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

摘要

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1 72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(x2=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.%objective To study the incidence of and the risk factors for non-alcoholic fatty liver dis-ease(NAFLD) in elderly patients with coronary heart disease(CHD). Methods Three hundred and fifty-nine elderly patients with coronary arteriography-confirmed CHD(172 with NAFLD and 187 without NAFLD) were enrolled in this study. The patients underwent abdominal ultrasonog-raphy after admission and their medical history was recorded. The morbidity rate, liver function and its relation with coronary lesions were studied. Results The incidence of diabetes mellitus and the serum levels of alanine aminotransferase and aspartate aminotransferase were significantly higher in NAFLD patients than in non-NAFLD patients(P<0. 05,P<0. 01). Correlation analysis showed that NAFLD was positively correlated with the severity of coronary lesions(χ2 = 16. 182, P<0. 01). The detection rate of plaques and the number of plaques were significantly higher in NAFLD patients than in non-NAFLD patients(89. 7% vs 78. 3%,2. 27 ± 1. 20 vs 1.81 ± 1. 32,P< 0. 05). Multivariate logistic regression analysis demonstrated that diabetes mellitus and multi-vessel lesions or left main stem lesions were correlated with NAFLD. Conclusion The morbidity rate of NAFLD increases with the severity of coronary lesions in elderly CHD patients.