2型糖尿病患者NAFLD与心房颤动的相关性及其对脑卒中发病的影响
|
摘要
目的通过研究非酒精性脂肪肝(NAFLD)与心房颤动的相关性,并对比是否合并NAFLD的2型糖尿病(T2DM)患者间并发心房颤动的比例和脑卒中事件的发生情况,从病因学的角度分析NAFLD引起的病理变化及对T2DM患者并发脑卒中的影响。方法将临床诊断为T2DM的患者350例,依据是否并发心房颤动分为并发心房颤动组及未并发心房颤动组,对比两组患者的基本情况,同时应用Logistic回归分析研究NAFLD与心房颤动间的相关性。根据是否合并NAFLD分为合并NAFLD组及不合并NAFLD组,对比分析两组间心房颤动的发生率及脑卒中事件的发生情况。结果并发心房颤动组T2DM患者中女性比例更高,年龄更大,高血压患者更多,左室高电压检出率更高,慢性阻塞性肺疾病、心力衰竭、瓣膜性心脏病、甲状腺功能亢进症发生率更高,谷氨酰转肽酶及糖化血红蛋白水平更高,合并NAFLD的患者比例更高,且NAFLD为T2DM患者并发心房颤动的独立预测因素。合并NAFLD组发生心房颤动的概率高于不合并NAFLD组(14.6%vs.5.4%,P=0.018),发生脑卒中事件的概率也增加(25.3%vs.8.6%,P=0.001)。结论合并NAFLD的T2DM患者中发生心房颤动和脑卒中的概率增加,且NAFLD是T2DM患者并发心房颤动的独立预测因素。
Objective To study the relationship between the non-alcoholic fatty liver disease(NAFLD)and atrial fibrillation,and compare with the incidence rate of atrial fibrillation and stroke between the clinical diagnosed 350 T2DM patients with or without NAFLD,in order to analyze the influence of the pathological mechanism of NAFLD on T2DM related stroke from aetiology angle.Methods According to whether the patients appeared atrial fibrillation,patients were divided into the atrial fibrillation group and the non-atrial fibrillation group,then the basic characters of the two groups were compared,and the Logistic regression analysis used to analyze the relationship between NAFLD and atrial fibrillation.The the incidence rate of atrial fibrillation and stroke between the two groups were compared.Results The proportion of women was higher in the atrial fibrillation group,the patients were older.GGT and HbA1 cwere higher in the atrial fibrillation group.And hypertension,electrocardiographic,chronic obstructive pulmonary disease,cardiac failure,valvular heart disease,hyperthyroidism and NAFLD appeared more frequently in the atrial fibrillation group.NAFLD was found to be the independent predictive factor of atrial fibrillation.The incidence rate of atrial fibrillation in the atrial fibrillation group was higher than that in the non-atrial fibrillation group(14.6% vs.5.4%,P=0.018).While the incidence rate of stroke in the atrial fibrillation group was higher than that in the non-atrial fibrillation group(25.3% vs.8.6%,P=0.001).Conclusion Those T2 DM patients with NAFLD are more probably to occur atrial fibrillation and stroke,NAFLD is found to be the independent predictive factor of atrial fibrillation.
Objective To study the relationship between the non-alcoholic fatty liver disease(NAFLD)and atrial fibrillation,and compare with the incidence rate of atrial fibrillation and stroke between the clinical diagnosed 350 T2DM patients with or without NAFLD,in order to analyze the influence of the pathological mechanism of NAFLD on T2DM related stroke from aetiology angle.Methods According to whether the patients appeared atrial fibrillation,patients were divided into the atrial fibrillation group and the non-atrial fibrillation group,then the basic characters of the two groups were compared,and the Logistic regression analysis used to analyze the relationship between NAFLD and atrial fibrillation.The the incidence rate of atrial fibrillation and stroke between the two groups were compared.Results The proportion of women was higher in the atrial fibrillation group,the patients were older.GGT and HbA1 cwere higher in the atrial fibrillation group.And hypertension,electrocardiographic,chronic obstructive pulmonary disease,cardiac failure,valvular heart disease,hyperthyroidism and NAFLD appeared more frequently in the atrial fibrillation group.NAFLD was found to be the independent predictive factor of atrial fibrillation.The incidence rate of atrial fibrillation in the atrial fibrillation group was higher than that in the non-atrial fibrillation group(14.6% vs.5.4%,P=0.018).While the incidence rate of stroke in the atrial fibrillation group was higher than that in the non-atrial fibrillation group(25.3% vs.8.6%,P=0.001).Conclusion Those T2 DM patients with NAFLD are more probably to occur atrial fibrillation and stroke,NAFLD is found to be the independent predictive factor of atrial fibrillation.
引文
[1]若扎·包拉特江,周贤惠,汤宝鹏,等.4 490例非瓣膜性心房颤动患者脑卒中相关危险因素分析[J].中华心律失常杂志,2017,21(3):251-256.
[2]杨艳敏,颜红兵,朱俊,等.解读美国心脏协会/美国心脏病学学会/心律学会最新心房颤动治疗指南[J].中华心血管病杂志,2014,42(11):971-973.
[3]KARAJAMAKI A J,PATSI O P,SAVOLAINEN M,et al.Non-alcoholic fatty liver disease as a predictor of atrial fibrillation in middle-aged population(OPERA study)[J].PLoS ONE,2015,10(11):e0142937.
[4]FORLANI G,GIORDA C,MANTI R,et al.The burden of NAFLD and its characteristics in a nationwide population with type 2diabetes[J].J Diabetes Res,2016,2016(1):2931985.
[5]MANTOVANI A,PERNIGO M,BERGAMINI C,et al.Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2diabetes[J].PLoS One,2015,10(8):e229.
[6]SHEN Z,MUNKER S,LUO F,et al.Effect of non-alcoholic fatty liver disease on estimated glomerular filtration rate could be dependent on age[J].PLoS One,2015,10(6):e0130614.
[7]TARGHER G,BYRNE C D.Clinical review:nonalcoholic fatty liver disease:a novel cardiometabolic risk factor for type 2diabetes and its complications[J].J Clin Endocrinol Metab,2013,98(2):483-495.
[8]MANTOVANI A,RIGAMONTI A,BONAPACE S,et al.Nonalcoholic fatty liver disease is associated with ventricular arrhythmias in patients with type 2diabetes referred for clinically indicated 24-hour holter monitoring[J].Diabetes Care,2016,39(8):1416-1423.
[9]TARGHER G,DAY C P,BONORA E.Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease[J].N Engl J Med,2010,363(14):1341-1350.
[10]ANSTEE Q M,TARGHER G,DAY C P.Progression of NAFLD to diabetes mellitus,cardiovascular disease or cirrhosis[J].Nat Rev Gastroenterol Hepatol,2013,10(6):330-344.
[11]MANGI M A,MINHAS A M,REHMAN H,et al.Association of non-alcoholic fatty liver disease with conduction defects on electrocardiogram[J].Cureus,2017,9(3):e1107.
[12]王建刚,席建堂,李劲松,等.老年非瓣膜性心房颤动患者发生缺血性脑卒中的危险因素分析[J].中国循环杂志,2015,25(8):753-756.
[13]RIJZEWIJK L J,VAN DER MEER R W,SMIT J W,et al.Myocardial steatosis is an independent predictor of diastolic dysfunction in type 2diabetes mellitus[J].J Am Coll Cardiol,2008,52(22):1793-1799.
[14]FOX C S,GONA P,HOFFMANN U,et al.Pericardial fat,intrathoracic fat,and measures of left ventricular structure and function:the framingham heart study[J].Circulation,2009,119(12):1586-1591.
[15]THANASSOULIS G,MASSARO J M,O′DONNELL CJ,et al.Pericardial fat is associated with prevalent atrial fibrillation:the framingham heart study[J].Circ Arrhythm Electrophysiol,2010,3(4):345-350.
[16]MAKAR G A,WEINER M G,STEPHEN E,et al.Incidence and prevalence of abnormal liver associated enzymes in patients with atrial fibrillation in a routine clinical care population[J].Pharmacoepidemiol Drug Saf,2008,17(1):43-51.
[17]SINNER M F,WANG N,FOX C S,et al.Relation of circulating liver transaminase concentrations to risk of newonset atrial fibrillation[J].Am J Cardiol,2013,111(2):219-224.
[2]杨艳敏,颜红兵,朱俊,等.解读美国心脏协会/美国心脏病学学会/心律学会最新心房颤动治疗指南[J].中华心血管病杂志,2014,42(11):971-973.
[3]KARAJAMAKI A J,PATSI O P,SAVOLAINEN M,et al.Non-alcoholic fatty liver disease as a predictor of atrial fibrillation in middle-aged population(OPERA study)[J].PLoS ONE,2015,10(11):e0142937.
[4]FORLANI G,GIORDA C,MANTI R,et al.The burden of NAFLD and its characteristics in a nationwide population with type 2diabetes[J].J Diabetes Res,2016,2016(1):2931985.
[5]MANTOVANI A,PERNIGO M,BERGAMINI C,et al.Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2diabetes[J].PLoS One,2015,10(8):e229.
[6]SHEN Z,MUNKER S,LUO F,et al.Effect of non-alcoholic fatty liver disease on estimated glomerular filtration rate could be dependent on age[J].PLoS One,2015,10(6):e0130614.
[7]TARGHER G,BYRNE C D.Clinical review:nonalcoholic fatty liver disease:a novel cardiometabolic risk factor for type 2diabetes and its complications[J].J Clin Endocrinol Metab,2013,98(2):483-495.
[8]MANTOVANI A,RIGAMONTI A,BONAPACE S,et al.Nonalcoholic fatty liver disease is associated with ventricular arrhythmias in patients with type 2diabetes referred for clinically indicated 24-hour holter monitoring[J].Diabetes Care,2016,39(8):1416-1423.
[9]TARGHER G,DAY C P,BONORA E.Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease[J].N Engl J Med,2010,363(14):1341-1350.
[10]ANSTEE Q M,TARGHER G,DAY C P.Progression of NAFLD to diabetes mellitus,cardiovascular disease or cirrhosis[J].Nat Rev Gastroenterol Hepatol,2013,10(6):330-344.
[11]MANGI M A,MINHAS A M,REHMAN H,et al.Association of non-alcoholic fatty liver disease with conduction defects on electrocardiogram[J].Cureus,2017,9(3):e1107.
[12]王建刚,席建堂,李劲松,等.老年非瓣膜性心房颤动患者发生缺血性脑卒中的危险因素分析[J].中国循环杂志,2015,25(8):753-756.
[13]RIJZEWIJK L J,VAN DER MEER R W,SMIT J W,et al.Myocardial steatosis is an independent predictor of diastolic dysfunction in type 2diabetes mellitus[J].J Am Coll Cardiol,2008,52(22):1793-1799.
[14]FOX C S,GONA P,HOFFMANN U,et al.Pericardial fat,intrathoracic fat,and measures of left ventricular structure and function:the framingham heart study[J].Circulation,2009,119(12):1586-1591.
[15]THANASSOULIS G,MASSARO J M,O′DONNELL CJ,et al.Pericardial fat is associated with prevalent atrial fibrillation:the framingham heart study[J].Circ Arrhythm Electrophysiol,2010,3(4):345-350.
[16]MAKAR G A,WEINER M G,STEPHEN E,et al.Incidence and prevalence of abnormal liver associated enzymes in patients with atrial fibrillation in a routine clinical care population[J].Pharmacoepidemiol Drug Saf,2008,17(1):43-51.
[17]SINNER M F,WANG N,FOX C S,et al.Relation of circulating liver transaminase concentrations to risk of newonset atrial fibrillation[J].Am J Cardiol,2013,111(2):219-224.