非酒精性脂肪性肝病与西方和亚洲队列中亚临床动脉粥样硬化的相关性：更新的荟萃分析。

Association between non-alcoholic fatty liver disease and subclinical atherosclerosis in Western and Asian cohorts: an updated meta-analysis.

机构信息

Department of Cardiology, National Heart Center Singapore, Singapore.

Duke-NUS Medical School, Singapore.

出版信息

Open Heart. 2021 Dec;8(2). doi: 10.1136/openhrt-2021-001850.

DOI:10.1136/openhrt-2021-001850

PMID:34933963

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8693165/

Abstract

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a well-established risk factor for cardiovascular disease, with ethnic and regional differences noted. With the recent surge of research within this field, we re-examine the evidence associating NAFLD with subclinical atherosclerosis, and investigate potential regional differences.

METHODS

This is a systematic review and meta-analysis. PubMed and EMBASE were systematically searched for publications from January 1967 to July 2020 using standardised criteria. Original, observational studies investigating the association between NAFLD and either carotid intima-media thickness (CIMT) and/or coronary artery calcification (CAC) were included. Key outcomes included differences in mean CIMT, the presence of increased CIMT, the presence of CAC and the development/progression of CAC. Pooled ORs and pooled standard differences in means were calculated using random-effects models. Between-study heterogeneity was quantified using the Q statistic and I². Subgroup analyses stratified by region of study (Asian vs Western) were also conducted.

RESULTS

64 studies involving a total of 172 385 participants (67 404 with NAFLD) were included. 44 studies assessed the effect of NAFLD on CIMT, with the presence of NAFLD associated with increased CIMT (OR 2.00, 95% CI 1.56 to 2.56). 22 studies assessed the effects of NAFLD on CAC score, with the presence of NAFLD associated with the presence of any coronary calcification (OR 1.21, 95% CI 1.12 to 1.32), and the development/progression of CAC (OR 1.26, 95% CI 1.04 to 1.52). When stratified by region, these associations remained consistent across both Asian and Western populations (p>0.05). The majority (n=39) of studies were classified as 'high quality', with the remaining 25 of 'moderate quality'.

CONCLUSIONS

There is a significant positive association between various measures of subclinical atherosclerosis and NAFLD, seen across both Western and Asian populations. These results re-emphasise the importance of early risk evaluation and prophylactic intervention measures to preclude progression to clinical cardiovascular disease in patients with NAFLD.

摘要

背景

非酒精性脂肪性肝病（NAFLD）是心血管疾病的一个公认的危险因素，具有种族和地区差异。随着该领域研究的最新兴起，我们重新审视了 NAFLD 与亚临床动脉粥样硬化相关的证据，并研究了潜在的区域差异。

方法

这是一项系统评价和荟萃分析。使用标准化标准，从 1967 年 1 月至 2020 年 7 月，对 PubMed 和 EMBASE 进行了系统检索。纳入了原始观察性研究，这些研究调查了 NAFLD 与颈动脉内膜中层厚度（CIMT）和/或冠状动脉钙化（CAC）之间的相关性。主要结局包括平均 CIMT 的差异、CIMT 增加的存在、CAC 的存在以及 CAC 的发展/进展。使用随机效应模型计算了合并的优势比和合并标准差异。使用 Q 统计量和 I² 来量化研究间的异质性。还进行了按研究区域（亚洲与西方）分层的亚组分析。

结果

共纳入 64 项研究，总计 172385 名参与者（67404 名患有 NAFLD）。44 项研究评估了 NAFLD 对 CIMT 的影响，结果显示，存在 NAFLD 与 CIMT 增加相关（OR 2.00，95%CI 1.56 至 2.56）。22 项研究评估了 NAFLD 对 CAC 评分的影响，结果显示，存在 NAFLD 与任何冠状动脉钙化的存在（OR 1.21，95%CI 1.12 至 1.32）以及 CAC 的发展/进展相关（OR 1.26，95%CI 1.04 至 1.52）。按地区分层时，这些关联在亚洲和西方人群中均保持一致（p>0.05）。大多数（n=39）研究被归类为“高质量”，其余 25 项研究为“中等质量”。