非酒精性脂肪性肝病男性患者的冠心病发病风险与血管紧张素Ⅱ水平的相关性研究

Relationship between coronary heart disease risk and serum angiotensinⅡconcentration in male patients with nonalcoholic fatty liver disease

摘要:

目的：探讨非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）男性患者的冠心病（coronary heart disease，CHD）发病风险与血管紧张素Ⅱ（angiotensinⅡ，AngⅡ）水平的相关性。方法：受试者均为不吸烟男性。正常对照组35名，病例组85名。测定其血清AngⅡ浓度，胰岛素抵抗指数稳态模型（homeostasis model assessment of insulin resistance，HOMA-IR）评估其胰岛素抵抗程度，Framingham风险评分（Framingham risk score，FRS）预测其未来10年CHD发病风险。病例组按有无合并代谢综合征（metabolic syndrome，MS）分为MS（+）组和MS（-）组，按FRS是否小于0分为FRS＜0组和FRS≥0组。结果：AngⅡ浓度在MS（-）组显著高于正常对照组（P＜0.001），而在MS（+）组较MS（-）组无统计学差异。FRS在MS（-）组显著高于正常对照组（P=0.035），且MS（+）组亦显著高于MS（-）组（P=0.042）。AngⅡ浓度在FRS≥0组显著高于FRS＜0组（P=0.017）。10年CHD发病率与空腹胰岛素、HOMA-IR和Ang Ⅱ浓度呈显著正相关（r’=0.248、0.335、0.222，P’=0.009、＜0.001、0.02）。结论：NAFLD男性患者未来10年CHD发病风险明显增高，与胰岛素抵抗程度及AngⅡ浓度呈正相关。抑制AngⅡ可能有助于降低NAFLD男性患者的CHD发病风险。

Abstract:

Objective：To investigate the relationship between coronary heart disease（CHD） risk and serum angiotensinⅡ（AngⅡ） con－centration in male patients with nonalcoholic fatty liver disease（NAFLD）. Methods：All participants were non-smoking males，includ－ing 35 normal controls and 85 NAFLD patients. Fasting serum Ang Ⅱ concentration was measured，insulin resistance（IR） was esti－mated by homeostasis model assessment of insulin resistance（HOMA-IR） and 10-year CHD risk was assessed by Framingham risk score（FRS）. According to the international diabetes federation criteria for metabolic syndrome（MS），NAFLD patients were subdivided into MS（+） and MS（-） groups. According to FRS，NAFLD patients were divided into FRS<0 and FRS≥0 groups. Results：Serum AngⅡ concentration was significantly higher in MS（-） and FRS≥0 groups than in control group（P<0.001） and FRS<0 group（P=0.017），respectively. There was no significant difference in Ang Ⅱ concentration between MS（+） and MS（-） groups. FRS was sig－nificantly higher in MS（-） than in control group（P=0.035），significantly higher in MS（+） group than in MS（-） group（P=0.042）. Ten-year CHD incidence risk ratio was positively associated with fasting plasma insulin，HOMA-IR and serum AngⅡ concentration （r’=0.248，0.335，0.222，P’=0.009，<0.001，0.02）. Conclusions：Increased 10-year CHD risk in male NAFLD patients is positively associated with IR and serum AngⅡ concentration. Inhibition of AngⅡ may decrease CHD risk in male NAFLD patients.