Correlation between Nonalcoholic Fatty Liver Disease and Early Left Ventricular Diastolic Dysfunction

doi:10.12114/j.issn.1007-9572.2022.0252

Abstract

Abstract:

Background

As the most common chronic liver disease, nonalcoholic fatty liver disease (NAFLD) has been reported to be associated with significant changes in myocardial structure and function, but it is still a controversial issue whether it is an independent risk factor for abnormalities in cardiac structure and function.

Objective

To assess the correlation of NAFLD with early left ventricular diastolic dysfunction by comparing left ventricular structure and functional indices between NAFLD and non-NAFLD patients.

Methods

A total of 519 inpatients from Geriatric Medicine Unit, Peking University People's Hospital were enrolled during 2018 to 2020, and divided into NAFLD group and non-NAFLD group according to the results of abdominal ultrasound or CT examination. Left ventricular structural and functional indices of two groups were comparatively analyzed. Early left ventricular diastolic dysfunction was defined as the ratio of the peak velocity of the early filling (E) wave to the atrial contraction (A) wave <1. Multivariate Logistic regression was used to assess the correlation between NAFLD and early left ventricular diastolic dysfunction. FIB-4 index was used to assess the risk of liver fibrosis in NAFLD patient〔low risk (<1.30) , medium risk (1.30-3.25) , and high risk (>3.25) 〕. NAFLD patients were divided into low-risk subgroup (n=81) and medium-high risk subgroup (n=100) according to whether FIB-4 index <1.30.

Results

Compared with the non-NAFLD patients (n=338) , NAFLD patients had lower E/A ratio〔 (0.79±0.25) vs (0.87±0.34) , t=2.607, P=0.009) 〕 and greater end-diastolic interventricular septal thickness〔 (0.92±0.13) cm vs (0.89±0.13) cm, t=-2.525, P=0.012〕. Multivariate Logistic regression analysis showed that NAFLD was independently associated with the risk of early left ventricular diastolic dysfunction〔OR=2.941, 95%CI (1.736, 4.981) , P<0.001〕. NAFLD patients with medium-high risk subgroup had lower E/A ratio〔 (0.75±0.21) vs (0.84±0.28) , t=2.275, P=0.024〕 and higher left ventricular mass index than did those with low-risk subgroup〔 (80.22±14.92) g/m² vs (74.72±16.83) g/m², t=-2.327, P=0.021〕.

Conclusion

NAFLD may be an independent risk factor for early left ventricular diastolic dysfunction. The higher risk of advanced fibrosis in NAFLD patients, the worse was the left ventricular diastolic function.

Key words: Non-alcoholic fatty liver disease, Hepatic fibrosis, Left ventricle, Ventricular dysfunction, Root cause analysis

摘要：

背景

非酒精性脂肪性肝病（NAFLD）已成为最常见的慢性肝病，有研究认为NAFLD对心肌结构及功能均有明显影响，但NAFLD是否是心肌结构或功能异常的独立危险因素仍存在争议。

目的

比较NAFLD患者与非NAFLD患者左心室结构及功能指标的异同，初步探究NAFLD与左心室早期舒张功能不全的相关性。

方法

选取2018—2020年北京大学人民医院老年科符合纳入标准的519例住院患者为研究对象，根据腹部超声或CT检查结果分为NAFLD组与非NAFLD组。比较两组患者左心室结构及功能指标差异。以左心室舒张早期左房室瓣血流最大流速与左心房收缩期左房室瓣血流最大流速之比（E/A）<1判定为左心室早期舒张功能不全。采用多因素Logistic回归分析探究NAFLD与左心室早期舒张功能不全的关系。采用FIB-4指数评估NAFLD患者肝纤维化风险，其中FIB-4指数<1.30、1.30~3.25、>3.25分别判定为低风险、中风险、高风险。依据FIB-4指数是否<1.30将NAFLD组患者分为低风险亚组（n=81）和中高风险亚组（n=100）。

结果

519例住院患者中NAFLD患者181例（NAFLD组）、非NAFLD患者338例（非NAFLD组）。与非NAFLD组患者相比，NAFLD组患者E/A较低〔（0.79±0.25）和（0.87±0.34），t=2.607，P=0.009〕，室间隔舒张末期厚度（IVSd）较厚〔（0.92±0.13）cm和（0.89±0.13）cm，t=-2.525，P=0.012〕。多因素Logistic回归分析结果显示，合并NAFLD是左心室早期舒张功能不全的独立危险因素〔OR=2.941，95%CI（1.736，4.981），P<0.001〕。中高风险亚组患者E/A低于低风险亚组〔（0.75±0.21）和（0.84±0.28），t=2.275，P=0.024〕，左心室质量指数（LVMI）高于低风险亚组〔（80.22±14.92）g/m²和（74.72±16.83）g/m²，t=-2.327，P=0.021〕。

结论

合并NAFLD是左心室早期舒张功能不全的独立危险因素，NAFLD患者的肝纤维化风险越高，左心室舒张功能越差。

关键词: 非酒精性脂肪性肝病, 肝纤维化, 左心室, 心室功能障碍, 影响因素分析

Fangyuan CONG,Qian XUE,Lihua DENG, et al. Correlation between Nonalcoholic Fatty Liver Disease and Early Left Ventricular Diastolic Dysfunction[J]. Chinese General Practice, 2022, 25(26): 3290-3297. DOI: 10.12114/j.issn.1007-9572.2022.0252.
丛方远,薛倩,邓利华等. 非酒精性脂肪性肝病与左心室早期舒张功能不全的相关性研究[J]. 中国全科医学, 2022, 25(26): 3290-3297. DOI: 10.12114/j.issn.1007-9572.2022.0252.

Figures/Tables 9

References 44

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组别	例数	性别（男/女）	年龄（±s，岁）	BMI（±s，kg/m²）	BSA（±s，m²）
NAFLD组	181	76/105	66.4±12.1	25.7±3.0	1.84±0.16
非NAFLD组	338	139/199	70.6±13.1	23.5±3.5	1.74±0.15
t（χ²）值		0.035^a	3.550	-7.315	-7.227
P值		0.851	<0.001	<0.001	<0.001

组别	例数	性别（男/女）	年龄（±s，岁）	BMI（±s，kg/m²）	BSA（±s，m²）
NAFLD组	181	76/105	66.4±12.1	25.7±3.0	1.84±0.16
非NAFLD组	338	139/199	70.6±13.1	23.5±3.5	1.74±0.15
t（χ²）值		0.035^a	3.550	-7.315	-7.227
P值		0.851	<0.001	<0.001	<0.001

组别	例数	ALT〔M（QR），U/L〕	AST（U/L）	γ-GT〔M（QR），U/L〕	TC（mmol/L）	TG（mmol/L）	HDL-C（mmol/L）	LDL-C（mmol/L）	Alb（g/L）
NAFLD组	181	20.0（13.0）	21.25±6.97	20.0（16.5）	4.59±1.13	1.80±1.00	1.18±0.80	3.01±1.28	40.44±3.47
非NAFLD组	338	15.0（8.5）	20.88±12.88	18.0（13.0）	4.50±1.05	1.25±0.61	1.56±0.55	2.74±1.00	38.74±4.39
t（Z）值		-7.062^a	-0.354	-4.675^a	-0.952	-6.785	0.918	-2.66	-4.835
P值		<0.001	0.724	<0.001	0.341	<0.001	0.359	0.008	<0.001
组别	UA（μmol/L）	Cr（μmol/L）	eGFR〔ml·min^-1·（1.73 m²）^-1〕	BNP〔M（QR），ng/L〕	Hb（g/L）	PLT（×10⁹/L）	Glu（mmol/L）	HbA_1c（%）
NAFLD组	252.67±183.74	72.41±29.21	85.32±16.76	46.0（58.0）	135.97±13.45	213.95±57.72	6.00±1.90	6.71±1.35
非NAFLD组	216.77±159.91	74.28±48.62	82.72±18.29	33.0（35.0）	127.71±16.39	205.10±69.21	5.96±1.28	6.11±1.06
t（Z）值	-2.147	0.471	-1.579	-4.378^a	-5.808	-1.55	-0.042	-5.035
P值	0.033	0.638	0.115	<0.001	<0.001	0.122	0.967	<0.001

组别	例数	ALT〔M（QR），U/L〕	AST（U/L）	γ-GT〔M（QR），U/L〕	TC（mmol/L）	TG（mmol/L）	HDL-C（mmol/L）	LDL-C（mmol/L）	Alb（g/L）
NAFLD组	181	20.0（13.0）	21.25±6.97	20.0（16.5）	4.59±1.13	1.80±1.00	1.18±0.80	3.01±1.28	40.44±3.47
非NAFLD组	338	15.0（8.5）	20.88±12.88	18.0（13.0）	4.50±1.05	1.25±0.61	1.56±0.55	2.74±1.00	38.74±4.39
t（Z）值		-7.062^a	-0.354	-4.675^a	-0.952	-6.785	0.918	-2.66	-4.835
P值		<0.001	0.724	<0.001	0.341	<0.001	0.359	0.008	<0.001
组别	UA（μmol/L）	Cr（μmol/L）	eGFR〔ml·min^-1·（1.73 m²）^-1〕	BNP〔M（QR），ng/L〕	Hb（g/L）	PLT（×10⁹/L）	Glu（mmol/L）	HbA_1c（%）
NAFLD组	252.67±183.74	72.41±29.21	85.32±16.76	46.0（58.0）	135.97±13.45	213.95±57.72	6.00±1.90	6.71±1.35
非NAFLD组	216.77±159.91	74.28±48.62	82.72±18.29	33.0（35.0）	127.71±16.39	205.10±69.21	5.96±1.28	6.11±1.06
t（Z）值	-2.147	0.471	-1.579	-4.378^a	-5.808	-1.55	-0.042	-5.035
P值	0.033	0.638	0.115	<0.001	<0.001	0.122	0.967	<0.001

组别	例数	高血压〔n（%）〕	高血压病程〔M（QR），年〕	糖尿病〔n（%）〕	糖尿病病程〔M（QR），年〕	OSAHS〔n（%）〕	降脂药物服用史〔n（%）〕	降压药物服用史〔n（%）〕	降糖药物服用史〔n（%）〕	吸烟史〔n（%）〕	心脏病家族史〔n（%）〕
NAFLD组	181	107（59.1）	10.0（15.0）	64（35.4）	10.0（14.2）	10（5.5）	71（39.2）	103（56.9）	64（35.4）	30（16.6）	17（9.4）
非NAFLD组	338	164（48.5）	10.0（13.0）	83（24.6）	11.0（15.0）	6（1.7）	100（29.6）	158（46.7）	82（24.3）	41（12.1）	16（4.7）
χ²（Z）值		5.634	-0.992^a	6.778	-0.286^a	6.008	4.959	4.868	7.182	1.972	4.296
P值		0.018	0.321	0.009	0.775	0.014	0.026	0.027	0.007	0.160	0.038