在2013年欧洲肝病学会（European Association for the Study of the Liver,EASL）主办的国际肝病大会（the International Liver Congress,ILC）上发表的一项研究发现，非酒精性脂肪性肝病（NAFLD）增加早期动脉粥样硬化病变的风险，并且是心血管风险的独立预测指标。
这项研究为了评估非酒精性脂肪肝疾病（NAFLD）、动脉粥样硬化早期预测因子和10年Framingham风险评分（FRS）的关系。
超过2个心血管（cardiovascular，CV) 危险因素（高血压，糖尿病或高血糖，血脂异常，肥胖，烟草），既往无CV事件、酒精的摄入量低（<50g/day）且无已知肝病（病毒性肝炎，血色病，Wilson病或药物性肝损伤）的患者接受颈动脉超声检查，测定颈动脉内膜中层厚度（IMT）。计算脂肪肝指数（FLI，脂肪肝的替代标志物，FLI>60时为脂肪肝）和Framingham评分（FRS）。颈动脉斑块（CP）被定义为颈动脉分叉处C-IMT>1.5 mm。
纳入的患者共5685例：男性53%，平均年龄55岁（69%＞50岁），平均体重26.4kg/m2，26%有≥1个CP，平均C-IMT：0.62mm（s.d. 0.14），平均FRS为10.6（SD 8.1），平均FLI为45（s.d.30.4）。与FLI＜60岁组相比，FLI在60或以上的患者BMI水平高，肝酶（ALT，AST，GGT）水平增高（P<0.0001）。他们也有较高的C-IMT（0.64±0.16 vs 0.61±0.13，P＜0.0001），和FRS（14.7±8.8 vs 8.3±6.6，P＜0.0001）。多因素分析显示，FLI与C-IMT（P<0.0001）和CP（β=0.179，P=0.01）独立相关，与年龄、胆固醇水平、糖尿病或高血压无关。
论文摘要：
Patients with NAFLD have an excess prevalence of cardiovascular (CV) events. It is unknown if this is mediated through a higher risk of early atherosclerotic lesions.
论文摘要：
Patients with NAFLD have an excess prevalence of cardiovascular (CV) events. It is unknown if this is mediated through a higher risk of early atherosclerotic lesions.
Aim: To evaluate the relationship between NAFLD, early predictors of atherosclerosis and the 10-year Framingham risk score (FRS) in patients at high cardiovascular risk.
Methods: Patients with ≥2 CV risk factors (high BP, diabetes or high fasting glucose, dyslipidemia, obesity, tobacco), without previous CV events, known liver disease and drinking <50 g of alcohol/day underwent carotid ultrasonography with measurement of carotid intima-media thickness (C-IMT). The Fatty Liver Index (FLI), a surrogate marker of hepatic steatosis when >60, and the Framingham score (FRS) were calculated. Carotid plaques (CP) were defined as C-IMT>1.5mm at carotid bifurcation.
Results: 5685 subjects were enrolled: 53% males, mean age 55 years (69% >50yrs), mean BMI 26.4 kg/m2, 26% had ≥1 CP, mean C-IMT: 0.6mm (s.d. 0.14), mean FRS 10.6 (s.d. 8.1), mean FLI 45 (s.d.30.4). Compared to subjects with FLI <60, those with FLI>60 had higher BMI, ALT, AST and GGT (p < 0.0001). They also had higher C-IMT (0.64±0.16 v.s. 0.61±0.13, p < 0.0001), and higher FRS (14.7±8.8 v.s. 8.3±6.6, p < 0.0001). The interaction between FLI and CP was age-dependent. In subjects ≥50, a high FLI (>60) was associated with CP (36 vs. 32%, p < 0.01) while no difference
existed in subjects <50 yrs (10% vs. 12%). Moreover, FLI was significantly correlated with FRS (r = 0.46 p < 0.0001) and increased with each FRS quintile (p < 0.0001). In multivariate analysis FLI was independently associated with C-IMT (p < 0.0001) and CP (beta=0.179, p = 0.01), independent of age, cholesterol level, presence of diabetes or high blood pressure.
Conclusions: NAFLD increases the risk of early atherosclerotic lesions independent of established CV risk factors. NAFLD is an independent predictor of 10-year CV risk. Acknowledgements: Funding from the FP7/2007–2013 project under grant agreement no. Health-F2–2009–241762, FLIP project.
