冠心病伴发非酒精性脂肪性肝病的危险因素分析

目的探讨冠心病伴发非酒精性脂肪性肝病(NAFLD)的患病率和危险因素。方法 1346例经冠状动脉造影诊断为冠心病的患者入院期间进行空腹肝胆超声检查,分为NAFLD组和非NAFLD组,观察NAFLD的发生率、肝功能酶学异常比例及其与冠状动脉病变程度的关系。结果 NAFLD的发生率为50.4%(678/1346)。NAFLD组合并糖尿病、空腹血糖、血清总胆固醇、甘油三酯、谷丙转氨酶及谷草转氨酶水平高于无NAFLD组(P<0.01)。NAFLD的发生率随着冠状动脉病变程度的加重而增加(P<0.01)。多因素Logistic回归分析显示,糖尿病和冠心病多支病变(或左主干病变)是NAFLD的独立危险因素。结论冠心病患者NAFLD的发生率随着冠状动脉粥样硬化病变程度的加重而增加,尤其是糖尿病患者。     

老年冠心病患者合并非酒精性脂肪性肝病的危险因素分析

目的探讨老年冠心病患者合并非酒精性脂肪性肝病(NAFLD)的患病率和危险因素。方法入选冠状动脉造影诊断为冠心病的老年患者359例,NAFLD组172例,非NAFLD组187例,住院期间经腹部超声检查和采集病史,观察2组患病率、肝脏酶学异常比例及其与冠状动脉病变程度的关系。结果 NAFLD组糖尿病、丙氨酸转氨酶、天冬氨酸转氨酶水平明显高于非NAFLD组,差异有统计学意义(P<0.05,P<0.01)。NAFLD与冠状动脉病变严重程度呈正相关(χ2=16.182,P<0.01)。NAFLD组患者斑块检出率、斑块数目明显高于非NAFLD组,差异有统计学意义[89.7%vs 78.3%,(2.27±1.20)个vs(1.81±1.32)个,P<0.05]。多因素logistic回归分析显示,糖尿病和冠状动脉多支病变(或左主干病变)与NAFLD的发生相关。结论老年冠心病患者NAFLD的患病率随着冠状动脉病变程度加重而增加。     

早发冠心病与晚发冠心病的危险因素及冠状动脉病变特点比较

目的:探讨早发冠心病与晚发冠心病的危险因素及冠状动脉病变特点。方法:收集2015-01至2016-02在我院心血管内科经冠状动脉造影(CAG)检查的747例患者一般资料和临床数据,根据CAG结果和患者发病年龄分为早发冠心病组(n=138)、晚发冠心病组(n=364)和非冠心病组(n=245)。冠心病诊断标准即至少有1支主要冠状动脉管径狭窄≥50%,早发冠心病指冠心病发生时男性低于55岁,女性低于65岁。分析早发冠心病与晚发冠心病患者的危险因素及病变特点。结果:早发冠心病组中有高血压家族史、血糖异常比例及体重指数、甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A和载脂蛋白B水平均高于晚发冠心病组(P均0.05),合并高血压比例低于晚发冠心病组(P0.05)。多分类Logistic回归分析显示,合并高血压和糖尿病(OR=2.98,95%CI:1.04~8.57)、高血压家族史(OR=3.50,95%CI:1.28~9.57)、血糖异常(OR=1.98,95%CI:1.04~3.80)和高水平载脂蛋白B(OR=36.67,95%CI:3.51~99.83)增加早发冠心病的风险。高龄(OR=1.20,95%CI:1.15~1.24)、男性(OR=6.22,95%CI:3.31~11.69)、合并高血压(OR=1.75,95%CI:1.08~2.82)、同时合并高血压和糖尿病(OR=3.25,95%CI:1.42~7.46)、高水平载脂蛋白B(OR=16.39,95%CI:1.74~99.44)增加晚发冠心病的风险。早发冠心病组与晚发冠心病组比,双支病变患者比例高(38.4%vs 22.3%),多支病变患者比例低(31.2%vs 48.1%),差异均有统计学意义(P均0.05)。结论:早发冠心病组的危险因素中高血压家族史、血糖异常比例及体重指数和载脂蛋白B水平高于晚发冠心病组。积极开展有针对性的预防措施,对早发冠心病患者的危险因素进行有效防治。     

非酒精性脂肪性肝病与冠状动脉粥样硬化相关性及冠脉病变特点分析

[目的]探讨非酒精性脂肪肝病(NAFLD)与冠状动脉动脉粥样硬化病变的关系。[方法]84例疑诊冠心病患者同时检测血生化指标、肝脏超声和行冠脉CTA检查,并将患者分为NAFLD组(97例)和非NAFLD组(87例),比较2组一般情况、冠心病患病率、冠脉病变特点,采用二分类Logistic回归分析冠心病的危险因素。[结果]NAFLD组体质指数、吸烟率、糖尿病和高血压病患病率、TC、TG、ALT水平均明显高于非NAFLD组(P0.05)。NAFLD组冠心病患病率、多支病变率及非钙化斑块率均高于非NAFLD组(P0.05)。多因素Logistic回归分析显示NAFLD增加冠心病发病风险[P=0.013,OR=4.116,95%CI(1.904~9.270)]。[结论]NAFLD是冠心病独立危险因素,且与冠脉病变严重程度相关。     

早发冠心病危险因素和冠状动脉病变特点的研究

目的总结早发冠心病患者的临床特点,探讨其冠状动脉病变的特点及早发冠心病的危险因素。方法415例经冠状动脉造影确诊为冠心病的患者,按年龄分为早发组180例(男性≤55岁,女性≤65岁)和晚发组235例,对两组患者的临床特点及冠状动脉病变特点进行统计学比较,并应用多因素分析筛选早发冠心病的危险因素。结果早发冠心病组女性患者比例(35.6%比22.1%,P=0.003)、血脂代谢紊乱比例(74.4%比55.7%,P<0.001)、陈旧心肌梗死比例(21.1%比13.2%,P=0.032)及冠心病家族史的比例(57.8%比41.3%,P=0.001)均显著高于晚发组。与晚发组相比,早发组患者舒张压水平(73±9.0mmHg比70±7.0mmHg,P<0.001)、三酰甘油(1.99±1.34mmol/L比1.51±0.84mmol/L,P<0.001)及血清总胆固醇水平(4.65±0.91mmol/L比4.33±0.91mmol/L,P=0.001)均显著升高。冠状动脉造影结果显示,两组患者在单支、多支血管病变所占比例,累及分支血管比例及病变长度等方面差异均无统计学意义。多因素分析结果显示:女性、高三酰甘油血症、陈旧心肌梗死史、冠心病家族史是早发冠心病的危险因素。结论早发冠心病患者冠状动脉病变并不轻于晚发患者,对于早发冠心病患者亦应加强危险因素的综合防治,同时应加强对女性早发冠心病患者的重视。     

回族与汉族早发冠心病危险因素和冠状动脉病变的差异

目的:探讨回族和汉族早发冠心病患者的危险因素及冠状动脉病变的差异。方法:回顾性分析早发冠心病患者回族组78例和汉族组238例。对8个常见心血管危险因素(年龄、性别、BMI、家族遗传、糖尿病、高血压病、血脂异常和吸烟史)及冠状动脉病变特征进行对比分析。结果:回族组吸烟比例、糖尿病比例高于汉族组(P<0.05)。回族组急性心肌梗死比例高于汉族组,而心绞痛比例低于汉族组(P<0.05)。两民族均以A型病变为主,回族组C型病变高于汉族组(P<0.05)。两民族均以单支病变为主,回族组3支病变高于汉族组(P<0.05)。Gensini积分比较,回族组高于汉族组(P<0.05)。结论:比较汉族早发冠心病患者,回族早发冠心病患者吸烟比例高、糖尿病比例高、3支病变率高、C型病变多、冠状动脉病变程度重。     

女性早发冠心病病人冠状动脉病变特点及危险因素分析

目的探讨女性早发冠心病病人冠状动脉病变特点及其危险因素。方法入选我院2012年6月—2015年4月经冠状动脉造影诊断为冠心病的女性病人300例,根据年龄≤55岁为早发组与非早发组。统计病人入院基本临床资料,比较两组病人冠状动脉病变的特点,并运用多因素Logistic回归分析探讨女性早发冠心病病人危险因素。结果与女性非早发组相比,女性早发组主要临床表现为急性冠脉综合征(69.6%vs 25.3%,P0.05),早发组病人吸烟、高脂血症、早发冠心病家族史比例更高,两组之间比较有统计学意义(P0.05),血浆纤维蛋白原(Fg)、三酰甘油(TG)水平均显著高于非早发组,两组之间有统计学意义(P0.05);就冠状动脉病变特征而言,与非女性早发组相比,女性早发组病人冠状动脉病变以单支病变为主(58.7%vs30.7%,P0.05),二者在病变部位上无差别;女性早发组平均冠状动脉病变支数、平均Gensini积分均低于非早发组(1.86±0.73 vs2.73±0.88,P0.05;10.47±2.56 vs53.82±14.02,P0.05);多因素Logistic回归分析显示吸烟(OR=9.5 3 2,9 5%CI:8.2 3 5~22.053,P=0.000)、早发冠心病家族史(OR=11.734,95%CI:6.362~21.523,P=0.001)、Fg(OR=5.146,95%CI:3.804~17.186,P=0.002)、TG(OR=3.073,95%CI:1.832~12.627,P=0.001)是女性早发冠心病病人独立的危险因素。结论吸烟、女性早发冠心病家族史、Fg、TG是女性早发冠心病病人的独立危险因素,积极戒烟、改善不良生活方式能够预防女性早发冠心病的发生。     

2型糖尿病合并冠心病患者冠状动脉造影结果分析

分析46例糖尿病合并冠心病患者与同期80例非糖尿病的冠心病患者的临床和冠脉造影资料。结果:两组患者冠心病危险因素(血脂、高血压、吸烟、冠心病家族史)及冠状动脉支架植入术无显著差异,糖尿病并冠心病三支病变和弥漫病变者分别为56.6%和60%,明显高于非糖尿病者(21.4%和28.7%)。且糖尿病组急性心肌梗死比例高于非糖尿病组。结论:糖尿病并冠心病者冠脉造影三支病变发生率高,且病变部位弥漫、严重、易发生心肌梗死。     

糖化白蛋白与糖尿病并发冠心病的关系

目的探讨糖化白蛋白与糖尿病并发冠心病的关系。方法测定349例糖尿病患者和340例正常对照者的血清糖化白蛋白和糖化血红蛋白浓度。糖尿病患者根据冠状动脉造影管腔直径狭窄是否超过70%分为冠状动脉非显著狭窄组(n=166)和显著狭窄组(n=183)。采用多元回归分析判断糖尿病患者冠状动脉显著狭窄的独立危险因素。结果冠状动脉显著狭窄组血清糖化白蛋白浓度显著高于非显著狭窄组和对照组(P<0.01)。血清糖化白蛋白浓度与冠状动脉血管病变数呈显著相关(r=0.19,P<0.01)。但冠状动脉非显著狭窄组和显著狭窄组之间糖化血红蛋白浓度无统计学差异。多元回归分析发现年龄≥65岁、男性、血清糖化白蛋白浓度、脂蛋白(a)和高血压是糖尿病并发冠心病的独立危险因素。结论糖尿病患者糖化白蛋白水平与冠心病发生及病变严重程度显著相关,是并发冠心病的独立危险因素。     

早发冠心病患者冠状动脉病变特点及危险因素的临床研究

目的探讨早发冠心病患者的冠状动脉病变特点及相关危险因素。方法152例经冠状动脉造影确诊的冠心病患者，根据年龄分为早发冠心病组（男性〈55岁，女性〈65岁）74例和老年冠心病组78例。对两组患者的相关资料进行回顾性统计分析，比较二者的冠状动脉病变特点、血脂水平、高血压病史、糖尿病病史、冠心病家族史、吸烟史、饮酒史等，评价其是否存在差异性。结果早发冠心病组中吸烟史，冠心病家族史，血清总胆固醇高于老年冠心病组；而高血压病史、糖尿病史低于老年冠心病组。早发冠心病组冠状动脉病变多为单支病变，老年冠心病组以多支病变为主。结论吸烟、冠心病阳性家族史，高胆固醇血症均是早发冠心病的主要危险因素。冠状动脉病变特点以单支病变为主。     

Nonalcoholic fatty liver disease is associated with coronary artery disease in Koreans

AIM:To investigate whether nonalcoholic fatty liver disease(NAFLD)affects coronary artery disease(CAD)and identify candidate mediators.METHODS:Patients who underwent coronary angiography were consecutively recruited.The patients were classified into four groups by coronary artery stenosis:A,insignificant;B,one-vessel disease;C,two-vessel disease;and D,three-vessel disease.Abdominal ultrasonography was performed to determine the presence of a fatty liver and categorize by grade:0,no evidence;1,mild;2,moderate;and 3,severe.We measured not only known CAD risk factors,but also serum insulin,HOMA-index,adiponectin,interleukin-6,tumor necrosis factor-αand high-sensitivity C-reactive protein levels.RESULTS:Of the 134 patients who met the inclusion criteria,82(61.2%)had ultrasonographically diagnosed NAFLD.Among the 46 patients with CAD,37(80.4%)had evidence of a fatty liver.The two groups(A vs B-D)were significantly different in terms of age,total cholesterol,triglycerides,low-density lipoprotein levels and fatty liver.Coronary artery stenosis was strongly associated with fatty liver in a grade-dependent manner(P=0.025).In binary logistic regression,NAFLD was a significant independent predictor of CAD(P=0.03,OR=1.685;95%CI:1.051-2.702).Among the candidate mediators,the serum adiponectin level showed a trend toward lowering based on CAD progression(P=0.071).CONCLUSION:NAFLD is an independent risk factor for CAD in a grade-dependent manner.Moreover,adiponectin might be related to the pathogenesis of NAFLD.     

非酒精性脂肪性肝病合并冠心病患者冠脉病变程度及其危险因素分析*

目的 分析非酒精性脂肪性肝病（NAFLD）合并冠心病（CHD）患者冠脉病变程度及其危险因素。方法 2015年1月~2017年1月我院收治的154例NAFLD患者,经冠脉造影诊断CHD 71例。使用超声和CT检查诊断脂肪肝程度,应用Gensini评分评判冠脉病变程度。采用Logistic多因素回归分析影响冠脉病变的因素。结果 71例CHD与83例非CHD患者在合并糖尿病、吸烟及FPG、TC、TG、ALT、AST、GGT、hs-CRP和HOMA -IR水平方面比较有显著性差异（t/x²=7.62、5.38、3.82、5.80、3.72、8.79、3.10、5.75、5.25、5.93,P<0.05或P<0.01）;多因素Logistic回归分析显示,合并糖尿病、FPG、TC、ALT、hs-CRP、HOMA-IR是NAFLD合并CHD的独立危险因素（P<0.05或P<0.01）;37例轻度、23例中度和11例重度NAFLD合并CHD患者单支、双支和三支冠状病变比例比较有显著性差异（x²=14.8,P<0.01）。结论 NAFLD合并CHD发病率较高,及时了解其发生的独立危险因素,做好重点监测和防治是减少CHD发生的积极措施。     

冠心病患者伴非酒精性脂肪性肝病的临床特征分析

目的 分析冠心病(CAD)伴非酒精性脂肪性肝病(NAFLD)患者的临床特征.方法 234例接受冠状动脉造影检查的患者,并有糖、脂代谢指标及腹部超声检查结果,男性148例,女性86例,平均年龄66.6岁.应用冠脉狭窄指数(CSI)评价冠状动脉病变严重程度,代谢综合征采用2007年中国成人血脂异常防治指南中关于代谢综合征的诊断标准.结果 234例研究对象中,62例患者为NAFLD.与无NAFLD组相比,NAFLD患者中心性肥胖的患病率明显升高(75.8%对50.0%,P<0.01).CAD伴NAFLD在60岁以下患者中的发生率显著高于60岁以上者(27.4%对13.7%,P=0.005).尽管CAD亚组与CAD合并NAFLD亚组的CSI评分差异无统计学意义(P>0.05),但后者的年龄明显低于CAD亚组(P=0.006).Logistic回归分析显示中心性肥胖为NAFLD的独立危险因子(β:1.701,P<0.001).Logistic回归与多元逐步回归分析发现,年龄分别是影响冠脉病变的独立危险因素(β=0.032,P=0.027)以及影响CSI评分的主要因素(β=0.125,P=0.022).结论 中年肥胖及脂肪肝人群应当重视冠心病的筛查.     

Comparison of major coronary risk factors in female and male patients with premature coronary artery disease

OBJECTIVE: The present study was designed to analyse and compare the major coronary risk factors of female and male patients with premature coronary artery disease (CAD) aged < or = 45 years. METHODS: We evaluated 4613 consecutive patients who underwent coronary angiography at our institution; 572 symptomatic patients (489 men and 83 women) diagnosed as having premature CAD (age < or = 45 years) were included in our analysis. For each patient, the presence of major coronary risk factors such as family history of CAD, hypercholesterolaemia, diabetes mellitus, hypertension and cigarette smoking were recorded. Besides, clinical presentation and angiographic findings were also recorded. RESULTS: The most common risk factor was cigarette smoking in young men (70.3%). However, the major coronary risk factor was hypercholesterolaemia in young women (67.5%). When we compared two groups with respect to major coronary risk factors, we found that the prevalence of diabetes mellitus and hypertension were significantly higher in young women than in young men (diabetes mellitus: 27.7% vs. 12.3%, respectively, P < 0.001, hypertension: 56.6% vs. 23.4%, respectively, P < 0.001). However, cigarette smoking was found to be significantly higher in men than in women (70.3% vs. 28.9% respectively, P < 0.001). CONCLUSION: We have shown for the first time the impact of gender on the coronary risk factor profile in young Turkish patients with premature CAD. These findings may be useful for gender-based management and risk factor modification of young patients with premature CAD.     

Mild drinking habit is a risk factor for hepatocarcinogenesis in non-alcoholic fatty liver disease with advanced fibrosis

AIM The impact of mild drinking habit(less than 20 g/d of ethanol) on the clinical course of non-alcoholic fatty liver disease(NAFLD) has not been determined. We examined the influence of a mild drinking habit on liver carcinogenesis from NAFLD. METHODS A total of 301 patients who had been diagnosed as having NAFLD by liver biopsy between 2003 and 2016 [median age: 56 years, 45% male, 56% with nonalcoholic steatohepatitis, 26% with advanced fibrosis(F3-4)] were divided into the mild drinking group withe thanol consumption of less than 20 g/d(mild drinking group, n = 93) and the non-drinking group(n = 208). Clinicopathological features at the time of liver biopsy and factors related to hepatocellular carcinoma(HCC) occurrence were compared between the groups.RESULTS We observed significant differences in male prevalence(P = 0.01), platelet count(P = 0.04), and gammaglutamyl transpeptidase(P = 0.02) between the test groups. Over 6 years of observation, the HCC appearance rate was significantly higher in the mild drinking group(6.5% vs 1.4%, P = 0.02). Multivariate survival analysis using Cox's regression model revealed that hepatic advanced fibrosis(F3-4)(P 0.01, risk ratio: 11.60), diabetes mellitus(P 0.01, risk ratio: 89.50), and serum triglyceride(P = 0.04, risk ratio: 0.98) were factors significantly related to HCC in all NAFLD patients, while the effect of a drinking habit was marginal(P = 0.07, risk ratio: 4.43). In patients with advanced fibrosis(F3-4), however, a drinking habit(P = 0.04, risk ratio: 4.83), alpha-fetoprotein(P = 0.01, risk ratio: 1.23), and diabetes mellitus(P = 0.03, risk ratio: 12.00) were identified as significant contributors to HCC occurrence. CONCLUSION A mild drinking habit appears to be a risk factor for hepatocarcinogenesis in NAFLD patients, especially those with advanced fibrosis.     

Nonalcoholic fatty liver disease is associated with coronary artery calcification

Nonalcoholic fatty liver disease (NAFLD) is related to risk factors of coronary artery disease, such as dyslipidemia, diabetes, and metabolic syndrome, which are closely linked with visceral adiposity. The aim of this study was to investigate whether NAFLD was associated with coronary artery calcification (CAC), which is used as a surrogate marker for coronary atherosclerosis independent of computed tomography (CT)-measured visceral adiposity. Out of 5,648 subjects who visited one of our health screening centers between 2003 and 2008, we enrolled 4,023 subjects (mean age, 56.9 ± 9.4 years; 60.7% males) without known liver disease or a history of ischemic heart disease. CAC score was evaluated using the Agatston method. On univariate analysis, the presence of CAC (score >0) was significantly associated with age, sex, body mass index, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein cholesterol, triglycerides, and increased risk of diabetes, hypertension, smoking, and NAFLD. Increasing CAC scores (0, <10, 10-100, ≥ 100) were associated with higher prevalence of NAFLD (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.61-2.10; P<0.001). Multivariable ordinal regression analysis was adjusted for traditional risk factors, and CT-measured visceral adipose tissue area in a subgroup of subjects showed that the increased CAC scores were significantly associated with the presence of NAFLD (OR, 1.28, 95% CI, 1.04-1.59; P = 0.023) independent of visceral adiposity. CONCLUSION: Patients with NAFLD are at increased risk for coronary atherosclerosis independent of classical coronary risk factors, including visceral adiposity. These data suggest that NAFLD might be an independent risk factor for coronary artery disease.     

Evaluation of vulnerable coronary plaques and non-alcoholic fatty liver disease (NAFLD) by 64-detector multislice computed tomography (MSCT).

BACKGROUND: Multislice computed tomography (MSCT) permits direct visualization of not only coronary artery stenosis but also the characteristics of plaques in patients with coronary artery disease (CAD). Also, because of its potential to be a novel risk factor for cardiovascular disease, interest in non-alcoholic fatty liver disease (NAFLD) is increasing. METHODS AND RESULTS: Participants comprised 298 consecutive patients who received MSCT to diagnose CAD. Patients with an alcohol intake exceeding 20 g/day or with a history of known liver disease were excluded from the study. Liver steatosis and 4 coronary artery findings, including remodeling lesions, lipid core plaques, calcified plaques and narrowing of lumen, were assessed. Liver steatosis was evaluated by computed tomography density of the liver and spleen. In the study, NAFLD was defined as having a liver and spleen (L:S) ratio of <1.1. The L:S ratios of patients with remodeling lesions or lipid core plaques were significantly lower than those without. NAFLD was related significantly to those findings, but there was no correlation between calcified plaques, narrowing of lumen and L:S ratios. Adjusted odds ratio of NAFLD for remodeling lesions was 2.41 (95% confidence interval (CI), 1.24-4.67; p=0.009), and those for lipid core lesions was 2.29 (95% CI, 1.15-4.56; p=0.018). CONCLUSION: NAFLD is a novel risk factor for vulnerable plaques.     

Association between nonalcoholic fatty liver disease and coronary artery disease

AIMS: To demonstrate whether there is a relationship between the presence of nonalcoholic fatty liver disease (NAFLD) and the presence and extent of coronary artery disease (CAD). PATIENTS AND METHODS: Ninety-two consecutive patients who planned to undergo coronary angiographies (CAG) without known CAD, other than findings of acute coronary syndrome, were enrolled in this study. Abdominal ultrasonography was performed before the CAG to detect NAFLD. CAD was defined as a stenosis of at least 50% in at least one major coronary artery. The extent of CAD was measured according to the number of major coronary artery/arteries affected by CAD. All the risk factors for CAD were included in a binary logistic regression model. Forward, backward, or step-wise selections were not used. P<0.05 was accepted as being significant. RESULTS: Sixty-five of the 92 patients (70.7%) were detected, by abdominal ultrasonography, to have fatty liver and 43 patients out of 92 (46.7%) were detected, by CAG, to have significant CAD. According to the results of logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG [odds ratio (OR), 95% confidence interval (CI): 6.73 (1.14-39.61); P=0.035]; this was despite factoring in the other risk factors for CAD and the components of metabolic syndrome. NAFLD was more commonly found in patients as the extent of CAD increased (P=0.001). CONCLUSION: The presence of NAFLD is independently associated with the presence and extent of CAD. Future studies are needed to explain the mechanisms of this relationship.