高血压病合并脂肪肝发病的危险因素分析

目的探讨高血压病合并脂肪肝发病的危险因素。方法选择进行了肝脏B超检查的住院高血压病患者,根据超声影像的诊断结果分为高血压合并脂肪肝组(98例)和高血压未合并脂肪肝组(102例),分析体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、胰岛素抵抗指数(HO-MA-IR)、糖耐量试验各时段的血糖水平、胰岛素释放试验的胰岛素水平与脂肪肝之间的关系。结果(1)Logistic回归分析的结果表明空腹血糖升高、肥胖、糖负荷后3小时胰岛素水平升高、高甘油三酯血症是高血压患者脂肪肝形成的独立危险因素;(2)高血压合并脂肪肝组的HOMA-IR、TG、空腹和糖负荷后2、3小时的血糖和胰岛素水平高于对照组(均P<0.05)。校正两组BMI后,上述差异仍然存在。结论(1)高血压病患者脂肪肝发病的独立危险因素是空腹血糖升高、肥胖、糖负荷后3小时胰岛素水平升高、高甘油三酯血症,随着这些危险因素的聚集,脂肪肝的检出率增加。(2)脂肪肝是高血压病患者胰岛素抵抗的“重要标志”,脂肪肝是代谢综合征的一种表现。

Analysis on the risk factors of fatty liver in patients with hypertension

Objective To analyze the risk factors of fatty liver in patients with hypertension.Methods Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamy-transferase (GGT), insulin resistant index (HOMA-IR), plasma glucose and serum insulin of each time interval after oral glucose tolerance test were investigated in 98 hypertensive patients with fatty liver and 102 hypertensives without fatty liver.Results (1) The result of logistic regression analysis showed that elevating level of fasting plasma glucose, triglyceride, the third hour serum insulin after oral glucose tolerance test and obesity were independent risk factors of fatty liver; (2) Insulin resistant index (HOMA-IR), the level of triglyceride, fasting blood glucose, the second and third hour blood glucoses after oral glucose tolerance test, fasting serum insulin, the second and third hour serum insulin after oral glucose tolerance test in hypertensives with fatty liver were much higher than that of hypertensive controls, and the significant difference existed between two group even after BMI being adjusted. Conclusions (1) The independent risk factors of fatty liver in hypertensives were elevating level of fasting blood glucose, triglyceride, the third hour serum insulin after oral glucose tolerance test and obesity. The detecting rate of fatty liver was rising with more risk factors getting together. (2) Fatty liver is important signal of insulin resistant in hypertensives and is a part of metabolic syndrome.