CAJ | 학술논문

目的探讨血清游离脂肪酸水平与非酒精性脂肪性肝病(NAFLD)及颈动脉内膜中层厚度(CIMT)的关系.方法入选402例具备完整的问卷、体格检查、血压、糖脂代谢、游离脂肪酸水平及肝脏超声、颈动脉超声结果的男性.以空腹游离脂肪酸水平四分位点将研究对象分为Q1 ～Q4四组,比较各组临床参数.NAFLD的诊断采用中华医学会肝病学分会2010年NAFLD诊疗指南的标准；代谢综合征采用2007年中国成人血脂异常防治指南的标准.结果 (1)与非NAFLD组比较,NAFLD组体重指数、腰围、血压、血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、肝酶、胰岛素、稳态模型评估的胰岛素抵抗指数(HOMA-IR)、CIMT及游离脂肪酸水平均明显升高(均P＜0.05),而高密度脂蛋白胆固醇降低(P＜0.01).(2)与空腹游离脂肪酸水平处于Q1组比较,Q4组收缩压、血糖、总胆固醇、甘油三酯、肝酶、餐后2h胰岛素、餐后2h游离脂肪酸明显升高(均P＜0.05),NAFLD频率亦显著升高(P＜0.01).(3)Logistic回归分析显示,空腹游离脂肪酸、HOMA-IR、体重指数及谷丙转氨酶是NAFLD的独立影响因素(β=0.001,0.253,0.312,0.043,均P＜0.05).结论空腹游离脂肪酸水平与男性NAFLD独立相关,NAFLD患者CIMT增厚.
목적 탐토혈청유리지방산수평여비주정성지방성간병(NAFLD)급경동맥내막중층후도(CIMT)적관계.방법 입선402례구비완정적문권、체격검사、혈압、당지대사、유리지방산수평급간장초성、경동맥초성결과적남성.이공복유리지방산수평사분위점장연구대상분위Q1 ～Q4사조,비교각조림상삼수.NAFLD적진단채용중화의학회간병학분회2010년NAFLD진료지남적표준；대사종합정채용2007년중국성인혈지이상방치지남적표준.결과 (1)여비NAFLD조비교,NAFLD조체중지수、요위、혈압、혈당、총담고순、감유삼지、저밀도지단백담고순、간매、이도소、은태모형평고적이도소저항지수(HOMA-IR)、CIMT급유리지방산수평균명현승고(균P＜0.05),이고밀도지단백담고순강저(P＜0.01).(2)여공복유리지방산수평처우Q1조비교,Q4조수축압、혈당、총담고순、감유삼지、간매、찬후2h이도소、찬후2h유리지방산명현승고(균P＜0.05),NAFLD빈솔역현저승고(P＜0.01).(3)Logistic회귀분석현시,공복유리지방산、HOMA-IR、체중지수급곡병전안매시NAFLD적독립영향인소(β=0.001,0.253,0.312,0.043,균P＜0.05).결론 공복유리지방산수평여남성NAFLD독립상관,NAFLD환자CIMT증후.
Objective To study the relationship of free fatty acid (FFA) with non-alcoholic fatty liver disease (NAFLD) and carotid intima-media thickness (CIMT).Methods Four hundred and two male individuals with complete data on questionnaire,physical examination,blood pressure,plasma glucose,lipid profiles,and FFA underwent liver ultrasound scan and carotid ultrasound scan were divided into four groups according to fasting FFA quartile.NAFLD was diagnosed according to NAFLD clinic guide (2010) and metabolic syndrome was diagnosed according to the Guideline on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults (2007).Results (1) Compared with non-NAFLD group,subjects in NAFLD group had significantly higher body mass index,waist circumference,blood pressure,fasting plasma glucose,and 2 h postprandial glucose,total cholesterol,triglycerides,low density lipoprotein-cholesterol,liver enzymes,fasting insulin,2 h postprandial insulin,homeostasis model assessment for insulin resistance (HOMA-IR),CIMT,fasting and 2 h postprandial FFA (all P＜0.05),while the level of high density lipoprotein-cholesterol was decreased(P＜0.01).(2) Compared with those in the lowest quartiles of fasting FFA,subjects in the highest quartile had significantly higher level of systolic blood pressure,fasting plasma glucose,2 h postprandial glucose,total cholesterol,triglycerides,liver enzymes,2 h postprandial insulin,2 h postprandial FFA (all P ＜ 0.05),and frequency of NAFLD was also increased (P ＜0.01).(3)Logistic regression analysis showed that fasting FFA,HOMA-IR,body mass index,and alanine aminotransferase were independently correlated with N AFLD after adjustment of other parameters (β =0.001,0.253,0.312,0.043,respectively,all P＜0.05).Conclusions Fasting FFA was independently and positively associated with NAFLD.CIMT level was higher in patients with NAFLD.