摘要
目的探讨青中年非酒精性脂肪性肝炎（NASH）与动脉内皮功能和动脉粥样硬化（AS）的关系，为预测和预防NASH患者AS提供临床依据。方法根据51例非酒精性脂肪性肝病患者的组织学特征分为NASH组40例和单纯非酒精性脂肪肝（NAFL）组11例。进行常规人体学指标检测、血液生物化学和代谢指标测定，计算胰岛素抵抗稳态模型指数。酶联免疫吸附法检测血清超敏C-反应蛋白、可溶性细胞间黏附分子-1、内皮素-1；并用彩色超声诊断仪检测颈动脉内膜中层厚度，动脉硬化测定仪检测臂踝脉搏波传导速度和踝臂指数。组间数据比较采用f检验或秩和检验。结果超敏C-反应蛋白在NAsH组为3．69（2．56，6．48）mg／L，高于NAFL组的1．47（1.34，2.40）mg／L，Z=-3．962，P〈0．01，可溶性细胞间黏附分子-1在NASH组和NAFL组分别为（624．78±40．12）ng／ml和（464．49±24．81）ng／ml，t=-12．552，P〈0．01；内皮素-1在两组分别为67．57（66．58，70．42）pg／ml、58．00（55．46，61．28）pg／ml，Z=-4．237，P〈0．01。比较NASH组与NAFL组颈动脉内膜中层厚度[0．900（0．850，0．990）rain与0．075（0．070，0．080）mm]、臂踝脉搏波传导速度[1505．75（1377．90，1583．80）cm／s与1390．50（1306．50，1416．00）cm／s]，Z值分别为-4．419和-2．199，P值均〈0．05。胰岛素抵抗稳态模型指数NASH组（1．95土0．84）明显高于NAFL组（1．25±0．40），f=3．888，P〈0．01。结论非酒精性脂肪肝患者肝脏炎症与动脉内皮功能紊乱和AS密切相关，对青中年脂肪肝患者应及早积极干预以预防心脑血管疾病。，
Objective To study the relationship between non-alcoholic steatohepatitis （NASH） and atherosclerosis in young and middle-aged patients, and to provide clinical evidence that will aid in prevention and prediction of development of atherosclerosis or cardiovascular diseases in patients with non-alcoholic fatty liver disease （NAFLD）. Methods Fifty-one patients with biopsy-proven NAFLD （18 to 60 years in age） were divided into two groups： cases with simple non-alcoholic fatty liver （NAFL, n = 11） and cases with NASH （n = 40）. All subjects underwent physical examination and anthropometric measurements. Fasting serum was assayed by blood biochemistry. Insulin resistance was estimated by the homeostatic model assessment index （HOMA-IR）. Serum levels of high-sensitivity C-reactive protein （hs-CRP）, soluble intercellular adhesion molecule- 1 （sICAM- 1）, and endothelin- 1 （ET- 1） were detected by enzyme-linked immunosorbent assay. Carotid intima-media thickness （CIMT） was estimated by carotid ultrasound. Brachial-ankle pulse wave velocity （baPWV） and ankle-brachial index were estimated using a volume-plethymographic apparatus. Data for the two groups were summarized as mean ± SD or interquartile range and intergroup differences were evaluated by paired t-test orWilcoxon test, with two-sided P-values 〈 0.05 indicating significance. Results The serum levels of hs- CRP, slCAM-1, and ET-1 were significantly higher in the NASH group than the NAFL group （allP 〈 0.001）. In addition, the CIMT and baPWV were significantly higher in the NASH group than the NAFL group （both P 〈 0.05）. The HOMA-IR was also significantly higher in the NASH group than the NAFL group （P 〈 0.001）. Conclusion Liver inflammation and insulin resistance may play important, and possibly collaborative, roles in promoting arterial endothelial dysfunction and atherosclerosis in NAFLD patients. NASH patients, especially those who are young and middle-aged, may benefit fzom early monitoring and prevention strategies to help decrease the risk of developing severe cardiovascular diseases.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2014年第3期205-208,共4页
Chinese Journal of Hepatology
关键词
脂肪肝
动脉内皮功能
动脉粥样硬化
Fatty liver
Arterial endothelial function
Atherosclerosis
