肝脏脂肪含量与颈动脉内膜中层厚度的相关性

目的探讨超声测定的肝脏脂肪含量与颈动脉内膜中层厚度（C-IMT）的关系。方法选取2009年12月至2010年6月上海肥胖研究（SHOS）中单个社区人群1217人，筛选具备完整临床资料以及超声测定的肝脏衰减系数与颈动脉内膜中层厚度的人群，以肝脏衰减系数半定量判定肝脏脂肪含量。按肝脏衰减系数三分位点分组比较研究对象的临床特点，分析C-IMT与各临床参数的相关性，并采用多元逐步回归分析影响C-IMT的危险因素。结果（1）超声定性诊断无颈动脉斑块且无非酒精性脂肪性肝病（NAFLD）者505人，其中男225人，女280人，年龄34～66岁，平均（50±6）岁。与肝脏衰减系数下三位组相比，上三位组的年龄（t=-2．41，P〈0．05）、舒张压（DBP）显著升高（Z=-1．27，P〈0．05），腰围（w）、体质指数（BMI）显著降低（t=3．95、6．17，均P〈0．05）。（2）C-IMT水平随着肝脏衰减系数的升高而显著增加（F=13．83，P〈0．05），肝脏衰减系数上三分位组较下三位点组C-IMT增厚的频率显著升高（35．3％比23．2％，）（x2=6．19，P〈0．05）。（3）多元逐步回归分析显示除年龄、w、收缩压（SBP）、空腹血糖（FPG）、吸烟状态外，肝脏衰减系数是C-IMT的独立影响因素（β=0．03，ρ〈0．05）。结论超声定性不能识别的NAFLD人群中肝脏脂肪含量与C-IMT密切相关，肝脏衰减系数对筛选代谢风险无显著升高人群的早期亚临床动脉粥样硬化有一定临床价值。

The relationship of liver fat content and carotid intima media thickness

Objective To explore the relationship between liver fat content and carotid intima media thickness （C-IMT） with ultrasound measurement. Methods 1217 subjects with complete data on physical examination, plasma glucose, blood pressure and lipid profile from a community of Shanghai Obesity Study （SHOS） between December 2009 and June 2010 were enrolled. All of them underwent carotid artery ultrasound scan and liver attenuation coefficient tested by ultrasonography to evaluate liver fat content. Subjects were grouped by tertile analysis of liver attenuation coefficient. The comparison of clinical indexes and C-IMT was conducted, using correlation analysis and multiple stepwise regression to explore the risk factors which affected C-IMT. Results （1）A total of 505 subjects （225 men and 280 women）, who aged from 34 to 66 years old was diagnosed as non-Nonalcoholic fatty liver disease （NAFLD） without history of cardiovascular disease and non-carotid arterial plaque. Compared with those in the lowest tertile of liver attenuation coefficient, subjects in the highest group had significantly higher age （ t = - 2. 41, P 〈 0. 05 ） and diastolic blood pressure （DBP） （ Z = - 1.27, P 〈 O. 05 ） , and significantly lower waist circumference （W） （t =3.95, P 〈0.05） and body mass index （BMI） （t =6. 17, P 〈0. 05）. （2） C-IMT significantly increased with the increment of liver attenuation coefficient （ F -- 13.83, P 〈 0.05 ）. The frequency ofC-IMT elevation was also significantly higher in the highest tertile group compared with the lowest one （35.3% vs 23. 2%, X2 =6. 19, P 〈0. 05）. （3） Multiple stepwise regression analysis showed that liver attenuation coefficient was independent risk factor with C-IMT after adjustment of age, W, SBP fasting blood glucose （FBG） and smoking （β = 0. 03, P 〈 0.05）. Conclusion Liver attenuation coefficient measured by ultrasonography is an effective method to identify liver fat content, which is closely correlated with C-IMT among undiagnosed NAFLD subjects by ultrasonography and it shows a clinical significance for early screenin~ of subclinical atherosclerosis even amon low cardiometabolic risk subiects.