非酒精性脂肪肝对急性心肌梗死患者预后的影响

目的探讨急性心肌梗死(acute myocardial infarction, AMI)并发非酒精性脂肪肝(non-alcoholic fatty liver disease, NAFLD)患者血脂、血清炎性因子水平变化,及NAFLD对AMI预后的影响。方法 AMI患者712例,其中350例有NAFLD者为观察组,362例无NAFLD者为对照组。比较2组入院时年龄,性别比例,体质量指数(body mass index, BMI),合并高血压、2型糖尿病情况,ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)及非STEMI比率,冠状动脉病变支数,行经皮冠状动脉介入术(percutaneous coronary intervention, PCI)比率,药物治疗情况以及血清肌钙蛋白I(cardiac troponin I, cTnI)、尿酸(uric acid, UA)、同型半胱氨酸(homocysteine, Hcy)、C反应蛋白(C-reactive protein, CRP)、总胆固醇(total cholesterol, TC)、三酰甘油(triacylglycerol, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、白细胞计数(white blood cell count, WBC),D-二聚体(D-dimer, D-D)、血小板/淋巴细胞比值(platelet lymphocyte ratio, PLR);随访观察主要心脑血管不良事件(major cardiovascular and cerebrovascular adverse events, MACCE)发生率及生存时间;Pearson相关分析SYNTAX积分与UA等指标的相关性。结果观察组BMI[(29.00±1.41)kg/m^2]、合并2型糖尿病比率(60.57%)、SYNTAX积分[(24.50±2.37)分]及血清TC[(5.67±0.63)mmol/L]、TG[(2.31±0.27)mmol/L]、LDL-C[(3.13±0.51)mmol/L]、UA[(502.20±31.51)μmol/L]、Hcy[(16.91±1.85)μmol/L]、CRP[(22.30±0.37)mg/L]、WBC[(13.08±2.09)×10^9/L]、D-D[(1.36±0.32)g/L]、PLR(191.34±8.15)均高于对照组[BMI:(27.00±1.69)kg/m^2,合并糖尿病比率:41.99%,SYNTAX积分:(19.60±3.95)分,TC:(5.02±0.35)mmol/L,TG:(1.91±0.40)mmol/L,LDL-C:(2.38±0.55)mmol/L,UA:(446.20±51.08)μmol/L,Hcy:(13.63±1.50)μmol/L,CRP:(13.20±0.33)mg/L,WBC:(11.16±0.98)×10^9/L,D-D:(0.95±0.26)g/L,PLR:158.85±8.35](P<0.05);2组年龄,性别比例,合并高血压比率,冠状动脉病变支数,STEMI、非STEMI、PCI比率,阿司匹林等药物应用比率,血清HDL-C、cTnI水平比较差异无统计学意义(P>0.05);观察组MACCE发生率(9.71%)高于对照组(5.52%)(P<0.05),中位生存时间(14.5个月)较对照组(15.4个月)短(P<0.05);Pearson相关分析显示,SYNTAX积分与UA(r=0.876,P<0.001)、Hcy(r=0.736,P<0.001)、CRP(r=0.278,P=0.038)、TC(r=0.644,P<0.001)、TG(r=0.641,P<0.001)、LDL-C(r=0.633,P<0.001),BMI(r=0.599,P<0.001)、PLR(r=0.456,P<0.001)均呈正相关。结论 NFALD可能加剧AMI患者炎性反应,增高血脂,加重冠状动脉血管狭窄程度,增加MACCE发生率,影响AMI患者预后。

Influence of non-alcoholic fatty liver disease on acute myocardial infarction

Objective To investigate the changes of lipid indexes and serum inflammatory cytokines as well as the influence of non-alcoholic fatty liver disease(NAFLD) on acute myocardial infarction(AMI). Methods In 712 patients with AMI, 350 patients were complicated with NAFLD(observation group) and 362 patients were not complicated with NAFLD(control group), and were compared the age, sex ratio, body mass index, complications of hypertension and type 2 diabetes mellitus, percentages of ST-segment elevation myocardial infarction(STEMI) and non-STEMI, coronary artery lesion, percentage of percutaneous coronary intervention(PCI), drug therapy, and the levels cardiac troponin I(cTnI), uric acid(UA), homocysteine(Hcy), C-reactive protein(CRP), total cholesterol(TC), triacylglycerol(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), white blood cell count(WBC), D-dimer(D-D) and platelet lymphocyte ratio(PLR). The incidence of major cardiovascular and cerebrovascular adverse events(MACCE) and survival were followed up. Pearson regression analysis was adopted to analyze the correlation between SYNTAX score and UA. Results BMI((29.00±1.41) kg/m^2), incidence of type 2 diabetes mellitus(60.57%),SYNTAX score(24.50±2.37),serum TC((5.67±0.63)mmol/L),TG((2.31±0.27)mmol/L),LDL-C((3.13±0.51)mmol/L),UA((502.20±31.51)μmol/L),Hcy((16.91±1.85)μmol/L),CRP((22.30±0.37)mg/L),WBC((13.08±2.09)×109/L),D-D((1.36±0.32)g/L)and PLR(191.34±8.15)in observation group were significantly higher than those in control group((27.00±1.69)kg/m2,41.99%,19.60±3.95,(5.02±0.35)mmol/L,(1.91±0.40)mmol/L,(2.38±0.55)mmol/L,(446.20±51.08)μmol/L,(13.63±1.50)μmol/L,(13.20±0.33)mg/L,(11.16±0.98)×109/L,(0.95±0.26)g/L,158.85±8.35)(P<0.05),and there were no significant differences in the age,sex ratio,complication of hypertension,branch of coronary artery lesion,STEMI,non-STEMI,PCI percentage,aspirin application,and serum levels of HDL-C and cTnI between two groups(P>0.05).The incidence of MACCE was higher in observation group(9.71%)than that in control group(5.52%)(P<0.05),and the medium survival time was significantly shorter in observation group(14.5 months)than that in control group(15.4 months)(P<0.05).The SYNTAX score was positively correlated with UA(r=0.876,P<0.001),Hcy(r=0.736,P<0.001),CRP(r=0.278,P=0.038),TC(r=0.644,P<0.001),TG(r=0.641,P<0.001),LDL-C(r=0.633,P<0.001),BMI(r=0.599,P<0.001)and PLR(r=0.456,P<0.001).Conclusion NFALD might aggravate the inflammatory response in patients with AMI,increase lipid level,aggravate the degree of coronary artery stenosis,increase the incidence of MACCE,and affect the prognosis of AMI patients.