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比较腹部脂肪沉积和异位肝脏脂肪沉积对外周血管僵硬度的影响

, PP. 543-547

Keywords: 腹型肥胖,非酒精性脂肪肝,动脉僵硬度,动脉粥样硬化

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Abstract:

目的通过测定有非酒精性脂肪肝(nonalcoholicfattyliverdisease,NAFLD)的正常体质量人群和没有NAFLD的腹型肥胖人群的心-踝血管指数(cardio-anklevascularindex,CAVI),来比较腹部脂肪沉积和异位肝脏脂肪沉积对外周血管僵硬度的影响大小。方法选取2012年1-12月在我院体检中心进行健康体检的111552名中国汉族成人。按体质指数(BMI)和腰围(WC)及是否有脂肪肝,分为正常体质量对照组(NW,n=23599),没有脂肪肝的腹型肥胖组(OB,n=3238)和有脂肪肝的正常体质量组(NAFLD-NW,n=1161)。比较各组CAVI值的大小。并且采用回归分析模型逐步矫正了年龄、性别、血压、血脂、血糖、肝酶、肌酐等混杂因素后,分析腹型肥胖自身和NAFLD自身与CAVI值的关系。NAFLD采用彩色多普勒超声检测。CAVI值采用动脉硬化检测仪测量,CAVI>8m/s为动脉僵硬度升高。结果NAFLD在正常体质量人群和肥胖人群的发生率分别为4.69%和66.08%。NW-NAFLD组的CAVI值比OB组的CAVI值显著升高[(8.12±1.16)vs(7.93±1.38),P<0.01]。当把腹型肥胖自身和NAFLD自身各自纳入回归分析模型时,矫正混杂因素后腹型肥胖自身和NAFLD自身均各自与CAVI值显著相关。然而当把腹型肥胖自身和NAFLD自身同时纳入回归分析模型时,矫正混杂因素后NAFLD自身仍然与CAVI值显著相关,而腹型肥胖自身与CAVI值不再有显著相关性。并且回归分析显示NAFLD具有CAVI值升高风险的比值比(oddsratio,OR)均高于腹型肥胖的比值比。结论异位肝脏脂肪沉积者比腹部脂肪沉积者有更高的动脉硬化的风险,因此在体质量正常者人群中进行NAFLD的筛查有助于早期预防动脉硬化。

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