高血压合并非酒精性脂肪肝患者心外膜脂肪评价的临床意义

M. Statsenko, A. Streltsova
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The indicators of carbohydrate and lipid metabolism, chronic low-intensity inflammation (C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α)) were determined, insulin resistance indices were calculated. The structural and functional state of the liver and heart was assessed by ultrasound, and the thickness of the EAT was determined. The SCORE scale was used to assess the 10-year fatal risk.Results. Indicators characterizing chronic low-intensity systemic inflammation (CRP, TNF-α) and insulin resistance (HOMA-IR metabolic index (MI), triglycerides (TG) / high-density lipoproteins (HDL)) were higher in patients with HTN and NAFLD than in patients with isolated HTN. Echocardiography showed that patients with comorbid pathology had greater EAT thickness (p < 0,001) and more profound left ventricular myocardial hypertrophy (thickness of the left ventricular posterior wall (LVPW) (p = 0,019), interventricular septum (IVS) (p = 0,012), left ventricular myocardial mass (LVMM) (p = 0,029)). In the group of patients with HTN and NAFLD, the correlation analysis showed direct moderate-strong relationships between EAT thickness and TPWLV (r = 0,345, p < 0,001), IVS (r = 0,344, p < 0,001), LVMM (r = 0,372, p < 0,001), index LVMM (r = 0,221, p = 0,015), FLI (r = 0,722, p < 0,001), TNF-α (r = 0,495, p < 0,001), HOMA-IR (r = 0,38, p < 0,001), MI (r = 0,374, p < 0.001), TG/HDL (r = 0,354, p < 0,001), CRP (r = 0,30, p = 0,002), TG (r = 0,305, p = 0,001), very low density lipoprotein cholesterol (r = 0,306, p = 0,001) and medium strength inverse relationship with HDL (r = 0,30, p = 0,008). A multiple regression analysis was performed to assess the relationship between EAT thickness and the severity of chronic systemic inflammation and insulin resistance in patients with HTN and NAFLD: with an increase in TNF-α by 1 pg/ml and TG/HDL by 1, an increase in EAT thickness by 0,15 and 0,68 mm, respectively, should be expected. An increase in EAT thickness by 1 mm was accompanied by an increase in LVMM by 12,8 g. Logistic regression analysis showed a direct relation between EAT thickness and the probability of cardiovascular 10-year risk increase by 5,0% or more.Conclusions. This study showed that in patients with HTN and NAFLD, the EAT thickness was significantly higher, which strongly correlates with indicators of left ventricular hypertrophy, the severity of liver steatosis (FLI), chronic low-intensity systemic inflammation, and insulin resistance. With an increase in TNF-α and TG/HDL, an increase in the EAT thickness should be expected. 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引用次数: 0

摘要

目标。探讨高血压合并非酒精性脂肪性肝病(NAFLD)患者心外膜脂肪组织(EAT)厚度与心脏结构和功能特征指标及心血管危险的关系。设计和方法。一项比较横断面研究纳入了120例患者,年龄45至65岁,患有I-II期,1-2度的高血压(HTN),伴有NAFLD(脂肪肝指数(FLI 60))和非NAFLD。进行临床检查:病史、体格检查、“办公室”血压和心率测量、人体测量参数(身高、体重、体重指数)。测定糖脂代谢指标、慢性低强度炎症(c反应蛋白(CRP)、肿瘤坏死因子α (TNF-α)),计算胰岛素抵抗指标。超声检查肝脏和心脏的结构和功能状态,并测定食管厚度。采用SCORE量表评估10年死亡风险。表征慢性低强度全身性炎症(CRP、TNF-α)和胰岛素抵抗的指标(HOMA-IR代谢指数(MI)、甘油三酯(TG) /高密度脂蛋白(HDL))在HTN和NAFLD患者中高于单纯HTN患者。超声心动图显示,合并病理的患者有更大的EAT厚度(p < 0.001)和更严重的左心室心肌肥厚(左心室后壁厚度(LVPW) (p = 0.019)、室间隔(IVS) (p = 0.012)、左心室心肌肿块(LVMM) (p = 0.029))。群HTN和非酒精性脂肪肝患者,相关性分析显示直接进展吃厚度之间的关系和TPWLV (r = 0345, p < 0001),静脉注射(r = 0344, p < 0001), LVMM (r = 0372, p < 0001),索引LVMM (r = 0221, p = 0015), FLI (r = 0722, p < 0001),肿瘤坏死因子-α(r = 0495, p < 0001), HOMA-IR (r = 0, 38岁,p < 0001), MI (r = 0374, p < 0.001), TG / HDL (r = 0354, p < 0001), c反应蛋白(r = 0 30 p = 0002), TG (r = 0305, p = 0001),极低密度脂蛋白胆固醇(r = 0,306, p = 0,001)和中等强度与HDL呈负相关(r = 0,30, p = 0,008)。采用多元回归分析评估HTN和NAFLD患者EAT厚度与慢性全系统炎症严重程度和胰岛素抵抗之间的关系:TNF-α和TG/HDL分别增加1 pg/ml和1 pg/ml,预计EAT厚度分别增加0.15和0.68 mm。胃粘膜厚度每增加1 mm, LVMM增加12.8 g。Logistic回归分析显示,EAT厚度与心血管10年风险增加5%、0%或以上的概率有直接关系。本研究显示,HTN和NAFLD患者的EAT厚度明显较高,与左室肥厚、肝脂肪变性(FLI)严重程度、慢性低强度全身炎症、胰岛素抵抗等指标密切相关。随着TNF-α和TG/HDL的升高,可以预期EAT厚度的增加。在HTN和NAFLD患者中,EAT厚度与LVMM的增加以及心血管并发症高风险和极高风险的增加显著相关。
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Clinical significance of epicardial fat assessment in hypertensive patients with non-alcoholic fatty liver disease
Objective. To study the relationship between the thickness of epicardial adipose tissue (EAT) and indicators of the structural and functional heart characteristics and cardiovascular risk in hypertensive patients with nonalcoholic fatty liver disease (NAFLD).Design and methods. A comparative cross-sectional study was conducted involved 120 patients, aged 45 to 65 years, with hypertension (HTN) of I–II stages, degrees 1–2, with NAFLD (Fatty Liver Index (FLI > 60)) and without NAFLD. A clinical examination was carried out: history, physical examination, measurement of “office” blood pressure and heart rate, anthropometric parameters (height, weight, body mass index). The indicators of carbohydrate and lipid metabolism, chronic low-intensity inflammation (C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α)) were determined, insulin resistance indices were calculated. The structural and functional state of the liver and heart was assessed by ultrasound, and the thickness of the EAT was determined. The SCORE scale was used to assess the 10-year fatal risk.Results. Indicators characterizing chronic low-intensity systemic inflammation (CRP, TNF-α) and insulin resistance (HOMA-IR metabolic index (MI), triglycerides (TG) / high-density lipoproteins (HDL)) were higher in patients with HTN and NAFLD than in patients with isolated HTN. Echocardiography showed that patients with comorbid pathology had greater EAT thickness (p < 0,001) and more profound left ventricular myocardial hypertrophy (thickness of the left ventricular posterior wall (LVPW) (p = 0,019), interventricular septum (IVS) (p = 0,012), left ventricular myocardial mass (LVMM) (p = 0,029)). In the group of patients with HTN and NAFLD, the correlation analysis showed direct moderate-strong relationships between EAT thickness and TPWLV (r = 0,345, p < 0,001), IVS (r = 0,344, p < 0,001), LVMM (r = 0,372, p < 0,001), index LVMM (r = 0,221, p = 0,015), FLI (r = 0,722, p < 0,001), TNF-α (r = 0,495, p < 0,001), HOMA-IR (r = 0,38, p < 0,001), MI (r = 0,374, p < 0.001), TG/HDL (r = 0,354, p < 0,001), CRP (r = 0,30, p = 0,002), TG (r = 0,305, p = 0,001), very low density lipoprotein cholesterol (r = 0,306, p = 0,001) and medium strength inverse relationship with HDL (r = 0,30, p = 0,008). A multiple regression analysis was performed to assess the relationship between EAT thickness and the severity of chronic systemic inflammation and insulin resistance in patients with HTN and NAFLD: with an increase in TNF-α by 1 pg/ml and TG/HDL by 1, an increase in EAT thickness by 0,15 and 0,68 mm, respectively, should be expected. An increase in EAT thickness by 1 mm was accompanied by an increase in LVMM by 12,8 g. Logistic regression analysis showed a direct relation between EAT thickness and the probability of cardiovascular 10-year risk increase by 5,0% or more.Conclusions. This study showed that in patients with HTN and NAFLD, the EAT thickness was significantly higher, which strongly correlates with indicators of left ventricular hypertrophy, the severity of liver steatosis (FLI), chronic low-intensity systemic inflammation, and insulin resistance. With an increase in TNF-α and TG/HDL, an increase in the EAT thickness should be expected. EAT thickness was significantly associated with an increase in LVMM and increased chance of high and very high risk of cardiovascular complications in patients with HTN and NAFLD.
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来源期刊
Arterial Hypertension (Russian Federation)
Arterial Hypertension (Russian Federation) Medicine-Cardiology and Cardiovascular Medicine
CiteScore
0.90
自引率
0.00%
发文量
38
期刊介绍: The main aims of the Journal include collecting and generalizing the knowledge in hypertensiology; education and professional development of cardiologists and medical doctors of other specialties, who deal with different issues regarding diagnostics, management and prevention of hypertension in both clinical practice and research. The Journal also calls attention to the most urgent and up-to-date questions in hypertensiology, cardiology and related sciences. There are additional objectives, such as increasing the availability, accessibility and recognition of Russian medical scientific achievements at the international level by improving the quality of the publication and the way they are presented; enabling the exchange of opinions and information between scientists and their wider communication. The main criteria for publication selection fit with the mentioned objectives and include currency, singularity, scientific and practical novelty, applied relevance etc.
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