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目的比较非酒精性脂肪性肝病(NAFLD)合并代谢综合征(MS)患者与单纯NAFLD患者内皮功能差异,并分析其影响因素。方法 2015年1月至2015年10月在新疆医科大学第一附属医院住院并诊断为NAFLD,除外合并动脉粥样硬化终末期脏器损伤后,91例患者被分为A组(单纯NAFLD组)和B组(NAFLD合并MS组),收集临床资料;采用Endo-PAT 2000检测仪无创测定指端反应性充血指数(RHI);采用二项Logistic多元回归分析影响内皮功能的因素。结果 52例A组与39例B组RHI差异有统计学意义(1.63±0.29对1.81±0.29,P<0.01);A组腰围(92.75±9.10)cm、体质指数(25.99±2.98)kg/m~2、收缩压(117.87±15.08)mm Hg、空腹血糖(5.08±0.89)mmol/L和甘油三脂(1.46±0.65)mmol/L均显著低于B组【(101.64±10.86)cm、(28.07±3.97)kg/m~2、(127.41±12.03)mm Hg、(6.87±2.90)mmol/L和(2.69±2.22)mmol/L,P<0.05】,而A组高密度脂蛋白胆固醇(1.26±0.34)mmol/L、天门冬氨酸氨基转移酶(62.48±9.79)U/L和丙氨酸氨基转移酶(93.04±19.56)U/L均显著高于B组【(0.93±0.30)mmol/L、(37.70±10.45)U/L和(55.39±15.59)U/L,P<0.01】;Logistic回归分析显示空腹血糖(OR=1.34)、游离脂肪酸(OR=5.58)和丙氨酸氨基转移酶(OR=1.04)为NAFLD患者内皮功能障碍的独立危险因素。结论 NAFLD合并MS患者与单纯NAFLD患者内皮功能存在差异,影响NAFLD患者内皮功能的多个因素与糖脂代谢和肝脏炎症相关。
Objective To compare the difference of endothelium function in non-alcoholic fatty liver disease (NAFLD) patients with metabolic syndrome (MS) and simple NAFLD and analyze the influencing factors. Methods From January 2015 to October 2015, the first affiliated hospital of Xinjiang Medical University was hospitalized and diagnosed as NAFLD. Excluding the combined atherosclerotic end-stage organ injury, 91 patients were divided into group A (NAFLD-only group) And group B (NAFLD combined with MS group). Clinical data were collected. End-reactivity index (RHI) was measured by Endo-PAT 2000 non-invasively. Logistic regression analysis was used to analyze the influencing factors on endothelial function. Results The RHI of 52 cases in group A and 39 cases in group B were statistically significant (1.63 ± 0.29 vs 1.81 ± 0.29, P <0.01). The waist circumference (92.75 ± 9.10) cm, body mass index (25.99 ± 2.98) kg / m Systolic blood pressure (117.87 ± 15.08) mmHg, fasting blood glucose (5.08 ± 0.89) mmol / L and triglyceride (1.46 ± 0.65) mmol / L were significantly lower than those in group B (101.64 ± 10.86 cm, 28.07 ± 3.97 kg / m ~ 2, 127.41 ± 12.03 mm Hg, 6.87 ± 2.90 mmol / L and 2.69 ± 2.22 mmol / L, respectively, P <0.05; while the high density lipoprotein cholesterol 1.26 ± 0.34 mmol / L, aspartate aminotransferase 62.48 ± 9.79 U / L and alanine aminotransferase 93.04 ± 19.56 U / L were significantly higher than those in group B (0.93 ± 0.30) (OR = 1.34), free fatty acid (OR = 5.58), and alanine (P <0.01) by Logistic regression analysis. Aminotransferase (OR = 1.04) was an independent risk factor for endothelial dysfunction in NAFLD patients. Conclusion There are differences in endothelial function between patients with NAFLD and those with NAFLD alone. Several factors affecting endothelial function in patients with NAFLD are associated with glucose and lipid metabolism and liver inflammation.