Gut 2011 Dec;60 (12): 1721-7. [IF:10.614]
Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease.
Wong VW , Wong GL , Yip GW , Lo AO , Limquiaco J , Chu WC , Chim AM , Yu CM , Yu J , Chan FK , Sung JJ , Chan HL .
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong; hlychan@cuhk.edu.hk.
香港中文大学内科及药物治疗学系，香港威尔斯亲王医院
Abstract
Objective Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and is associated with cardiovascular risk. The aim of this study was to determine the role of fatty liver in predicting coronary artery disease and clinical outcomes in patients undergoing coronary angiogram. Methods This was a prospective cohort study carried out in a University hospital. Consecutive patients who underwent coronary angiogram had ultrasound screening for fatty liver. Significant cardiovascular disease was defined as ≥50% stenosis in at least one coronary artery. The primary outcome was a composite end point comprising cardiovascular deaths, non-fatal myocardial infarction and the need for further coronary intervention during prospective follow-up. Results Among 612 recruited patients, 356 (58.2%) had fatty liver by ultrasonography, 318 (52.0%) had elevated serum alanine aminotransferase and 465 (76.0%) had significant coronary artery disease. Coronary artery disease occurred in 84.6% of patients with fatty liver and 64.1% of those without fatty liver (p<0.001). After adjusting for demographic and metabolic factors, fatty liver (adjusted OR 2.31; 95% CI 1.46 to 3.64) and alanine aminotransferase level (adjusted OR 1.01; 95% CI 1.00 to 1.02) remained independently associated with coronary artery disease. At a mean follow-up of 87±22 weeks, 30 (10.0%) patients with fatty liver and 18 (11.0%) patients without fatty liver reached the composite clinical end point (p=0.79). Conclusions In patients with clinical indications for coronary angiogram, fatty liver is associated with coronary artery disease independently of other metabolic factors. However, fatty liver cannot predict cardiovascular mortality and morbidity in patients with established coronary artery disease.
摘要：
目的：非酒精性脂肪肝（NAFLD）是肝脏代谢综合征的表现，并且常伴随着发生心血管疾病的风险。本文的的目的是想通过脂肪肝来预测冠心病和冠脉造影病人的预后。
方法：本文是一个在大学医院开展的前瞻性队列研究。对接受过冠脉造影的患者进行超声筛查脂肪肝，至少有一条冠状动脉发生50%以上的狭窄就可以确立为显著的冠心病。主要评价指标是一个复合终点值，包括：因心血管疾病死亡、非致命性心肌梗塞以及在随访中需要进一步的冠脉介入治疗。
结果：在入组的612名病人中，通过超声检查发现356(58.2%)患有脂肪肝，318 (52.0%)名患者血清丙氨酸转移酶升高，465 (76.0%)名患者有显著的冠心病。脂肪肝患者冠心病的发生率为84.6%，而在没有脂肪肝的人群中冠心病的发生率为64.1%(p<0.001)。通过校正人口因素和代谢因素后，脂肪肝（校正OR 2.31;95%置信区间 1.46-3.64）和丙氨酸转移酶水平（校正OR 1.01，95%置信区间 1.00-1.02）仍然与冠心病独立相关。经过平均87±22周的随访，30名(10.0%)患有脂肪肝的病人和18 名(11.0%)非脂肪肝患者到达实验终点。
结论：在有临床冠脉造影指征的病人中，脂肪肝与冠心病的发生有相关关系，并且与其他代谢指标相对独立。然而，脂肪肝并不能作为预测已确诊为冠心病患者的心血管疾病的死亡率和患病率的指标。
