非酒精性脂肪肝识别基于CTA颈动脉高危斑块

doi:10.6040/j.issn.1671-7554.0.2023.0389

摘要/Abstract

摘要： 目的通过颈动脉CT血管成像(CTA),探讨非酒精性脂肪肝(NAFLD)与颈动脉高危斑块之间的相关性。方法搜集因疑似心血管疾病行颈动脉CTA的203例患者(男119例、女84例)病历资料,平均(61.4±12.5)岁。NAFLD定义为非增强CT(肝脾CT值比值<1)显示的肝脏脂肪变性,无临床肝病、肝硬化或酒精滥用。根据腹部CT检查结果分为NAFLD(病例组)及非NAFLD组(对照组)。比较两组一般临床资料、高危斑块特征(正性重构、溃疡、脂质斑块、“餐巾环”征)、斑块性质及颈动脉狭窄程度。采用二元Logistic回归分析NAFLD与颈动脉高危斑块的存在之间的相关性。结果 NAFLD患者的糖尿病患病率高(P=0.047),丙氨酸氨基转移酶(P=0.015)、谷氨酰转肽酶(P=0.029)、甘油三酯(P=0.004)及高密度脂蛋白(P<0.001)高于非NAFLD组,差异均具有统计学意义。NAFLD患者高危斑块的存在(P=0.001)、颈总动脉及颈内动脉颅外段的非钙化斑块(P=0.015)、部分钙化斑块(P=0.008)发生率,颈内动脉颅内段的非钙化斑块(P=0.022)、部分钙化斑块(P=0.002)均高于非NAFLD患者,差异具有统计学意义。在多变量Logistic回归分析中,调整年龄、性别、糖尿病史、高血压、GGT、尿酸、颈总动脉、颈内动脉钙化斑块、非钙化斑块及部分钙化斑块和狭窄程度后,NAFLD仍与颈动脉高危斑块独立相关(OR:4.85;95%CI:1.77~13.28;P=0.002)。结论非酒精性脂肪肝与CTA检测的颈动脉高危斑块独立相关。

关键词: 非酒精性脂肪肝, 颈动脉斑块, 高危斑块, 颈动脉粥样硬化, 颈动脉CT血管造影

Abstract: Objective To investigate the correlation between non-alcoholic fatty liver disease(NAFLD)and carotid artery high-risk plaques by computed tomographic angiography(CTA). Methods A total of 203 patients(119 males and 84 females)aged 61.4±12.5 years who underwent carotid CTA for suspected cardiovascular diseases during Jan. and Oct. 2022 were involved. NAFLD was defined as hepatic steatosis without clinical liver disease, cirrhosis or alcohol abuse as demonstrated by non-enhanced CT(hepatosplenic CT value ratio <1). The patients were divided into NAFLD(case group)and non-NAFLD group(control group)according to the abdominal CT findings. The general clinical data, characteristics of high-risk plaques(positive remodeling, ulceration, lipid plaques, "napkin ring" sign), nature of plaques, and degree of carotid stenosis were compared between the two groups. The correlation between NAFLD and presence of high-risk plaques in carotid arteries was analyzed with binary Logistic regression. Results Patients in the NAFLD group had a significantly higher prevalence of diabetes mellitus(P=0.047), levels of alanine aminotransferase(P=0.015), glutamyl transpeptidase(P=0.029), triglycerides(P=0.004), and high-density lipoprotein(P<0.001)than the non-NAFLD group; the presence of high-risk plaques(P=0.001), non-calcified plaques(P=0.015)and incidence of partially calcified plaques(P=0.008)in the common carotid artery and extracranial segment of the internal carotid artery, and non-calcified plaques(P=0.022)and incidence of partially calcified plaques(P=0.002)in the intracranial segment of the internal carotid artery were also higher than the non-NAFLD group. In multivariate Logistic analysis, NAFLD remained independently associated with high-risk plaques after adjusments of age, sex, history of diabetes, hypertension, GGT, uric acid, total carotid artery, calcified plaques in the internal carotid artery, noncalcified plaques, and partially calcified plaques and degree of stenosis(OR: 4.85; 95%CI: 1.77-13.28; P=0.002). Conclusion NAFLD is independently associated with carotid high-risk plaques detected by CTA.

Key words: Non-alcoholic fatty liver disease, Carotid plaque, High-risk plaque, Carotid atherosclerosis, Carotid CT angiography

中图分类号:

R445.3

许天旗,常娜,张帅,李莎,矫秉轩,于鑫鑫,王锡明. 非酒精性脂肪肝识别基于CTA颈动脉高危斑块[J]. 山东大学学报 (医学版), 2023, 61(12): 36-43.

XU Tianqi, CHANG Na, ZHANG Shuai, LI Sha, JIAO Bingxuan, YU Xinxin, WANG Ximing. Identification of carotid high-risk plaques by non-alcoholic fatty liver disease based on CTA[J]. Journal of Shandong University (Health Sciences), 2023, 61(12): 36-43.

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