, intermediate if 7.5-19.9% and high if ≥ 20%. Intima-media thickness (IMT) was measured with ultrasound.
RESULTS
Prevalence of steatosis and of severe fibrosis in this cohort was 31.7% and 4.8%, respectively. ASCVD score was evaluated in patients with and without steatosis and according to the risk of severe fibrosis. By ordinal regression analysis, both steatosis (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.13-2.33, P = 0.009) and severity of fibrosis (OR 1.67, 95% CI 1.18-2.36, P = 0.003) were independent risk factors for a higher ASCVD risk after adjusting for obesity. Subjects with NAFLD, when compared with those without, did not differ for IMT (0.75 vs 0.72 mm; P = 0.11) and IMT ≥ 1 mm (15.6% vs 12.1%; P = 0.24). Higher prevalence of IMT ≥ 1 mm was found in patients at high or intermediate risk of severe fibrosis (24% and 28.6%, respectively) compared with those at low risk (12.1%) (P = 0.03); this association was maintained after adjusting for confounders (OR 2.70, 95% CI 1.01-2.86, P = 0.04).
CONCLUSION
In the setting of a general adult population, the presence of NAFLD and severe fibrosis are associated with to a higher cardiovascular risk profile, pointing towards the need for specific preventive measures.
背景与目的
非酒精性脂肪性肝病（NAFLD）是全球肝脏疾病的主要病因，也会导致心血管事件风险升高。我们旨在评估普通人群中脂肪肝和肝纤维化对心血管风险的影响。
方法
招募了542名纳入基于社区的ABCD（营养、心血管健康与糖尿病）研究的受试者。通过FibroScan评估肝脂肪变性（受控衰减参数>288 dB/m）和严重肝纤维化（低风险，M探头测量的肝脏硬度值[LSM]<7.9 KPa且XL探头测量的<5.7 KPa；中度风险，M探头测量的LSM为7.9 - 9.5 KPa且XL探头测量的为5.7 - 9.2 KPa；高风险，M探头测量的LSM≥9.6 KPa且XL探头测量的≥9.3 KPa）。通过动脉粥样硬化性心血管疾病（ASCVD）风险评估器评估心血管风险，若<5%则定义为低风险，5%至7.4%为临界风险，7.5%至19.9%为中度风险，≥20%为高风险。用超声测量内膜中层厚度（IMT）。
结果
该队列中肝脂肪变性和严重肝纤维化的患病率分别为31.7%和4.8%。对有和无肝脂肪变性以及根据严重肝纤维化风险的患者进行了ASCVD评分评估。通过有序回归分析，调整肥胖因素后，肝脂肪变性（比值比[OR] 1.62，95%置信区间[CI] 1.13 - 2.33，P = 0.009）和肝纤维化严重程度（OR 1.67，95% CI 1.18 - 2.36，P = 0.003）均为ASCVD风险升高的独立危险因素。与无NAFLD的受试者相比，患有NAFLD的受试者在IMT方面无差异（0.75 vs 0.72 mm；P = 0.11），IMT≥1 mm的情况也无差异（15.6% vs 12.1%；P = 0.24）。与低风险患者（12.1%）相比，严重肝纤维化高风险或中度风险患者中IMT≥1 mm的患病率更高（分别为24%和28.6%）（P = 0.03）；调整混杂因素后这种关联仍然存在（OR 2.70，95% CI 1.01 - 2.86，P = 0.04）。
结论
在普通成年人群中，NAFLD和严重肝纤维化与更高的心血管风险状况相关，这表明需要采取特定的预防措施。
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