脂蛋白(a)水平预测早期颈动脉粥样硬化的能力在代谢相关脂肪性肝病相关的晚期肝纤维化患者中受损。
The Ability of Lipoprotein (a) Level to Predict Early Carotid Atherosclerosis Is Impaired in Patients With Advanced Liver Fibrosis Related to Metabolic-Associated Fatty Liver Disease.
机构信息
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China.
Department of Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China.
出版信息
Clin Transl Gastroenterol. 2022 Jul 1;13(7):e00504. doi: 10.14309/ctg.0000000000000504. Epub 2022 May 23.
INTRODUCTION
Hepatic fibrosis reduces the serum level of lipoprotein (a) (Lp(a)) and may affect its accuracy in cardiovascular disease prediction of metabolic-associated fatty liver disease (MAFLD). We aimed to estimate the association between Lp(a) levels and the risk of carotid atherosclerosis in MAFLD patients with advanced fibrosis.
METHODS
This was a cross-sectional study enrolling 4,348 consecutive individuals (1,346 patients with MAFLD and 3,002 non-MAFLD patients) who were admitted to the First Affiliated Hospital, Sun Yat-sen University, and underwent abdominal and carotid ultrasonography from 2015 to 2021. Lp(a) levels, liver biochemical markers, metabolic indices, and anthropometric parameters were measured. Liver fat content and fibrosis severity were assessed by MRI-PDFF, using the NAFLD fibrosis score (NFS) and liver stiffness measurement (LSM) of two-dimensional shear wave elastography, respectively.
RESULTS
There was an L-shaped relationship between Lp(a) levels and LSMs in patients with MAFLD, and Lp(a) levels had a different relationship with liver fat content in MAFLD patients with F1-2 versus those with F3-4. Non-MAFLD patients had higher levels of Lp(a) than MAFLD patients with or without advanced fibrosis (both P < 0.05). Lp(a) levels and degree of liver fibrosis were both positively correlated with carotid atherosclerosis in patients with MAFLD. Lp(a) levels performed well on carotid atherosclerosis risk prediction for non-MAFLD patients with an area under the curve (AUC) of 0.819, which was significantly better than the carotid atherosclerosis risk prediction for MAFLD patients with NFS ≤ -1.836 (AUC: 0.781), NFS > -1.836 (AUC: 0.692), and LSM ≥ 9.0 kPa (AUC: 0.635) (all P < 0.05).
DISCUSSION
Advanced liver fibrosis significantly reduces the predictive value of Lp(a) levels for the risk of carotid atherosclerosis in patients with MAFLD.
简介
肝纤维化会降低脂蛋白(a)（Lp(a)）的血清水平，并且可能会影响其在代谢相关脂肪性肝病（MAFLD）患者心血管疾病预测中的准确性。本研究旨在评估 Lp(a)水平与 MAFLD 患者伴晚期纤维化的颈动脉粥样硬化风险之间的相关性。
方法
这是一项横断面研究，纳入了 2015 年至 2021 年期间在中山大学附属第一医院接受腹部和颈动脉超声检查的 4348 名连续个体（1346 名 MAFLD 患者和 3002 名非 MAFLD 患者）。测量了 Lp(a)水平、肝生化标志物、代谢指数和人体测量参数。通过磁共振质子密度脂肪分数（MRI-PDFF）分别使用非酒精性脂肪性肝病纤维化评分（NFS）和二维剪切波弹性成像的肝硬度测量（LSM）评估肝脂肪含量和纤维化严重程度。
结果
MAFLD 患者的 Lp(a)水平与 LSM 之间存在 L 型关系，并且 Lp(a)水平与 MAFLD 患者 F1-2 与 F3-4 之间的肝脂肪含量有不同的关系。非 MAFLD 患者的 Lp(a)水平高于 MAFLD 患者，无论其是否伴有晚期纤维化（均 P < 0.05）。在 MAFLD 患者中，Lp(a)水平和肝纤维化程度均与颈动脉粥样硬化呈正相关。Lp(a)水平在非 MAFLD 患者的颈动脉粥样硬化风险预测中表现良好，曲线下面积（AUC）为 0.819，明显优于 NFS≤-1.836（AUC：0.781）、NFS＞-1.836（AUC：0.692）和 LSM≥9.0kPa（AUC：0.635）的 MAFLD 患者的颈动脉粥样硬化风险预测（均 P < 0.05）。
讨论
晚期肝纤维化会显著降低 Lp(a)水平对 MAFLD 患者颈动脉粥样硬化风险的预测价值。
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