Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
Front Endocrinol (Lausanne). 2021 Nov 8;12:752944. doi: 10.3389/fendo.2021.752944. eCollection 2021.
Although autonomic imbalance is associated with an increased risk for metabolic disease, its effects on nonalcoholic fatty liver disease (NAFLD) remains unclear. We aimed to evaluate whether autonomic dysfunction predicts the risk for nonalcoholic fatty liver disease (NAFLD).
A total of 33,899 participants without NAFLD who underwent health screening programs between 2011 and 2018 were enrolled. NAFLD was identified by ultrasonography. Autonomic activity was estimated using heart rate variability (HRV). Time domain [standard deviation of the normal-to-normal interval (SDNN) and root mean square difference (RMSSD)]; frequency domain [total power (TP), low frequency (LF), and high frequency (HF), and LF/HF ratio were analyzed.
A total 6,466 participants developed NAFLD within a median of 5.7 years. Subjects with incident NAFLD showed decreased overall autonomic modulation and vagal activity with lowered SDNN, RMSSD, HF, normalized HF, compared to those without NAFLD. As the SDNN, RMSSD, TP, LF, and HF tertiles increased, the risk of NAFLD decreased with tertile 1 being the reference group [the hazard ratios (95% confidence intervals) of tertile 3 were 0.90 (0.85-0.96), 0.83 (0.78-0.88), 0.91 (0.86-0.97), 0.93 (0.87-0.99) and 0.89 (0.83-0.94), respectively] after adjusting for potential confounders. The risk for NAFLD was significantly higher in subjects in whom sustained elevated heart rate, normalized LF, and LF/HF ratio values than in those with sustained decrease in these parameters during follow-up.
Overall autonomic imbalance, decreased parasympathetic activity, and recently increased sympathetic activity might increase the risk of NAFLD.
尽管自主神经失衡与代谢性疾病风险增加有关，但它对非酒精性脂肪性肝病（NAFLD）的影响尚不清楚。我们旨在评估自主神经功能障碍是否可预测非酒精性脂肪性肝病（NAFLD）的风险。
共纳入 2011 年至 2018 年间接受健康筛查计划且无 NAFLD 的 33899 名参与者。通过超声检查来确定 NAFLD。使用心率变异性（HRV）来评估自主活动。时域[正常-正常间期标准差（SDNN）和均方根差（RMSSD）]；频域[总功率（TP）、低频（LF）和高频（HF），以及 LF/HF 比值]进行分析。
在中位随访 5.7 年内，共有 6466 名参与者发生了 NAFLD。与无 NAFLD 者相比，发生 NAFLD 的患者整体自主调节和迷走神经活动下降，SDNN、RMSSD、HF、归一化 HF 降低。与参考组（第 1 三分位数）相比，随着 SDNN、RMSSD、TP、LF 和 HF 三分位数的增加，NAFLD 的风险降低（第 3 三分位数的危险比（95%置信区间）分别为 0.90（0.85-0.96）、0.83（0.78-0.88）、0.91（0.86-0.97）、0.93（0.87-0.99）和 0.89（0.83-0.94）），在调整了潜在混杂因素后。与这些参数持续下降的患者相比，持续升高的心率、归一化 LF 和 LF/HF 比值的患者发生 NAFLD 的风险显著更高。
整体自主神经失衡、副交感神经活性降低和近期交感神经活性增加可能会增加 NAFLD 的风险。
