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脂肪肝对心脏结构和功能的影响：一项基于健康体检的横断面研究

Effect of fatty liver on cardiac structure and function: a cross-sectional study based on health examination

    摘要
  • 摘要:
    目的  调查健康体检人群中不同脂肪肝分层与心脏结构和功能之间的横断面关联。
    方法  回顾性纳入2017年1月1日至12月31日在复旦大学附属中山医院健康管理中心接受健康体检的成年人6 545名，收集人口学特征和实验室指标数据。通过超声检查对肝脂肪变性进行分级，并根据丙氨酸氨基转移酶（alanine aminotransferase, ALT）或天冬氨酸氨基转移酶（aspartate aminotransferase, AST）水平，以及肝纤维化情况，对脂肪肝患者进行进一步分层。采用经胸超声心动图评估心脏形态及功能，并对左心室结构模式进行分类。采用多因素logistic回归分析评估不同脂肪肝分层与心脏异常之间的关联。
    结果 共有2 795例（42.7%）脂肪肝患者，其中832例（29.8%）存在明显的心脏结构改变，1 500例（53.7%）存在舒张功能障碍。重度脂肪肝患者心脏向心性重构及相对室壁厚度（relative wall thickness, RWT）风险增加（OR均为1.27，P＝0.012、0.009）；脂肪肝伴ALT或AST升高患者心脏向心性重构（OR＝1.45、1.56，P＝0.001、0.001）、RWT增加（OR＝1.48、1.57，P＜0.001、＜0.001）及心脏舒张功能障碍（OR＝1.27、1.32，P=0.035、0.040）风险增加。脂肪肝伴肝纤维化患者的心脏向心性重构（OR＝1.83，P＝0.046）和舒张功能障碍（OR＝2.64，P＝0.034）风险增加。
    结论 进展期脂肪肝（包括严重肝脂肪变性、伴肝酶升高或肝纤维化）提高心脏重构和舒张功能障碍风险，但不影响收缩功能。对于脂肪肝患者，建议定期进行超声心动图检查。

     

    Abstract:
    Objective To investigate the cross-sectional associations between different fatty liver classifications and cardiac structure and function in people undergo health examination.
    Methods A total of 6 545 adults who underwent health examinations at the Health Management Center of Zhongshan Hospital, Fudan University between January 1 and December 31, 2017, were retrospectively included. Demographic characteristics and laboratory data were collected. The hepatic steatosis was graded by ultrasonography. And patients with fatty liver were further stratified according to alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels, as well as the degree of liver fibrosis. Cardiac morphology and function were assessed by transthoracic echocardiography, and left ventricular geometric patterns were classified accordingly. Multivariate logistic regression analysis was performed to evaluate the associations between fatty liver classifications and cardiac abnormalities.
    Results  There were 2 795 patients (42.7%) with fatty liver, of whom 832 (29.8%) had significant cardiac structural alterations and 1 500 (53.7%) had diastolic dysfunction. Severe fatty liver was risk factor for concentric remodeling and increased relative wall thickness (RWT), with odds ratios (ORs) of 1.27 (P＝0.012) and 1.27 (P＝0.009), respectively. Fatty liver accompanied by elevated ALT or AST was risk factor for concentric remodeling (OR＝1.45,1.56; P＝0.001, 0.001), increased RWT (OR＝1.48,1.57; P＜0.001, ＜0.001), and diastolic dysfunction (OR＝1.27, 1.32; P＝0.035, 0.040), respectively. Fatty liver with liver fibrosis was risk factor for concentric remodeling (OR＝1.83, P＝0.046) and diastolic dysfunction (OR＝2.64, P＝0.034).
    Conclusions Advanced fatty liver, including severe hepatic steatosis, accompanied by elevated liver enzymes or liver fibrosis, could increase risks of cardiac remodeling and diastolic dysfunction, while systolic function is preserved. For patients with fatty liver, it is recommended to undergo regular ultrasonography examination.

     

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